Bradford Plumer and Glenn Reynolds discuss de-institutionalization of people with mental illness. It's the topic du jour in New York, after a homeless, mentally ill person, caused major damage to a subway.
De-institutionalization, and its follow on, caring for chronic mental illness in the community, have been shown to be no worse, on average, for people with mental illness.
But there's the rub. On average. There are still people who will benefit, themselves, from the more sustained, intensive care that hospitals provide. In other words, decision makers (policy and medical) have to be aware of where a patient fits in the distribution. Some people are sicker, and need more care. Others do well in the community.
And for people with mental illness. That's also a key part of the findings. Totally unsurprisingly, the burden of caring for people with mental illness has not been transferred from hospital nurse to community nurse, but also to unpaid family members, friends and neighbours. Few, few studies evaluate those costs; and few evaluate the total social costs of different arrangements for caring for people with mental illness.
On balance, de-institutionalization of people with mental illness was a good idea, but that doesn't mean the implementation of the policy was without flaws.
All of the foregoing is a shameless plug for my forthcoming article in Medical Care Research & Review on economic evaluations of community mental health care.
Posted by robe0419 at January 26, 2005 8:04 PM