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The future of specialist community teams in the care of those with severe mental illness*

Published online by Cambridge University Press:  18 May 2011

Peter Tyrer
Peter Tyrer*
Affiliation:
Department of Psychological Medicine, Division of Neuroscience and Mental Health, Imperial College London (United Kingdom)
*
Address for correspondence: Professor P. Tyrer, The Claybrook Centre, Charing Cross Campus, St. Dunstan's Road, London W6 8RP (United Kingdom). E-mail: [email protected]
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Summary

Aims – Specialist interventions in community psychiatry for severe mental illness are expanding and their place needs to be re-examined. Methods – Recent literature is reviewed to evaluate the advantages and disadvantages of specialist teams. Results – Good community mental health services reduce drop out from care, prevent suicide and unnatural deaths, and reduce admission to hospital. Most of these features have been also demonstrated by assertive community outreach and crisis resolution teams when good community services are not available. In well established community services assertive community teams do not reduce admission but both practitioners and patients prefer this service to other approaches and it leads to better engagement. Crisis resolution teams appear to be more successful than assertive community teams in preventing admission to hospital, although head- to-head comparisons have not yet been made. All specialist teams have the potential of fragmenting services and thereby reducing continuity of care. Conclusions – The assets of improved engagement and greater satisfaction with assertive, crisis resolution and home treatment teams are clear from recent evidence, but to improve integration of services they are probably best incorporated into community mental health services rather than standing alone.

Declaration of Interest: The author has been the sole consultant in two assertive outreach teams since 1994 and might there- fore be expected to be in favour of this genre of service. He has received grants for evaluation of different services models from the Department of Health (UK) and the Medical Research Council (UK).

Keywords

community mental health teamscrisis resolutionassertive community treatmentpsychiatric services
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 16 , Issue 3 , September 2007 , pp. 225 - 230
Copyright
Copyright © Cambridge University Press 2007

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Footnotes

*

Based on a paper presented at the XLIV Congresso della Società Italiana di psichiatria in Montesilvano, Italy (15-20 October, 2006).

