Comprehensive Community Care for Mentally Ill Cuts Hospital Days

Community care programs that offer severe mentally ill patients a full range of services around the clock, seven days a week, may be able to reduce the odds of those patients having to be hospitalized by as much as forty percent. In a study of the Program for Assertive Community Treatment (PACT) model of treating non-emergency psychiatric patients worked, researchers at the Johns Hopkins School of Public Health, the Medical University of South Carolina, and Duke University found that patients enrolled in a PACT were admitted to the hospital less often. Their decreased use of costly inpatient services resulted in significant savings.

The PACT model provides a full range of medical, psychosocial, and rehabilitative services seven days a week, 24-hours a day. It can be a viable alternative to hospital treatment, particularly for patients with severe and persistent mental illnesses, such as schizophrenia or bipolar disorders. For those patients, a PACT can keep them from "recycling" in and out of in-patient mental institutions. PACT programs were designed to keep patients in the community and reduce their number of hospital stays.

The study of PACT treatment versus inpatient appeared in the June, 1999 issue of Health Services Research. Lead author, David S. Salkever, PhD, professor, Health Policy and Management, said, "This study shows the PACT model provides both effective treatment and inpatient cost savings." The study showed that, assuming a constant cost of $19,000 per hospital user for the PACT subjects, the community-based treatment reduced hospital costs by $285,000 over an 18-month period per every 100 patients.

The researchers worked with 144 severely mentally ill patients who were assigned to either a PACT program or a control group. The control group went to a traditional community mental health center where workers had caseloads of between 34 and 68 clients. Hospital days for the both the PACT users and the control groups were measured for 18 months prior to the start of the study and again during the 18 months after the study started.

The researchers also found that patient caseload sizes affected inpatient hospitalizations and total cost of care. Analysis of the PACT data showed that as caseloads fell from 11.8 patients (approximately 8.5 staff per 100 clients) to 8 patients (approximately 12.5 staff per 100 clients) the number of clients who needed hospitalization dropped.