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Online ISSN: 1099-176X Print
ISSN: 1091-4358 Copyright © 2025 ICMPE. |
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Cost Effects of Diagnose, Indicate, and Treat Severe Mental Illness (DITSMI) in Residential Psychiatry |
Mike H. Veereschild,1* Eric O. Noorthoorn,2** Peter Lepping,3 Anneke J. Van der Veen,4 Giel J.M. Hutschemaekers5 |
1MD, MSc., GGNet Community Mental Health Centre, Warnsveld, The
Netherlands. |
*Correspondence to: H.M. Veereschild, MD., MSc., GGNet Community Mental Health Centre, Vordenseweg 12, 7231 AP, Warnsveld, The Netherlands. Tel.: +31-612513609 E-mail: m.veereschild@ggnet.nl.
**Supplementary Material: Data for sharing findings may be requested by contacting Eric O. Noorthoorn, MD, PhD, at e.noorthoorn@ggnet.nl
Source of Funding: This study was supported by ZonMw program ’Goed Gebruik Geneesmiddelen’ [Appropriate medication use] grant number 848022006. And by ZonMW program “actieprogramma lokale initiatieven voor mensen met verward gedrag” [ action program for local initiatives for people with confused behaviour]: grant nummer 6380210212. According to the guidelines ZonMW the funding authority had no influence on the content of the publication.
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| This observational study evaluates the economic impact of the DITSMI protocol (Diagnose, Indicate, and Treat Severe Mental Illness), implemented in 2015 in the eastern Netherlands. Data from 94 long-term residential psychiatric patients between 2012 and 2018 were analyzed to assess changes in healthcare costs and revenues. Following implementation, repeated measures ANOVA showed a significant decrease in inpatient admission days, accompanied by reductions in inpatient stay revenues and insurance payments. These reductions were associated with change in diagnosis, different treatment and medication changes. Although costs for psychiatrists, psychologists, and physicians increased, overall staff costs declined, particularly among patients whose diagnoses changed from schizophrenia to neurodevelopmental disorders. Findings suggest the DITSMI protocol contributes to deinstitutionalization and long-term cost reduction but may require initial investments in specialized staffing. Further research, including cluster randomized trials, is needed to confirm these findings and assess the generalizability of the protocol to broader patient populations. | |
Aims of the Study: This study investigates the impact of working from home on mental health during the first lockdown in Germany. Specifically, it aims to differentiate between selection effects (i.e., individuals who choose working from home based on their circumstances) and causal effects (i.e., the mental health consequences of working from home itself). The goal is to understand whether working from home, when imposed rather than voluntarily chosen, negatively affects mental well-being. Methods: We use data from the Mannheim Corona Study (MCS), which collected high-frequency panel data from a representative sample of the German population during the first lockdown (March–July 2020). The analysis focuses on employed individuals and excludes those not working. We create a binary working from home indicator and analyze its association with four mental health measures: two indicators of depressive symptoms, one of loneliness, and one of social interaction frequency. Both pooled linear regressions and fixed effects models are employed to estimate associations while accounting for confounders and unobserved heterogeneity. Results: Descriptive statistics reveal that working from home was more common among individuals with higher income and education, reflecting a socioeconomic selection effect. Pooled regression results show a significant association between working from home and increased loneliness, depressive symptoms, and reduced social interaction. These associations persist even after controlling for sociodemographic characteristics. Fixed effects panel regressions—focusing on within-individual changes—confirm a significant, though smaller, negative effect of working from home on mental health, particularly regarding loneliness and loss of interest. This strengthens the evidence for a causal link between working from home and reduced psychological well-being, independent of pre-existing personal characteristics. Discussion: The findings suggest that even privileged individuals working from home experienced a decline in mental health, highlighting the psychological costs of reduced social interaction during the lockdown. Limitations include the lack of pre-pandemic mental health data and the inability to distinguish between voluntary and enforced working from home beyond the lockdown context. Also, the relatively short observation period limits insights into long-term adaptation. Implications for Health Care Provision and Use: Health professionals should consider the mental health risks associated with remote work settings, especially in times of enforced isolation. Early identification of at-risk individuals and targeted support strategies may help prevent deterioration in mental well-being among remote workers. Implications for Health Policies: Policy makers should balance infection control measures with their broader psychosocial impacts. If remote work becomes a long-term strategy, accompanying mental health support mechanisms should be institutionalized. Flexibility in workplace options may help mitigate adverse psychological effects. Implications for Further Research: Future studies should explore how specific home-working conditions (e.g., workspace quality, household composition) moderate mental health outcomes. Longitudinal research beyond the lockdown period is necessary to assess the persistence and reversibility of these effects. Evaluating interventions that support mental health in remote work settings is also crucial. |
Received 15 June 2024; accepted 14 April 2025
Copyright © 2025 ICMPE