Rethink Report: Services for people with schizophrenia and psychosis

A report examined economic evidence to support the business case for investment in effective, recovery-focused services for people with schizophrenia and psychosis.
The report said there was a range of clinically effective interventions, and it called on local and regional commissioning and pathway development to draw on the evidence in order to achieve savings that could be reinvested in care.

The health service spent £2.0 billion on services for people with psychosis in 2012/13. Over half (54%) of this total was devoted to inpatient care.

This means that spending is currently skewed towards the more expensive parts of the system, at £350 average cost per day for inpatient care compared with £13 per day in some community settings.

• Early Detection (ED) services
• Early Intervention (EI) teams
• Individual Placement and Support (IPS)
• Family therapy
• Criminal justice liaison and diversion
• Physical health promotion, including health behaviours
• Supported housing
• Crisis Resolution and Home Treatment (CRHT) teams
• Crisis houses
• Peer support
• Self-management
• Cognitive Behavioural Therapy (CBT)
• Anti-stigma and discrimination campaigns
• Personal Budgets (PBs)
• Welfare advice

Many of these interventions are shown to be cost-effective, in some cases due to the role they play in preventing or delaying relapse, or reducing the need for the most expensive care. Some have much wider benefits related to wider recovery outcomes, such as employment, settled housing and better physical health. There is particularly clear evidence for interventions such as EI teams, IPS for employment, CBT and CRHT teams. However, there is evidence to suggest that all of the above interventions contribute to recovery outcomes, reduced costs and/or better value for money. Illustrative examples of the savings incurred through particular interventions include:

• Early Intervention: net savings of £6,780 per person after four years. Over a ten-year period, £15 in costs can be avoided for every £1 invested.
• Smoking cessation: £1,255 to gain an extra Quality-Adjusted Life Year (QALY), which lies well below the upper threshold of £30,000 recommended by National Institute for Health and Care Excellence (NICE).
• Peer support: £4.76 can be gained for every £1 invested.
• CBT: Cost per QALY gained of £27,373 for CBT compared to usual care, which is below the upper threshold used by NICE.

Local and regional commissioning and pathway development should draw on this evidence, since these interventions are both clinically effective and many will contribute to savings to be reinvested in care. While the scope of this report is primarily at intervention level, the intention is to inform local implementation.