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An Evaluation of Community-Based Psychiatric Care for People with Treated Long-Term Mental Illness

Published online by Cambridge University Press:  02 January 2018

Greg Wilkinson ,
Marco Piccinelli ,
Ian Falloon ,
Haroutyon Krekorian  and
Sheila McLees
Greg Wilkinson*
Affiliation:
Royal Liverpool University Hospital, Liverpool
Marco Piccinelli
Affiliation:
Department of Medical Psychology, Institute of Psychiatry, University of Verona, Italy
Ian Falloon
Affiliation:
Department of Psychiatry, University of Auckland, Private Bag 92019, Auckland, New Zealand
Haroutyon Krekorian
Affiliation:
The Mental Health Services, Weston-super-Mare, Avon
Sheila McLees
Affiliation:
Research & Development Department, Aylesbury Vale Community Healthcare NHS Trust, Manor House Hospital, Aylesbury, Bucks
*
Professor G. Wilkinson, The University of Liverpool, Royal Liverpool University Hospital, Liverpool L69 3BX
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Extract

Background

We evaluated integrated, multidisciplinary, community-based care for a cohort of people with treated long-term mental illness over two years in a field trial set in a semi-rural setting. The aim was to organise local psychiatric services on an extramural basis with general practitioner teams as the key element.

Method

Trained research workers used a structured interview to collect standardised baseline and three-monthly socio-demographic, clinical, social, family adjustment and burden, and treatment measures from patients, informants, and key-workers. Analysis included descriptive statistics and, for longitudinal data, analysis of best-fitted straight lines.

Results

We studied 34 patients (14 with schizophrenia, 11 with major affective disorders, and 9 with minor (non-major) affective disorders and anxiety disorders) who had a mean of 12 years continuous illness. At baseline, they were mainly characterised by research workers as mildly ill with fair social adaptive functioning, and by lay informants as having moderate target symptom severity and disturbance of social performance. Over two years, there were statistically significant, slight improvements in clinical global impressions ratings by research workers, and in informants ratings of target symptoms and social performance. Most patients continued to receive prescriptions for psychotropic drugs throughout follow-up, and they had a mean of 47 therapeutic contacts, mainly from nurses. Two patients were admitted to psychiatric hospital. There were few differences between patients in different diagnostic groups.

Conclusions

Integrated, multidisciplinary, community-based psychiatric care for people with treated long-term mental illness is feasible in a semi-rural setting: patients receiving pharmacotherapy and regular psychosocial treatments remained relatively stable on clinical and social measures over two years. The unique way in which the service was monitored, by making regular, systematic assessments of patients and carers, serves as an example for other services.

Type
Papers
Information
The British Journal of Psychiatry , Volume 167 , Issue 1 , July 1995 , pp. 26 - 37
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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References

