Psychological Medicine

Research Article

Cost-effectiveness of community psychiatric nurse or out-patient psychiatrist care of neurotic patients

S. P. Mangena1 c1, E. S. Paykela1 c2, J. H. Griffitha13, A. Burchella1 and P. Mancinia1

a1 Department of Psychiatry, St George's Hospital Medical School, London, and the Economic Advisers Office, Department of Health and Social Security


In a prospective controlled investigation chronic patients, the majority with neurotic conditions, were randomly allocated either to community psychiatric nurses (CPN) as the main therapist or to routine out-patient psychiatrist follow-up. There was no statistically significant difference in the mean public expenditure for the two modes of care. The direct costs of psychiatric care comprised a small proportion of total public expenditure and were initially greater in the nursing group. Subsequently, and over the whole 18-month study period, nursing was the cheaper option in terms of these direct costs. Clinical and social outcomes were comparable in both follow-up groups. Consumer satisfaction was significantly greater among CPN patients. On balance, these results confirm the benefit of community psychiatric nursing for this patient group.


c1 Address for correspondence: Dr S. P. Mangen, 9 The Butts, Brentford, Middlesex TW8 8BJ.

c2 Address for reprints: Professor E. S. Paykel, Department of Psychiatry, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE.


3 Present address: Kedren Community Mental Health Center, Los Angeles, USA.