Costs and Effects of Managing Chronic Psychotic Patients

Since the early 1970s, delivery of care to people who are consid ered to suffer from chronic psychotic disturbances has been at a crossroads. In 1983, the European Regional Office of the World Health Organization (WHO), within its health economics pro gramme, encouraged international research on the economic impli cations of alternative strategies of care for those patients. Origi nally, it was intended to compare at least two or more strategies of managing chronic psychotics, especially strategies which place dif ferent emphasis on inpatient and outpatient care. Instead of designing a fully coordinated, multinational, multi centre study based on a mutually agreed on study protocol, we de cided on the following: - To meet with researchers interested in the social, psychological, and economic features of health care for chronic psychotic pa tients - To stimulate ongoing research projects or to initiate new ones - To discuss quite different approaches from international and - terdisciplinary points of view - To review and revise the diversified end products of such an open research process For this purpose, we outlined a broad range of topics which could be included in the study: - Methodological problems of evaluation in this field - Social and economic implications of psychiatric deinstitutiona- zation - Scenarios of various degrees of deinstitutionalization - Assessment of (hospital) costs of the treatment for chronic sc- zophrenic and other psychotic patients - Public and private costs of the main treatment strategies - Time-expenditure analyses of chronic psychotic patients

Background Reports.- Studies on the Cost-Effectiveness of Managing Chronic Psychotic Patients. Report on a WHO Planning Meeting at Mannheim, 2-4 May, 1983.- Summary Report of the WHO Meeting 'Cost-Effectiveness of Managing Chronic Psychotic Patients', Munich, 16-18 December, 1985.- National Approaches.- Management of the Cost-Effectiveness of Managing Chronic Psychotic Persons in Ireland.- Social and Economic Policies in the Mental Health Sector in Greece.- Financing of Care for the Chronically Mentally Ill in the USA: A Patchwork of Policies.- Managing Chronic Psychotic Patients: A Clinical and a Political Point of View.- Regional Approaches.- Economic Analysis of Different Patterns of Psychiatric Treatment and Management of Chronic Psychotic Patients in the Basque Country.- Cost-Effectiveness of Health-Care Delivery to Chronic Psychotic Patients in Southern Alberta, Canada.- Schizophrenia: Results of a Cohort Study with Respect to Cost-Accounting Problems of Patterns of Mental Health Care in Relation to Course of Illness.- Cost-Effectiveness of Managing Chronic Psychotic Patients: Italian Experience Under the New Psychiatric Law.- Institutional Approaches.- The Application of Modified Cost-Benefit Analysis in the Evaluation of a Hostel Ward for Chronic Psychotic Patients.- The Cost of Long-Term Psychoses in a Scottish Psychiatric Hospital.- Management of Schizophrenia: Cost-Benefits, Time-Budget, Better Treatment? Which Time Frame Are We in?.- Methodological Approaches.- Methodological Problems of Comparing the Cost-Effectiveness of Different Mental Health Institutions.- Time-Budget Analysis for Chronic Patients. Towards a Cost-Effectiveness - Oriented Indicator System for Comparing Inpatient and Outpatient Psychiatric Care.