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From efficacy to effectiveness in community mental health services

PRiSM Psychosis Study 10

Published online by Cambridge University Press:  02 January 2018

Graham Thornicroft ,
Til Wykes ,
Frank Holloway ,
Sonia Johnson  and
George Szmuckler
Graham Thornicroft*
Affiliation:
Section of Community Psychiatry (PRiSM), Institute of Psychiatry, London
Til Wykes
Affiliation:
Department of Psychology, Institute of Psychiatry, London
Frank Holloway
Affiliation:
Maudsley Hospital, Denmark Hill, London
Sonia Johnson
Affiliation:
Department of Psychiatry & Behavioural Sciences, University College London Medical School, London
George Szmuckler
Affiliation:
Section of Community Psychiatry (PRiSM), Institute of Psychiatry, London
*
Professor Graham Thornicroft, Section of Community Psychiatry (PRiSM), Institute of Psychiatry, De Crespigny Park, London SE5 8AF. Tel: 0171 919 2610; Fax: 0171 277 1462
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Abstract

Background

The PRiSM Psychosis Study investigated the outcomes of community mental health services for epidemiologically representative cases of psychosis in London.

Method

The results presented in the preceding nine papers are interpreted.

Results

(a) The health and social gains reported in experimental studies of community health services are replicable in ordinary clinical settings, and are more effective than hospital-oriented services which they replace, (b) Dilution does occur - these gains are less pronounced than in experimental (efficacy) studies, (c) Both models of community services produced a range of improved outcomes, (d) Some limited extra advantages (in terms of met needs, improved quality of life, and social networks) were found in the intensive sector, (e) There is no consistent evidence that community-oriented services (which include in-patient beds) fail service users, their families or the wider public. On balance the results weigh slightly in favour of the two-team model (for acute and continuing care) in terms of clinical effectiveness, but the general model is almost as effective and is less expensive.

Conclusions

The evidence supports a community-oriented rather than a hospital-oriented approach and there is little difference between the community mental health team models.

Type
PRiSM Psychosis Study
Information
The British Journal of Psychiatry , Volume 173 , Issue 5 , November 1998 , pp. 423 - 427
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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References

