Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm, functional impairment, and educational and clinical outcomes

Abstract

Clinical guidelines recommend intensive community care service treatment (ICCS) to reduce adolescent psychiatric inpatient care. We have previously reported that the addition of ICCS led to a substantial decrease in hospital use and improved school re-integration. The aim of this study is to undertake a randomised controlled trial (RCT) comparing an inpatient admission followed by an early discharge supported by ICCS with usual inpatient admission (treatment as usual; TAU). In this paper, we report the impact of ICCS on self-harm and other clinical and educational outcomes. 106 patients aged 12–18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomisation, we compared the two treatment arms on the number and severity of self-harm episodes, the functional impairment, severity of psychiatric symptoms, clinical improvement, reading and mathematical ability, weight, height and the use of psychological therapy and medication. At six-month follow-up, there were no differences between the two groups on most measures. Patients receiving ICCS were significantly less likely to report multiple episodes (five or more) of self-harm (OR = 0.18, 95% CI: 0.05–0.64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28.2–208.6) fewer days in hospitals if they were in the ICCS group compared to TAU. The addition of ICCS to TAU may lower the risk of multiple self-harm and may reduce the duration of inpatient stay, especially in those patients admitted for private care. Early discharge with ICCS appears to be a viable alternative to standard inpatient treatment.

Pandemic-Related Emergency Psychiatric Presentations for Self-Harm of Children and Adolescents in 10 Countries (PREP-Kids): A Retrospective International Cohort Study

“…The reasons for this recent reduction are complex, however, a rapid expansion of intensive community care services may have been a deciding factor [13][14][15]. Lengthy inpatient admissions for children and adolescents with self-harm, although sometimes needed, have been linked with an increase in self-harm during admissions [16]. Alternatives to inpatient admissions exist, but their evaluation is still in its infancy [17].…”

Impact of the COVID-19 pandemic on child and adolescent mental health services

“…Despite advances in understanding and treatment, 12–14 the prevalence of self-harm and suicide in young people had been on the increase before the pandemic struck. Although the National Child Mortality Database indicated a possible increase in child suicide during the first UK lockdown, 15 self-harm presentations to emergency departments reduced very substantially at the beginning of the pandemic.…”

Intensive community and home-based treatments for eating disorders: a scoping review study protocol

“…Overall outcomes were similar in both groups, but patients allocated to intensive community care were significantly less likely to report multiple episodes of self-harm. 62 Furthermore, these care models have been shown to be a valuable alternative to inpatient treatment through avoiding hospital admissions, 63 thereby decreasing hospital days and readmission rates. 62 64 Overall, the evidence suggests that these treatment modalities are cost-effective, and have been to linked to positive clinical and social outcomes as well as rates of patient and carer satisfaction comparable to institutionally based intensive treatments.…”