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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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