Academic journal article British Journal of Occupational Therapy

Are Occupational Therapy Interventions for Service Users with Mental Health Problems Cost-Effective?

Academic journal article British Journal of Occupational Therapy

Are Occupational Therapy Interventions for Service Users with Mental Health Problems Cost-Effective?

Article excerpt

Introduction

In June 2013, the UK Government announced its second Spending Review (HM Treasury 2013), setting out its intentions to 2017-18. This indicated that, within the public sector, local government would be the hardest hit in terms of reductions to resource spending, suffering a further reduction of 10 per cent in 2015-16, adding to the reduction of 33 per cent since 2010. In 2015-16 the National Health Service (NHS) budget will see a real terms growth of only 0.1 per cent, meaning that NHS organisations face having less money available for frontline services due to the impact of population growth, population aging and inflation, as well as the need for technological advances. Together, these factors already place huge demands on health and social care budgets and will lead to expectations of greater cost efficiencies for the future.

As mental illness is the largest cause of disability in the United Kingdom (UK), an economic argument for improving efficiency exists (National Mental Health Development Unit 2010). As a result, services are required to reduce costs with initiatives such as the Quality, Innovation, Productivity and Prevention (QIPP) programme (Department of Health 2011). In England there is also an expectation that improvements will be delivered by increasing choice through Any Qualified Provider (AQP) (Department of Health 2011), which will challenge the NHS as the preferred provider for mental health services. Organisational income will become more dependent on demonstrating clinical and cost-effectiveness, as systems such as payment by results are extended to mental health services (Lee et al 2011).

Occupational therapy and cost-effectiveness

Bannigan (2004) has asserted that 'Occupational therapy costs money, usually taxpayers' money that could be spent on other effective services if our services are not effective' (Bannigan 2004, p147). These opportunity costs (the 'costs' of forgoing the benefits of the second choice option) will be used, increasingly, to guide future funding decisions.

Within occupational therapy, there have been calls to prioritise research that demonstrates both clinical and cost-effectiveness (Bannigan et al 2008), enabling the profession to market where it most adds value (College of Occupational Therapists [COT] 2010, Morley and Rennison 2011). Similar demands for research into clinical and cost-effectiveness of occupational therapy for service users with mental health problems have been made by the American Occupational Therapy Association (Gutman 2011): Gutman not only called on researchers to conduct studies in practice with actual service users, to examine the effect and cost-efficiency of occupational therapy services, but also highlighted the impact that the failure to address this has had on the profession. In the United States, the number of occupational therapists has declined to the point where many American states no longer approve and reimburse occupational therapists as providers of mental health services (Gutman 2011). Gutman argued that most research in mental health has considered the psychometric properties of assessments, the experience of disability or the nature of occupation, with limited published evidence of clinical or cost-effectiveness. However, Gutman (2011) cited several systemic reviews that provide some evidence that practitioners can use to advocate for occupational therapy (Gutman 2011).

Current economic evaluations

The occupational therapy crisis (Gutman 2011) in mental health services in the United States should serve as a case study from which the UK can learn. Despite the calls for occupational therapy clinicians and researchers to undertake economic evaluation, there appear to be a limited number of published reports. Four mental health occupational therapy studies in Europe have been found and are summarised in

Table 1. This opinion piece has not conducted a systematic review of these articles; rather, their inclusion reinforces the point that it is possible to conduct economic evaluations, despite the complex nature of occupational therapy interventions and the wide range of practice settings. …

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