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Developing mental health services in response to research evidence

Published online by Cambridge University Press:  18 May 2011

Helen Killaspy ,
Sonia Johnson ,
Michael King  and
Paul Bebbington
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Abstract

Over the last thirty to forty years, psychiatric care in England has relocated from hospital-based settings to community mental health teams (CMHTs) and supported accommodation. Since the 1980s, two forms of intensive home based treatment have evolved in addition to CMHTS, assertive community treatment (ACT) and crisis resolution teams (CRTs). On the basis of evidence for their efficacy in the US and other countries, they have been implemented across England through the Government's National Service Framework for Mental Health. This paper describes this evidence and the first UK studies that were carried out to evaluate these newly implemented services. Methods – Descriptions of the evaluations of ACT and CRTs in the inner London boroughs of Camden and Islington. Results – The implementation of CRTs in North London were associated with reduced use of inpatient services, but the ACT teams were not. Both types of team were associated with greater patient satisfaction with services and the ACTs were better able to engage patients than CMHTs. Conclusions – The authors comment on the implications of the findings for service planners in terms of the difficulties in implementing innovative approaches based on the best available evidence when it originates outside the local context.

Declaration of Interest: These studies were funded by Camden and Islington Health Authority, the King's Fund and the Department of Health.

Keywords

Assetive community treatmentcrisis reslution

Information

Type
Special Articles
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 1 , March 2008 , pp. 47 - 56
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

