Overview of UK studies

Introduction

The growth of community treatment programmes for acute psychiatric illness has provoked considerable discussion in relation to both service development and research. On the one hand, the ‘enthusiasts’ for community treatments argue that this is the superior form of care and imply that every district should switch their resources from hospital to community treatment. On the other hand, critics argue that the superiority of community treatment has yet to be firmly established, either pointing out weaknesses in the research or insisting that any beneficial effects are probably marginal, related to the enthusiasm of the staff involved and that the real costs (e.g. possible increased suicide rate or ‘burn-out’ of staff) have yet to come to light. The argument tends to highlight the missionary zeal of the community enthusiasts and the defensiveness of the traditionalists rather than being based on sound scientific principles. The research findings to date are not sufficiently persuasive to end the argument.

The studies most widely quoted in favour of the community approach are those of Stein & Test (1980) and Hoult (1986); as these are outside the UK they can be criticised or supported with a degree of detachment. This is not so for the recent UK studies; the results of these local studies need to be examined firstly, to inform decisions about how UK community psychiatric services might be developed (including how they may contribute to ‘Health of the Nation’ targets) and secondly, to establish the next generation of research questions (Rosen, 1992; NIMH, 1991).