Cost Analysis of a High Support Housing Initiative for Persons with Severe Mental Illness and Long-Term Psychiatric Hospitalization.

OBJECTIVE: The objective of this article was to conduct a cost analysis comparing the costs of a supportive housing intervention to inpatient care for clients with severe mental illness who were designated alternative-level care while inpatient at the Centre for Addiction and Mental Health in Toronto. The intervention, called the High Support Housing Initiative, was implemented in 2013 through a collaboration between 15 agencies in the Toronto area. METHOD: The perspective of this cost analysis was that of the Ontario Ministry of Health and Long-Term Care. We compared the cost of inpatient mental health care to high-support housing. Cost data were derived from a variety of sources, including health administrative data, expenditures reported by housing providers, and document analysis. RESULTS: The High Support Housing Initiative was cost saving relative to inpatient care. The average cost savings per diem were between $140 and $160. This amounts to an annual cost savings of approximately $51,000 to $58,000. When tested through sensitivity analysis, the intervention remained cost saving in most scenarios; however, the result was highly sensitive to health system costs for clients of the High Support Housing Initiative program. CONCLUSIONS: This study suggests the High Support Housing Initiative is potentially cost saving relative to inpatient hospitalization at the Centre for Addiction and Mental Health.

Which factors predict case management services and how do these services relate to client outcomes?

The current study explores two issues: which factors predict case management services and which case management services predict outcomes. Thirty individuals with schizophrenia participated in the study. Information regarding clients' characteristics and the working alliance was collected within the first 2 months of participation in the program and again 1 year later. Case managers completed a daily contact log for each client over the course of the year. Results suggest that the working alliance is a strong predictor of case management services. The working alliance and the frequency with which housing and medication were discussed were strong predictors of community functioning outcomes. Directions for future research are provided that are based upon these preliminary findings.

Altered electrodermal response to facial expression after closed head injury.

UNLABELLED: The objective was to determine whether diffuse damage to orbital and ventromedial regions of the prefrontal cortex usually associated with moderate-to-severe closed head injury (CHI) would affect the ability to perceive and respond to socially relevant information. METHODS: Participants with CHI and age-matched non-injured controls were presented with faces that varied with respect to emotional expression while electrodermal activity (EDA) was monitored. Cognitive and general adaptive functioning was also assessed. RESULTS: CHI was associated with a failure to increase EDA in response to negative facial expressions and with reduced ability to identify negative expressions, especially fear. The groups differed on other signs of orbital/medial prefrontal damage such as anosmia and in general social adaptability and awareness-of-deficit as measured by the Brock Adaptive Functioning Questionnaire. CONCLUSIONS: CHI affected the ability to identify and respond to negative facial expression. Addressing these deficits may enhance rehabilitative efforts within the social domain.