Andrews, G. (1990) England: An innovative community psychiatric service. The Lancet, 355, 1087–1088.Google Scholar
Beck, A. T., Rush, A. J., Shaw, B. F., et al (1979) Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Bellack, A. S., Hersen, M. & Himmelhoch, J. M. (1983) A comparison of social skills training, pharmacotherapy and psychotherapy for depression. Behaviour Research and Therapy, 21, 101–107.Google Scholar
Burns, T. & Raftery, J. (1991) Cost of schizophrenia in a randomised trial of home-based treatment. Schizophrenia Bulletin, 17, 407–410.Google Scholar
Candy, J. (1993) Realising a vision: psychiatry in Aylesbury 1983–91. Psychiatric Bulletin, 17, 458–461.CrossRefGoogle Scholar
Carpenter, W. T. & Heinrichs, D. W. (1983) Early intervention, time limited, targeted pharmacotherapy of schizophrenia. Schizophrenia Bulletin, 9, 34–43.Google Scholar
Dean, C., Phillips, J., Gadd, E. M., et al (1993) Comparison of community based service with hospital based service for people with acute, severe psychiatric illness. British Medical Journal, 307, 473–476.Google Scholar
Dilling, H., Weyerer, S. & Fichter, M. (1989) The Upper Bavarian Studies. Acta Psychiatrica Scandinavica, 79 (Suppl. 348), 113–140.Google Scholar
DSM–III (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn). American Psychiatric Association: Washington, DC.Google Scholar
Dunn, G. (1994) Statistical methods for measuring outcomes. Social Psychiatry and Psychiatric Epidemiology, 29, 198–204.CrossRefGoogle ScholarPubMed
Falloon, I. R. H. (1985) Family Management of Schizophrenia. Baltimore: Johns Hopkins University Press.Google Scholar
Falloon, I. R. H. (1992) Early intervention for first episodes of schizophrenia: a preliminary exploration. Psychiatry, 55, 4–14.Google Scholar
Falloon, I. R. H. & Fadden, G. (1993) Integrated Mental Health Care. Cambridge University Press: Cambridge.Google Scholar
Falloon, I. R. H., Krekorian, H., Shanahan, W. J., et al (1993) A family-based approach to adult mental disorders. Journal of Family Therapy, 15, 147–161.CrossRefGoogle Scholar
Falloon, I. R. H., Shanahan, W. & Laporta, M. (1992) Prevention of major depressive episodes: early intervention with family-based stress management. Journal of Mental Health, 1, 53–60.CrossRefGoogle Scholar
Fenton, F. R., Tessier, L., Contandriopoulos, A-P., et al (1982) A comparative trial of home and hospital psychiatric treatment: financial costs. Canadian Journal of Psychiatry, 27, 177–187.CrossRefGoogle ScholarPubMed
Fenton, F. R., Tessier, L., Struening, E. L., et al (1981) Home and Hospital Psychiatric Treatment. London: Croom-Helm.Google Scholar
Guy, W. (1976) Assessment Measures for Psychopharmacology, 1976. DHEW Publications (USA). Revised No. (ADM), 76–338.Google Scholar
Hogarty, G. E., Anderson, C. M., Reiss, D. J., et al (1986) Family psycho–education, social skills training and maintenance chemotherapy in the aftercare treatment of schizophrenia. Archives of General Psychiatry, 43, 636–642.Google Scholar
Hoult, J., Reynolds, I., Charbonneau-Powis, M., et al (1983) Psychiatric hospital versus community treatment: the results of a randomised trial. Australian and New Zealand Journal of Psychiatry, 17, 160–167.CrossRefGoogle ScholarPubMed
Kane, J. M., Woerner, M. & Sarenkatos, S. (1986) Depot neuroleptics: a comparative review of standard, intermediate and low-dose regimens. Journal of Clinical Psychiatry, 47, 30–33.Google ScholarPubMed
Knapp, M., Beecham, J., Koutsogeorgopoulos, V., et al (1994) Service use and costs of home-based versus hospital-based care for people with serious mental illness. British Journal of Psychiatry, 165, 195–203.Google Scholar
Leff, J., Kuipers, L., Berkowitz, R., et al (1982) A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry, 141, 121–134.Google Scholar
Marks, I. M. (1987) Fears, Phobias, and Rituals. New York: Wiley.Google Scholar
Platt, S., Weymann, A., Hirsch, S. R., et al (1980) The Social Behaviour Assessment Schedule (SBAS): rationale, contents, scoring and reliability of a new interview schedule. Social Psychiatry, 15, 43–45.CrossRefGoogle Scholar
Stein, L. I. & Test, M. A. (1980) An alternative to mental hospital treatment: I. Conceptual issues, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392–399.Google Scholar
Szmukler, G. (1994) Book review. Psychological Medicine, 24, 250–252.Google Scholar
Tarrier, N., Barrowclough, C., Vaughn, C., et al (1988) The community management of schizophrenia: a controlled trial of a behavioural intervention with families to reduce relapse. British Journal of Psychiatry, 153, 532–542.Google Scholar
Wallace, C. J. & Liberman, R. P. (1985) Social skills training for patients with schizophrenia: a controlled clinical trial. Psychiatry Research, 15, 239–247.CrossRefGoogle ScholarPubMed
Watts, C. A. H. (1966) Depressive Disorders in the Communiy. Bristol: John Wright.Google Scholar
Weisbrod, B. A., Test, M. A. & Stein, L. I. (1980) Alternative to mental hospital treatment. II. Economic benefit–cost analysis. Archives of General Psychiatry, 37, 400–405.CrossRefGoogle ScholarPubMed
Wilkinson, G., Williams, B., Krekorian, H., et al (1992) QALYs in mental health: a case study. Psychological Medicine, 22, 725–731.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) Present State Examination. The measurement and classification of psychiatric symptoms. Cambridge University Press: Cambridge.Google Scholar
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