References

REFERENCES

Abas, M.A., Vanderpyl, J., Robonson, E., Le Prou, T. & Crampton, P. (2006). Socio-economic deprivation and duration of hospital stay in severe mental disorder. British Journal of Psychiatry 188, 581–582.CrossRefGoogle ScholarPubMed
Allevi, L., Salvi, G. & Ruggeri, M. (2006). La qualita dei servizi di Salute Mentale: un esercizio di autovalutazione nel Servizio psichiatrico di Verona Sud. Epidemiologia e Psichiatrica Sociale 15, 138–147.CrossRefGoogle Scholar
Bond, G.R. & Salyers, M.P. (2004). Prediction of outcome from the Dartmouth assertive community treatment fidelity scale. CNS Spectrums 9, 937–942.CrossRefGoogle ScholarPubMed
Bridgett, C. & Polak, P. (2003). Social systems intervention and crisis resolution. Part 1: Assessment. Advances in Psychiatric Treatment 9, 424–431.CrossRefGoogle Scholar
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 353, 2185–2189.CrossRefGoogle ScholarPubMed
Burns, T., Catty, J. & Wright, C. (2006). De-constructing home-based care for mental illness: can one identify the effective ingredients? Ada Psychiatrica Scandinavica, Suppl. 429, 33–35.CrossRefGoogle Scholar
Campbell, M., Fitzpatrick, R., Haines, A., Sandercock, P., Spiegelhalter, D. & Tyrer, P. (2000). A framework for the design and evaluation of complex interventions to improve health. British Medical Journal 321, 694–696.CrossRefGoogle ScholarPubMed
Caplan, G. (1951). A public-health approach to child psychiatry: an introductory account of an experiment. Mental Hygiene 35, 235–249.Google ScholarPubMed
Caplan, G. (1964). Principles of Preventative Psychiatry. Basic Books: New York.Google Scholar
Catty, J., Burns, T., Knapp, M., Watt, H., Wright, C., Henderson, J. & Healey, A. (2002). Home treatment for mental health problems; a systematic review. Psychological Medicine 32, 383–401.CrossRefGoogle ScholarPubMed
Crawford, M.J., de Jonge, E., Freeman, G.K. & Weaver, T. (2004). Providing continuity of care for people with severe mental illness: a narrative review. Social Psychiatry and Psychiatric Epidemiology 39, 265–272.CrossRefGoogle ScholarPubMed
Garety, P.A., Craig, T.K.J., Dunn, G., Fornells-Ambrojo, M, Colbert, S., Rahaman, N., Read, J. & Power, P. (2006). Specialised care for early psychosis: symptoms, social functioning and patient satisfaction: Randomised controlled trial. British Journal of Psychiatry 188, 37–45.CrossRefGoogle ScholarPubMed
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
Gournay, K. & Thornicroft, G. (2000). Comments on the UK700 Case management trial. British Journal of Psychiatry 177, 371.CrossRefGoogle ScholarPubMed
Gold, P.B., Meisler, N., Santos, A.B., Carnemolla, M.A., Williams, O.H. & Keleher, J. (2006). Randomized trial of supported employment integrated with assertive community treatment for rural adults with severe mental illness. Schizophrenia Bulletin 32, 378–395.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: randomised controlled trial of enhanced community management in an outer London borough. Psychological Medicine 32, 413–426.CrossRefGoogle Scholar
Hassiotis, A., Ukoumunne, O.C., Byford, S., Tyrer, P, Harvey, K., Piachaud, J., Gilvarry, K. & Fraser, J. (2001). Intellectual functioning and outcome of patients with severe psychotic illness randomised to intensive case management: report from the UK700 case management trial. British Journal of Psychiatry 178, 166–171.CrossRefGoogle Scholar
Hill, A.B. (1977). Short Textbook of Medical Statistics. Hodder & Stoughton: London.Google Scholar
Hoult, J. (1986). Community care of the acutely mentally ill. British Journal of Psychiatry 149, 137–144.CrossRefGoogle ScholarPubMed
Hoult, J. & Reynolds, I. (1985). Schizophrenia: a comparative trial of community-oriented and hospital oriented psychiatric care. Ada Psychiatrica Scandinavica 69, 359–372.CrossRefGoogle Scholar
Issakidis, C., Sanderson, K., Teesson, M, Johnston, S. & Buhrich, N. (1999). Intensive case management in Australia: a randomized controlled trial. Ada Psychiatrica Scandinavica 99, 360–367.CrossRefGoogle ScholarPubMed
Jeppesen, P., Petersen, L., Thorup, A., Abel, M-B., øehlenschlaeger, J., Christensen, T.O., Krarup, G., Hemmingsen, R., Jørgensen, P. & Nordentoft, M. (2005). Integrated treatment of first-episode psychosis: effect of treatment on family burden: OPUS trial. British Journal of Psychiatry, Suppl. 48, 187, s85–s90.CrossRefGoogle ScholarPubMed
Johnson, S. & Thornicroft, G. (1993). The sectorisation of psychiatric services in England and Wales. Social Psychiatry and Psychiatric Epidemiology 28, 45–47.CrossRefGoogle ScholarPubMed
Johnson, S., Nolan, F., Pilling, S., Sandor, A., Hoult, J., McKenzie, N., White, I.R., Thompson, M. & Bebbington, P. (2005a). Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study. British Medical Journal 331, 599.CrossRefGoogle Scholar
Johnson, S., Nolan, F., Hoult, J., White, I.R., Bebbington, P., Sandor, A., McKenzie, N., Patel, S.N. & Pilling, S. (2005b). Outcomes of crises before and after introduction of a crisis resolution team. British Journal of Psychiatry 187, 68–75.CrossRefGoogle ScholarPubMed
Kendrick, T., Simons, L., Mynors-Wallis, L., Gray, A., Lathlean, J., Pickering, R., Harris, S., Rivero-Arias, O., Gerard, K & Thompson, C. (2006). Cost-effectiveness of referral for generic care or problem- solving treatment from community mental health nurses, compared with usual general practitioner care for common mental disorders: randomised controlled trial. British Journal of Psychiatry 189, 50–59.CrossRefGoogle ScholarPubMed
