Acute mental health care according to recent mental health legislation Part II. Activity-based costing

Objective: This is the second of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). Objectives for the review were to provide realistic estimates of cost for unit activities and to establish a quality assurance cycle that may facilitate cost centre management. Method: The study described and used activity-based costing (ABC) as an approach to analyse the recurrent cost of acute in-patient care for the financial year 2007-08. Fixed (e.g. goods and services; staff salaries) and variable recurrent costs (including laboratory'; 'pharmacy') were calculated. Cost per day; per user and per diagnostic group was calculated. Results: While the unit accounted for 4.6of the hospital's total clinical activity (patient days); the cost of R8.12 million incurred represented only 2.4of the total hospital expenditure (R341.36 million). Fixed costs constituted 90of the total cost. For the total number of 520 users that stayed on average 15.4 days; the average cost was R1;023.00 per day and R15748.00 per user. Users with schizophrenia accounted for the most (35) of the cost; while the care of users with dementia was the most expensive (R23;360.68 per user). Costing of the application of World Health Organization norms for acute care staffing for the unit; projected an average increase of 103in recurrent costs (R5.1 million); with the bulk (a 267increase) for nursing. Conclusion: In the absence of other guidelines; aligning clinical activity with the proportion of the hospital's total budget may be an approach to determine what amount should be afforded to acute mental health in-patient care activities in a general regional hospital such as HJH. Despite the potential benefits of ABC; its continued application will require time; infrastructure and staff investment to establish the capacity to maintain routine annual cost analyses for different cost centres

A situation analysis of mental health services and legislation in Ghana: challenges for transformation

Objective: To conduct a situation analysis of the status of mental health care in Ghana and to propose options for scaling up the provision of mental health care. Method: A survey of the existing mental health system in Ghana was conducted using the WHO Assessment Instrument for Mental Health Systems. Documentary analysis was undertaken of mental health legislation; utilizing the WHO Legislation checklists. Semi-structured interviews and focus group discussions were conducted with a broad range of mental health stakeholders (n=122) at the national; regional and district levels. Results: There are shortfalls in the provision of mental health care including insufficient numbers of mental health professionals; aging infrastructure; widespread stigma; inadequate funding and an inequitable geographical distribution of services. Conclusion: Community-based services need to be delivered in the primary care setting to provide accessible and humane mental health care. There is an urgent need for legislation reform; to improve mental health care delivery and protect human rights

Acute mental health care and South African mental health legislation Part 1- morbidity, treatment and outcome

Objective: This is the first of three reports on a follow-up review of mental health care at Helen Joseph Hospital (HJH). In this first part; qualitative and quantitative descriptions were made of the services and of demographic and clinical data on acute mental health care users managed at HJH; in a retrospective review of clinical records over a four year period. Objectives for this review were to provide information on mental health care outcome; to do a cost analysis and to establish a quality assurance cycle that may facilitate a cost centre management approach. The operational areas identified were service delivery; teaching; and research. Activities within each area were in-patient care; out-patients and consultation/liaison; under- and postgraduate teaching and self initiated or contract research. Method: The study reviewed the existing mental health care program and activities in context of relevant policy and legislation. Results: Norms from a World Health Organization model for acute mental health care showed that significant staff shortages existed; especially for nursing. A total of 520 users were admitted for in-patient mental health care during the financial year 2007/08. The average length of stay was 15.4 days and ranged from 1 to 85 days. Ninety users (17) had an extended period of stay of 25 days and more; while 39 users had multiple admissions during the 12 month period. The most common Axis I diagnoses made were schizophrenia n=138 (29); substance-related conditions n=99 (21) and bipolar mood disorder n=69 (14). After discharge; 139 users (27) were referred back to the HJH out-patient department for follow-up. Conclusion: The information from these reports may be used in the allocation of adequate resources to align this acute unit with its responsibilities according to recent legislation