Inpatient care is expensive. Even given the shift towards community support, supporting people in crisis remains by far the largest area of spending for mental health services with inpatient services being the largest area of spend overall80.
Once within inpatient settings delayed discharges impact on between 7-25% of patients (varies across Trusts). Within London it has been estimated that these delays account for an extra £19 million expenditure.
Early intervention and home based care is estimated as having the potential to save £38 million through the reduction in acute hospital admissions (700 per annum), shorter lengths of hospital stay (25% reduction) and less use of high cost intensive interventions81.
Home treatment delivered alongside inpatient care in an integrated care pathway saves up to £700 per patient per month. £2,200 compared with approximately £2,90082.
However it has been estimated by the Audit Commission that an additional £10 to 30 million of resources (depending on exact skill mix and variable costs such as training) would have to be diverted into CRHT services each year to increase capacity and improve multi-disciplinary and medical input83.
It is estimated that an acute mental health service making full use of CRHT services in appropriate cases costs approximately £600 less per crisis episode than one in which CRHT is not available. Mainly because some admissions will be avoided altogether and others will shorter, reducing the costs incurred with overnight stays. Increasing the proportion of cases in which CRHT is considered offers scope for further efficiency savings on a cautious estimate of some £12 million a year. Realising such savings needs careful management, however, as more severely ill service users will form an increased proportion of those remaining in inpatient wards.
The development of CRHT teams has been a major new area of investment with £17 million being made available in 2004 to enable Trusts to improve the co-ordination of crisis services82.