Recent changes in psychiatric services have produced a movement away from large hospitals to management within the community. A successful home treatment service with 24-hour cover has been described for severe acute psychiatric illness, though hospital admission was not entirely avoided (Dean et al, 1990). It is difficult to manage violent patients or those who will not comply with medication at home. If relatives are not supportive hospital admission will be required. Although living alone is not a contraindication to treatment at home, those who require constant supervision because they are, for example, suicidal need to be admitted. Concurrent physical problems may also necessitate hospital admission. Any future services must therefore include some in-patient care.
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