Altman, D.G. (1991). Randomisation. British Medical Journal 302, 1481–1482.CrossRefGoogle ScholarPubMed
Billings, J., Johnson, S., Bebbington, P., Greaves, A., Priebe, S., Muijen, M, Ryrie, I., Watts, J., White, I. & Wright, C. (2003). Assertive outreach teams in London: staff experiences and perceptions. Pan-London Assertive Outreach Study, part 2. British Journal Psychiatry 183, 139–147.CrossRefGoogle ScholarPubMed
Burns, T., Creed, F., Fahy, T., Thompson, S., Tyrer, P., & White, I. (1999). Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet 535, 2185–2189.CrossRefGoogle Scholar
Burns, T., Catty, J., Watt, H., Wright, C., Knapp, M. & Henderson, J. (2002). International differences in home treatment for mental health problems: results of a systematic review. British Journal of Psychiatry 181,375–382.CrossRefGoogle ScholarPubMed
Burns, T., Catty, J., Dash, M., Roberts, C., Lockwood, A. & Marshall, M. (2007) Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. British Medical Journal 335, 336–340.CrossRefGoogle ScholarPubMed
Catty, J., Burns, T., Knapp, M., Watt, H., Wright, C., Henderson, J. & Healey, A. (2002). Home treatment for mental health problems. Psychological Medicine 32, 383–401CrossRefGoogle ScholarPubMed
Department of Health (1999). National Service Framework for Mental Health. Retrieved January 10, 2008 from, http://www.dh.gov.uk/en/ Publicationsandstatistics/Lettersandcirculars/index.htmGoogle Scholar
Department of Health (2001). Mental Health Policy Implementation Guide. Retrieved January 10, 2008 from, http://www.dh.gov.uk/en/ Publicationsandstatistics/Publications/PublicationsPolicyAndGuida nce/DH_4009350Google Scholar
Department of Health (2004). National Service Framework for Mental Health, Five Years On. Retrieved January 10, 2008 from, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati onsPolicyAndGuidance/DH_4099120.Google Scholar
Glover, G., Arts, G. & Babu, K.S. (2006). Crisis resolution/home treatment teams and psychiatric admission rates in England. British Journal of Psychiatry 189,441–445.CrossRefGoogle ScholarPubMed
Harrison-Read, P., Lucas, B., Tyrer, P., Ray, J., Shipley, K., Simmonds, S., Knapp, M., Lowin, A., Patel, A. & Hickman, M. (2002). Heavy users of acute psychiatric beds: randomized controlled trial of enhanced community management in an outer London borough. Psychological Medicine 32, 403–416.CrossRefGoogle Scholar
Holloway, F. & Carson, J. (1998). Intensive case management for the severely mentally ill: controlled trial. British Journal of Psychiatry 172, 19–22.CrossRefGoogle ScholarPubMed
Hoult, J. (1986) Community care of the acutely mentally ill. British Journal of Psychiatry 149, 137–144.CrossRefGoogle ScholarPubMed
Hoult, J., Reynolds, I., Charbonneau-Powis, M., Weekes, P. & Briggs, J. (1983). Psychiatric hospital versus community treatment: the results of a randomised trial. Australian and New Zealand Journal of Psychiatry 17, 160–167.CrossRefGoogle ScholarPubMed
Johnson, S. & Lelliott, P. (1997). Mmental health services in London: evidence from research and routine data. In London's Mental Health Services (ed. Johnson, S., Ramsay, R., Thornicroft, G., Brooks, L., Lelliott, P., Peck, E., Smith, E., Chisholm, D., Audini, B., Knapp, M., et al), pp. 33–44. King's Fund: London.Google Scholar
Johnson, S., Nolan, F., Hoult, J., White, I.R.Bebbington, P.E., Sandor, A., McKenzie, N., Patel, S. & Pilling, S., (2005a). Outcomes of crises before and after introduction of a crisis resolution team: Islington Crisis Studies 1. British Journal of Psychiatry 187, 68–75.CrossRefGoogle Scholar
Johnson, S., Nolan, F., Pilling, S., Sandor, A., Hoult, J., McKenzie, N., White, I.R., Thompson, M. & Bebbington, P.E. (2005b). Randomised controlled trial of care by a crisis resolution team: the North Islington Crisis Study. British Medical Journal 331, 599–602.CrossRefGoogle Scholar
Killaspy, H., Bebbington, P.E., Blizard, R., Johnson, S., Nolan, F., Pilling, S. & King, M. (2006). The REACT study: a randomised evaluation of assertive community treatment in north London. British Medical Journal 332, 815–820.CrossRefGoogle ScholarPubMed
Killaspy, H. (2007). Intensive case management and assertive community treatment in psychiatry. Editorial. British Medical Journal 335, 311–312.CrossRefGoogle Scholar
Killaspy, H., Johnson, S., Pierce, B., Bebbington, P., Pilling, S., Nolan, F. & King, M. (submitted for publication). A mixed methods analysis of interventions delivered by assertive community treatment and community mental health teams in the REACT trial. Canadian Journal of Psychiatry.Google Scholar
Kluiter, H. (1997). In-patient treatment and care arrangements to replace it ot avoid it - searching for an evidence based balance. Current Opinion in Psychiatry 10, 160–167.CrossRefGoogle Scholar
Larsen, D.L., Attkisson, C.C., Hargreaves, W.A. & Nguyen, T.D. (1979). Assessment of client/patient satisfaction: development of a general scale. Evaluation and Program Planning 2, 197–207.CrossRefGoogle ScholarPubMed
