Abstract
OBJECTIVE--To determine the factors influencing the successful outcome of community treatment for severe acute psychiatric illnesses that are traditionally treated in hospital. DESIGN--All patients from a single electoral ward who were either admitted to hospital or treated at home over a two year period (1 October 1987 to 30 September 1989) were included in the study and their case notes audited. The second year of the study is reported. SETTING--Electoral ward of Sparkbrook, Birmingham. SUBJECTS--99 Patients aged 16-65 with severe acute psychiatric illness. RESULTS--65 Patients were managed by home treatment alone; 34 required admission to hospital. The location of treatment was significantly (all p less than 0.05) influenced by social characteristics of the patients (marital state, age (in men), ethnicity, and living alone) and by characteristics of the referral (occurring out of hours; assessment taking place at hospital or police station). DSM-III-R diagnosis was more weakly associated with outcome. Violence during the episode was significantly related to admission, although deliberate self harm was not. CONCLUSIONS--Home treatment is feasible for most patients with acute psychiatric illness. A 24 hour on call assessment service increases the likelihood of success because admission is determined more strongly by social characteristics of the patient and the referral than by illness factors. Admission will still be required for some patients. A locally based mental health resource centre, a 24 hour on call service, an open referral system, and an active follow up policy increase the effectiveness of a home treatment service.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Fenton F. R., Tessier L., Struening E. L. A comparative trial of home and hospital psychiatric care. One-year follow-up. Arch Gen Psychiatry. 1979 Sep;36(10):1073–1079. doi: 10.1001/archpsyc.1979.01780100043003. [DOI] [PubMed] [Google Scholar]
- Grad J., Sainsbury P. The effects that patients have on their families in a community care and a control psychiatric service--a two year follow-up. Br J Psychiatry. 1968 Mar;114(508):265–278. doi: 10.1192/bjp.114.508.265. [DOI] [PubMed] [Google Scholar]
- Hoult J., Rosen A., Reynolds I. Community orientated treatment compared to psychiatric hospital orientated treatment. Soc Sci Med. 1984;18(11):1005–1010. doi: 10.1016/0277-9536(84)90272-7. [DOI] [PubMed] [Google Scholar]
- Jarman B. Underprivileged areas: validation and distribution of scores. Br Med J (Clin Res Ed) 1984 Dec 8;289(6458):1587–1592. doi: 10.1136/bmj.289.6458.1587. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Langsley D. G., Flomenhaft K., Machotka P. Followup evaluation of family crisis therapy. Am J Orthopsychiatry. 1969 Oct;39(5):753–759. doi: 10.1111/j.1939-0025.1969.tb00656.x. [DOI] [PubMed] [Google Scholar]
- Mosher L. R., Menn A., Matthew S. M. Soteria: Evaluation of a home-based treatment for schizophrenia. Am J Orthopsychiatry. 1975 Apr;45(3):455–467. doi: 10.1111/j.1939-0025.1975.tb02556.x. [DOI] [PubMed] [Google Scholar]
- Pai S., Kapur R. L. Impact of treatment intervention on the relationship between dimensions of clinical psychopathology, social dysfunction and burden on the family of psychiatric patients. Psychol Med. 1982 Aug;12(3):651–658. doi: 10.1017/s0033291700055756. [DOI] [PubMed] [Google Scholar]
- Polak P. R., Kirby M. W. A model to replace psychiatric hospitals. J Nerv Ment Dis. 1976 Jan;162(1):13–22. doi: 10.1097/00005053-197601000-00003. [DOI] [PubMed] [Google Scholar]
- Reynolds I., Hoult J. E. The relatives of the mentally ill. A comparative trial of community-oriented and hospital-oriented psychiatric care. J Nerv Ment Dis. 1984 Aug;172(8):480–489. [PubMed] [Google Scholar]
- Stein L. I., Test M. A. Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry. 1980 Apr;37(4):392–397. doi: 10.1001/archpsyc.1980.01780170034003. [DOI] [PubMed] [Google Scholar]