Macias, C., Rodican, C.F., Hargreaves, W.A., Jones, D.R., Barreira, P.J. & Wang, Q (2006). Supported employment outcomes of a randomized controlled trial of ACT and clubhouse models. Psychiatric Services 57, 1406–1415.CrossRefGoogle ScholarPubMed
Malone, D., Newton-Howes, G., Nourmand, S. & Tyrer, P. (2007). Community mental health team services for severe mental illness. Cochrane Database of Systematic Reviews, Issue 3.Google Scholar
Marks, A.J., Test, M.A. & Stein, L.I. (1973). Extrahospital management of severe mental-illness – feasibility and effects of social functioning. Archives of General Psychiatry 29, 505–511.Google Scholar
Muijen, M., Cooney, M., Strathdee, G., Bell, R. & Hudson, A. (1994). Community psychiatric nurse teams: intensive support versus generic care. British Journal of Psychiatry 165, 211–217.CrossRefGoogle ScholarPubMed
Petersen, L., Nordentoft, M., Jeppesen, P., Øehlenschlaeger, J., Thorup, A., Christensen, T.O., Krarup, G., DahlstrØm, J., Haastrup, B. & JØrgensen, P. (2005). Improving 1-year outcome in first-episode psychosis: OPUS trial. British Journal of Psychiatry, suppl 48, s98–slO3.CrossRefGoogle ScholarPubMed
Priebe, S.Watts, J.Chase, M. & Matanov, A. (2005). Processes of disengagement and engagement in assertive outreach patients: qualitative study. British Journal of Psychiatry 187, 438–443.CrossRefGoogle ScholarPubMed
Rosen, A. (1997). Crisis management in the community. Medical Journal of Australia 167, 633–638.CrossRefGoogle ScholarPubMed
Rosen, A. & Teesson, M. (2001). Does case management work: the evidence and abuse of evidence-based medicine. Australian and New Zealand Journal of Psychiatry 35, 731–746.CrossRefGoogle ScholarPubMed
Rosenbaum, B., Valbak, K., Harder, S., Knudsen, P., Køster, A., Lajer, M., Lindhardt, A., Winther, G., Petersen, L., JØrgensen, P., Nordentoft, M. & Andreasen, A.H. (2005). The Danish National Schizophrenia Project: prospective, comparative longitudinal treatment study of first-episode psychosis. British Journal of Psychiatry 186, 394–399.CrossRefGoogle ScholarPubMed
Simmonds, S., Coid, J., Joseph, P., Marriott, S. & Tyrer, P. (2001). Community mental health team management in severe mental illness: a systematic review. British Journal of Psychiatry 178, 497–502.CrossRefGoogle ScholarPubMed
Stein, L.I. & Santos, A.B. (1998). Assertive Community Treatment of Persons with Severe Mental Illness. WW Norton: London and New York.Google Scholar
Stein, L.I. & Test, M.A. (1980). Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry 37, 392–397.CrossRefGoogle ScholarPubMed
Thornicroft, G. & Tansella, M. (2004). Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence. British Journal of Psychiatry 185, 283–290.CrossRefGoogle ScholarPubMed
Thornicroft, G., Becker, T., Holloway, F., Johnson, S., Leese, M., McCrone, P., Szmukler, G., Taylor, R. & Wykes, T. (1999). Community mental health teams: evidence or belief? British Journal of Psychiatry 175, 508–513.CrossRefGoogle ScholarPubMed
Turkington, D., Kingdon, D., Rathod, S., Hammond, K, Pelton, J. & Mehta, R. (2006). Outcomes of an effectiveness trial of cognitive-behavioural intervention by mental health nurses in schizophrenia. British Journal of Psychiatry 189, 36–40.CrossRefGoogle ScholarPubMed
Tyrer, P. (1999). What is the future of assertive community treatment? Epidemiologia e Psichiatrica Sociale 8, 16–18.CrossRefGoogle ScholarPubMed
Tyrer, P. (2000). Effectiveness of intensive treatment in severe mental illness. British Journal of Psychiatry 176, 492–493.CrossRefGoogle ScholarPubMed
Tyrer, P., Hassiotis, A., Ukoumunne, O., Piachaud, J., Harvey, K. & UK700 Group (1999). Intensive case management for psychotic patients with borderline intelligence. Lancet 354, 999–1000.CrossRefGoogle ScholarPubMed
Tyrer, P & Bajaj, P (2005). Nidotherapy: making the environment do the therapeutic work. Advances in Psychiatric Treatment, 11, 232–238.CrossRefGoogle Scholar
Tyrer, P, Nur, U, Crawford, M, Karlsen, S, McLean, C., Rao, B, & Johnson, T (2005). The Social Functioning Questionnaire: a rapid and robust measure of perceived functioning. International Journal of Social Psychiatry 51, 265–275.CrossRefGoogle ScholarPubMed
Tyrer, P., Balod, A., Germanavicius, A., McDonald, A., Varadan, M. & Thomas, J. (2007). Perceptions of assertive community treatment in the UK and Lithuania. International Journal of Social Psychiatry.CrossRefGoogle Scholar
Tyrer, P & Milner, K (2007). Complex interventions and service strategies. In Cambridge Textbook of Effective Treatments in Psychiatry (Tyrer, P. and Silk, K.). Cambridge University Press: Cambridge.Google Scholar
UK700 Group (2000). Cost-effectiveness of intensive v. standard case management for severe psychotic illness. UK700 case management trial. British Journal of Psychiatry 176, 537–543.CrossRefGoogle Scholar
Weaver, T., Tyrer, P., Ritchie, J. & Renton, A. (2003). Assessing the value of assertive outreach. Qualitative study of process and outcome in the UK700 trial. British Journal of Psychiatry 183, 437–445.CrossRefGoogle ScholarPubMed
Weisbrod, B.A., Test, M.A. & Stein, L.I. (1980). Alternatives to mental hospital treatment: II. Economic benefit-cost analysis. Archives of General Psychiatry 37, 400–405.CrossRefGoogle ScholarPubMed
Winter, D.A., Shivakumar, H., Brown, R.J., Roitt, M., Drysdale, W.J. & Jones, S. (1987). Explorations of a crisis intervention service. British Journal of Psychiatry 151, 232–239.CrossRefGoogle ScholarPubMed
Ziguras, S.J., Stuart, G.W. & Jackson, A.C. (2002). Assessing the evidence on case management. British Journal of Psychiatry 181, 17–21.CrossRefGoogle ScholarPubMed