Lehman, A.F., Dixon, L.B., Kernan, E., DeForge, B.R. & Postrado, L.T. (1997). A randomized trial of assertive community treatment for homeless persons with severe mental illness. Archives of General Psychiatry 54, 1038–1043.CrossRefGoogle ScholarPubMed
Lehman, A.F., Dixon, L., Hoch, J.S., Deforge, B., Kernan, E. & Frank, R. (1999). Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness. British Journal of Psychiatry 174, 346–352.CrossRefGoogle ScholarPubMed
Marshall, M. (1996). Case management: a dubious practice. British Medical Journal 312, 523.CrossRefGoogle ScholarPubMed
Marshall, M & Lockwood, A. (1998). Assertive community treatment for people with severe mental disorders (Cochrane Review). Cochrane Library, Issue 4.Google Scholar
Marshall, M., Bond, G., Stein, L., Shepherd, G., McGrew, J., Hoult, J., Rosen, A., Huxley, P., Diamond, R., Warner, R., Olsen, M., Latimer, E., Goering, P., Craig, T., Meisler, N. & Test, M.A. (1999). PRiSM Psychosis Study: Design limitations, questionable conclusions. British Journal of Psychiatry 175, 501–503.CrossRefGoogle ScholarPubMed
McGrew, J.H., Bond, G.R., Dietzen, L. & Salyers, M. (1994). Measuring the fidelity of implementation of a mental health program model. Journal of Consulting and Clinical Psychology 62, 670–678.CrossRefGoogle ScholarPubMed
Meltzer, D., Hale, A., Malik, S.J., Hogman, G.A. & Wood, S. (1991). Community care for patients with schizophrenia one year after hospital discharge. British Medical Journal 303, 1023–1026.CrossRefGoogle Scholar
Merson, S., Tyrer, P., Onyett, S., Lack, S., Birkett, P., Lynch, S. & Johnson, T. (1992). Early intervention in psychiatric emergencies: a controlled clinical trial. Lancet 339, 1311–1314.CrossRefGoogle ScholarPubMed
Merson, S., Tyrer, P., Carlen, D. & Johnson, T. (1996). The cost of treatment of psychiatric emergencies: a comparison of hospital and community services. Psychological Medicine 26, 727–734.CrossRefGoogle ScholarPubMed
Minghella, E., Ford, R., Freeman, T., Hoult, J., McGlynn, P. & O'Halloran, P. (1998). Open All Hours: 24-Hour Response for People with Mental Health Emergencies. Sainsbury Centre for Mental Health: London.Google Scholar
Mueser, K.T., Bond, G.R., Drake, R.E. & Resnick, S.G. (1998). Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin 24, 37–74.CrossRefGoogle ScholarPubMed
Muijen, M., Marks, I., Connolly, J. & Audini, B. (1992). Home based care and standard hospital care for patients with severe mental illness: a randomised controlled trial. British Medical Journal 304, 749–754.CrossRefGoogle ScholarPubMed
Nolan, F. (2005). Which patients like crisis teams and what do they like about them? Presentation at the Sainsbury Centre for Mental Health Conference on Crisis Resolution Teams, York, 8 September 2005.Google Scholar
Overall, J.E. & Gorham, D.R. (1962). Brief Psychiatric Rating Scale. Psychological Reports 10, 799–812.CrossRefGoogle Scholar
Park, M.J., Tyrer, P., Elsworth, E., Fox, J. & Ukoumunne, O.C. (2002). The measurement of engagement in the homeless mentally ill: The Homeless Engagement and Acceptance Scale (HEAS). Psychological Medicine 32, 855–861.CrossRefGoogle ScholarPubMed
Polak, P.R. & Kirby, M.W. (1976). A model to replace psychiatric hospitals. Journal of Nervous & Mental Disease 162, 13–22.CrossRefGoogle Scholar
Priebe, S., Huxley, P., Knight, S. & Evans, S. (1999). Application and results of the Manchester Short Assessment of quality of life. International Journal of Social Psychiatry 45, 7–12.CrossRefGoogle ScholarPubMed
Reynolds, I., Jones, J.E., Berry, D.W. & Hoult, J.E. (1990). A crisis team for the mentally ill: the effect on patients, relatives and admissions. Medical Journal of Australia 152, 646–652.CrossRefGoogle Scholar
Social Care Institute for Excellence (2007). Care Service Improvement Partnership, the Royal College of Psychiatrists and the Social Care Institute for Excellence. Joint Position Paper 08. A Common Purpose: Recovery in Future Mental Health Services. Social Care Institute for Excellence: London.Google Scholar
Stein, L.I. & Test, M.A. (1980). Alternatives to mental hospital treatment. Archives of General Psychiatry 37, 392–397CrossRefGoogle ScholarPubMed
Teague, G.P., Bond, G.R. & Drake, R.E. (1998). Programme fidelity in community treatment: development and views of measure. American Journal of Orthopsychiatry 68, 216–231.CrossRefGoogle Scholar
Thornicroft, G. & Bebbington, P.E. (1989). Deinstitutionalisation: From hospital closure to service development. British Journal of Psychiatry 155, 739–753.CrossRefGoogle ScholarPubMed
Thornicroft, G., Wykes, T., Holloway, F., Johnson, S. & Szmukler, G. (1998). From efficacy to effectiveness in community mental health services. PRiSM Psychosis Study 10. British Journal of Psychiatry 173, 423–427.CrossRefGoogle ScholarPubMed
Tyrer, P. (1988). Cost-effective or profligate community psychiatry? British Journal of Psychiatry 172, 1–3.CrossRefGoogle Scholar
Wright, C., Burns, T., James, P., Billings, J., Johnson, S., Muijen, M., Priebe, S., Ryrie, I., Watts, J. & White, I. (2003). Assertive outreach teams in London: models of operation. Pan-London Assertive Outreach Study, part 1. British Journal of Psychiatry 183, 132–138.CrossRefGoogle ScholarPubMed