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Abstract
The purpose of this study was to compare two clinical services for the seriously mentally ill in two catchment areas, one in the US and one in the UK, with similar demography. In addition, the study identified methodological challenges to the conduct of international health services research. A random sample of vulnerable individuals with severe and enduring mental illnesses, treated in the community, was compared on clinical observation and self-reported ratings of health status. Patterns of care and treatment cost were analyzed prospectively over a 12-month period. The two groups were functionally similar, but individuals living in Longbenton, UK reported higher levels of subjective distress than those living in Fitchburg, USA. Mental health treatment costs were similar, but per US patient per annum expenditures rose significantly when use of specialised residential programs were added. The authors conclude that (1) both the US and UK might increase the cost-effectiveness of their care by changing the mix of out-patient beds and supported residential programs and (2) a number of methodological difficulties in undertaking international studies were identified including understanding international cost differences when the production functions vary, by country.