Healthcare Costs for People with Serious Mental Illness in England: An Analysis of Costs Across Primary Care, Hospital Care, and Specialist Mental Healthcare

BackgroundSerious mental illness (SMI) is a set of disabling conditions associated with poor outcomes and high healthcare utilisation. However, little is known about patterns of utilisation and costs across sectors for people with SMI.ObjectiveThe aim was to develop a costing methodology and estimate annual healthcare costs for people with SMI in England across primary and secondary care settings.MethodsA retrospective observational cohort study was conducted using linked administrative records from primary care, emergency departments, inpatient admissions, and community mental health services, covering financial years 2011/12-2013/14. Costs were calculated using bottom-up costing and are expressed in 2013/14 British pounds (GBP). Determinants of annual costs by sector were estimated using generalised linear models.ResultsMean annual total healthcare costs for 13,846 adults with SMI were 4989 (median 1208) pound, comprising 19% from primary care (938 pound, median 531) pound, 34% from general hospital care (1717 pound, median 0) pound, and 47% from inpatient and community-based specialist mental health services (2334 pound, median 0) pound. Mean annual costs related specifically to mental health, as distinct from physical health, were 2576 pound (median 290) pound. Key predictors of total cost included physical comorbidities, ethnicity, neighbourhood deprivation, SMI diagnostic subgroup, and age. Some associations varied across care context; for example, older age was associated with higher primary care and hospital costs, but lower mental healthcare costs.Conclusions Annual healthcare costs for people with SMI vary significantly across clinical and socioeconomic characteristics and healthcare sectors. This analysis informs policy and research, including estimation of health budgets for particular patient profiles, and economic evaluation of health services and policies.