Impact on the use and cost of other services following intervention by an inpatient Pathway Homeless Team in an acute mental health Trust

Problem

This study describes how the KHP Pathway homeless team had an impact on the use and cost of in patient and other services. The Pathway model had never been tried in a mental health trust, and there had never been an economic analysis to evaluate service use before and after intervention.

Approach

We wanted to investigate whether the use of the KHP Pathway homeless team had an impact on the use and cost of other services. Ideally this would be assessed through a trial or other controlled study. This was not feasible in this case because of limited referral numbers and limited evaluation resources. It was agreed to use a simple before and after design which was both feasible and practical to undertake. Service use was measured using an adapted version of the Client Service Receipt Inventory (CSRI). Using the CSRI, data were collected at baseline and 3- and 6-month follow-up on whether services had been used in the previous three months and if so, how often. Unit costs of services were then attached to the service use data.

Findings

During the first 3-month follow-up period over half the participants saw a GP with an increase in the proportion seeing a psychiatrist, social worker and a mental health nurse. Attendance at A&E was substantially lower than at baseline. The mean total service cost was £818 at base line and £414 at 3 months.

Consequences

Previous evidence supports the role and value of specialist homeless health teams in secondary care in improving health and housing outcomes in homeless inpatients. While there is frequently a desire to focus solely on the economic benefits of new models of care, the KHP Pathway Homeless Team at SLaM supports the role of these services in mental health Trusts. It confirms that effective person-centred care in inclusion health groups, underpinned by values of equity and parity of care, can also offer value to health care systems and services and gives the patient the best opportunity to break the cycle of homelessness. Wider issues impacting the health of homeless and other inclusion health groups cannot be ignored. Austerity has driven cuts to public health, and substance use disorders services, mental health provision, appropriate housing availability, welfare support and chronic underfunding and fragmentation of health and social care. These factors are directly limiting the ability of sectors to work cohesively and of specialist services, such as the Pathway teams to achieve the best outcomes for patients.