Evaluating the Community Psychiatric Service in Chichester: Aims and Methods of Research

Sainsbury, Peter; Grad, Jacqueline

doi:10.2307/3349081

Cited by 25 publications

(6 citation statements)

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“…During the last 60 years, several CRHT experiences have been evaluated worldwide using a variety of study designs, including randomised controlled trials (RCT) [9][10][11][12][13][14][15][16][17][18][19][20][21], non-randomised comparative [22][23][24][25][26], and non-comparative [27][28][29][30] studies. Evidence synthesis endeavours are reported in systematic reviews [5,31,32], and highlight that CRHT can be an alternative to hospitalisation appreciated by patients and families.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography

et al. 2022

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Background Crisis Resolution Home Treatment (CRHT) is an alternative to inpatient treatment for acute psychiatric crises management. However, evidence on CRHT effectiveness is still limited. In the Canton of Ticino (Southern Switzerland), in 2016 the regional public psychiatric hospital replaced one acute ward with a CRHT. The current study was designed within this evaluation setting to assess the effectiveness of CRHT compared to standard inpatient treatment. Methods CRHT was offered to patients aged 18 to 65 with an acute psychiatric crisis that would have required hospitalization. We used a natural experiment based on geography, where intervention and control groups were formed according to the place of residence. Primary endpoints were reduction of psychiatric symptoms at discharge measured using the Health of the Nation Outcome Scales, treatment duration in days, and rate and length of readmissions during a two-year follow-up period after discharge. Safety during the treatment period was measured with the number of serious adverse events (suicide/suicide attempts, major self-harm episodes, acute alcohol/drug intoxications, aggressions to caregivers or family members). We used linear, log-linear and logistic regression models with propensity scores for the main analysis. Results We enrolled 321 patients; 67 were excluded because the treatment period was too short and 17 because they were transferred before the end of the treatment. Two hundred thirty-seven patients were available for data analysis, 93 in the intervention group and 144 in the control group. No serious adverse event was observed during the treatment period in both groups. Reduction of psychiatric symptoms at discharge (p-value = 0.359), readmission rates (p-value = 0.563) and length of readmissions (p-value = 0.770) during the two-year follow-up period did not differ significantly between the two groups. Treatment duration was significantly higher in the treatment group (+ 29.6% on average, p-value = 0.002). Conclusions CRHT was comparable to standard hospitalization in terms of psychiatric symptoms reduction, readmission rates and length of readmissions, but it was also characterized by a longer first treatment period. However, observational evidence following the study indicated that CRHT duration constantly lowered over time since its introduction in 2016 and became comparable to hospitalization, showing therefore to be an effective alternative also in terms of treatment length. Trial registration ISRCTN38472626 (17/11/2020, retrospectively registered).

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Section: Introductionmentioning

confidence: 99%

Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography

et al. 2022

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“…However, to the extent that schizophrenia tends to be an illness affecting individuals in lower socio-economic groups, admission rates for this category would be expected to reflect any class bias. Studies of discrete psychiatric services (Hoenig & Hamilton, 1969;Sainsbury & Grad, 1966;Wing & Fryers, 1976) provide a greater in-depth picture of changing patterns in local areas. The national data analysed here suggest that the trends reported previously fairly reflect the overall picture in England.…”

Section: Discussionmentioning

confidence: 99%

Integration of hospital care for the mentally ill: a status report

Miller

1979

Psychol. Med.

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SYNOPSISAnalysis of DHSS statistics from the Mental Health Enquiry for 1975 indicates that, contrary to some predictions, district general hospital psychiatric units (DGHU) are assuming a proportionate share of the burden of hospital care for most groups of mentally ill individuals. Comparisons of admissions to mental illness hospitals and DGHUs indicate no major differences in most categories of patient characteristics (age, sex, order of admission and diagnosis); where differences do exist, they appear to be decreasing. Concern that DGHUs might ‘cream off’ patients with less serious illnesses, with a resultant ‘two-tier’ system of mental hospital care, would thus appear to be unwarranted.

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“…Evaluative Research. Early comparative research suggested that community care systems were at least as effective as the traditional mental hospital in treating acute psychiatric disorders and alleviating the social problems that frequently accompany them (Grad and Sainsbury 1966;Hoenig and Hamilton 1969;Sainsbury and Grad 1966). These studies did not, however, consider the difficulties caused by more chronic conditions, since they dealt chiefly with referrals early in the course of psychiatric disorder.…”

Section: Applied Social Psychiatrymentioning

confidence: 99%

Social Psychiatry in the United Kingdom: The Approach to Schizophrenia

Wing

1980

Schizophrenia Bulletin

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British contributions to theoretical and applied social psychiatry have been determined in large part by a traditional empiricism and by developments in social welfare legislation over the past 70 years. The establishment of a national health service covering the whole population and the attempt to provide comprehensive social services have created special opportunities for epidemiological research and for practical community psychiatry. These developments have by no means been uniform throughout the country, and there has been plenty of scope for individual initiative. Open-door policies, domiciliary visiting, social and occupational rehabilitation, therapeutic communities, and long-term continuity of care were first introduced in pioneering centers and subsequently adopted elsewhere. The idea that disorders such as schizophrenia not only have the character of acute illnesses but can also take the form of chronic disabilities has led to recognition of the fact that services must be tailored to the needs of individuals, and to an emphasis on the importance of the family and other social environments. There is a readiness to capitalize on successes and to learn from mistakes, assisted by a wide range of evaluative studies, which promises well for the future.

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Evaluating the Community Psychiatric Service in Chichester: Aims and Methods of Research

Cited by 25 publications

References 0 publications

Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography

Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography

Integration of hospital care for the mentally ill: a status report

Social Psychiatry in the United Kingdom: The Approach to Schizophrenia

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