Beck, A., Croudace, T. J., Singh, S., et al (1997) The Nottingham Acute Bed Study: alternatives to acute psychiatric care. British Journal of Psychiatry, 170, 247–252.Google Scholar
Becker, T., Thornicroft, G., Leese, M., et al (1997) Social networks and service use among representative cases of psychosis in south London: British Journal of Psychiatry, 171, 15–19.CrossRefGoogle ScholarPubMed
Becker, T., Holloway, F., McCrone, P., et al (1998) Evolving service interventions in Nunhead and Norwood. PRiSM Psychosis Study 2. British Journal of Psychiatry, 173, 371–375.Google Scholar
Burns, T., Beadsmore, A., Bhat, A. V., et al (1993a) A controlled trial of home-based acute psychiatric services. I: Clinical and social outcome. British Journal of Psychiatry, 163, 49–54.Google Scholar
Burns, T., Raftery, J., Beadsmore, A., et al (1993b) A controlled trial of home-based acute psychiatric services. II: Treatment patterns and costs. British Journal of Psychiatry, 163, 55–61.CrossRefGoogle ScholarPubMed
Calman, K. & Royston, G. (1997) Risk language and dialects. British Medical Journal, 315, 939–942.Google Scholar
Cochrane, A. L. (1972) Effectiveness and Efficiency. Random Reflections on Health Services. London: Nuffield Provincial Hospital Trust.Google Scholar
Creed, F., Mbaya, P., Lancashire, S., et al (1997) Cost effectiveness of day and in-patient psychiatric treatment: results of a randomised controlled trial, British Medical Journal, 314, 1381–1385.CrossRefGoogle Scholar
Davies, S., Thornicroft, G., Leese, M., et al (1996) Ethnic differences in risk of compulsory admission among representative cases of psychosis in London. British Medical Journal, 312, 533–537.Google Scholar
Department of Health (1990) The Care Programme Approach for people with a mental illness referred to the specialist psychiatric services. (HC(90)23/HASSL(90)11.) London: DoH.Google Scholar
Department of Health (1994) Mental Illness Key Area Handbook, 2nd edn. London: HMSO.Google Scholar
Dixon, L. & Lehman, A. (1995) Family interventions for the treatment of schizophrenia. Schizophrenia Bulletin, 21, 631–643.Google Scholar
Furedi, F. (1997) Culture of Fear. Risk-Taking and the Morality of Low Expectation. London: Cassell.Google Scholar
Goldman, H., Morrissey, J. & Ridgely, S. (1994) Evaluating the Robert Wood Johnson Foundation Program on Chronic Mental Illness. The Millbank Quarterly, 72, 37–48.CrossRefGoogle Scholar
Hoult, J. (1986) Community care of the acutely mentally ill. British Journal of Psychiatry, 149, 137–144.CrossRefGoogle ScholarPubMed
Johnson, S., Pressor, D., Bindman, J., et al (1997a) Continuity of care for the severely mentally ill: concepts and measures. Social Psychiatry and Psychiatric Epidemiology, 32, 137–142.Google Scholar
Johnson, S., Ramsay, R., Thornicroft, G., et al (1997b) London's Mental Health. London: King's Fund.Google Scholar
Johnson, S., Leese, M., Brooks, L., et al (1998) Frequency and predictors of adverse events. PRiSM Psychosis Study 3. British Journal of Psychiatry, 173, 376–384.Google Scholar
Kassirer, J. P. (1993) Clinical trials and meta-analysis. What do they do for us? New England Journal of Medicine, 327, 273–274.Google Scholar
Kemp, R., Hayward, P., Applewhaite, G., et al (1996) Compliance therapy in psychotic patients: a randomized controlled trial. British Medical Journal, 312, 345–349.CrossRefGoogle Scholar
Kluiter, H. (1997) In-patient treatment and care arrangements to replace or avoid it - searching for an evidence-based balance. Current Opinion in Psychiatry, 10, 160–167.Google Scholar
Knapp, M. (1995) Community mental health services: towards an understanding of cost-effectiveness. In Community Psychiatry in Action: Analysis and Prospects. (eds Creed, F. & Tyrer, P.). Cambridge: Cambridge University Press.Google Scholar
Kuhn, T. S. (1962) The Structure of Scientific Revolutions. Chicago: University of Chicago Press.Google Scholar
Leff, J. (1993) Evaluating the transfer of care from psychiatric hospitals to district-based services. British Journal of Psychiatry, 162 (suppl. 19). 6.CrossRefGoogle Scholar
Lelliot, P., Audini, B. & Darroch, N (1995) Resolving London's bed crisis: there might be a way, is there the will? Psychiatric Bulletin, 19, 273–275.CrossRefGoogle Scholar
Light, D. W. (1991) Effectiveness and efficiency under competition: the Cochrane test. British Medical Journal, 303, 1253–1254.CrossRefGoogle ScholarPubMed
McCrone, P., Thornicroft, G., Phelan, M., et al (1998) Utilisation and costs of community mental health services. PRiSM Psychosis Study 5. British Journal of Psychiatry, 173, 391–398.CrossRefGoogle ScholarPubMed
McNaught, A. S., Jeffreys, S. E., Harvey, C. A., et al (1997) The Hampstead schizophrenia survey 1991. II: Incidence and migration in inner London. British Journal of Psychiatry, 170, 307–311.Google Scholar
Mari, J. & Streiner, D. (1996) Family Interventions for those with Schizophrenia. The Cochrane Library. London: BMJ Publications.Google Scholar
Marshall, M. (1996) Cose Management for People with Severe Mental Disorders. The Cochrane Library. London: BMJ Publications.Google Scholar
Martin, L. (1984) Hospitals in Trouble. Oxford: Blackwell.Google ScholarPubMed
Mueser, K., Bond, G., Drake, R., et al (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. M., Connolly, J., et al (1992) The Daily Living Programme: Preliminary comparison of community versus hospital-based treatment for the seriously mentally ill facing emergency admission. British Journal of Psychiatry, 160, 379–384.CrossRefGoogle ScholarPubMed
Parkman, S., Davies, S., Leese, M., et al (1997) Ethnic differences in satisfaction with mental health services among representative people with psychosis in South London: PRiSM Study 4. British Journal of Psychiatry, 171, 260–264.CrossRefGoogle ScholarPubMed
Sackett, D., Rosenberg, W., Muir Gray, J., et al (1996) Evidence based medicine: what it is and what it isn't. British Medical Journal, 312, 71–72.Google Scholar
Sartorius, N., Jablensky, A., Korten, A., et al (1986) Early manifestations and first-contact incidence of schizophrenia in different cultures. Psychological Medicine, 16, 909–928.CrossRefGoogle ScholarPubMed
Sayce, L., Craig, T. K. J. & Boardman, A. P. (1991) The development of Community Mental Health Centres in the United Kingdom. Social Psychiatry and Psychiatric Epidemiology, 26, 14–20.Google Scholar
Sledge, W., Tebes, J., Rakfeldt, J., et al (1996) Day hospital/crisis respite care inpatient care: part I - clinical outcomes. American Journal of Psychiatry, 153, 1065–1073.Google ScholarPubMed
Stein, L. I. & Test, M. A. (1980) Alternative to mental hospital treatment. Archives of General Psychiatry, 37, 392–397.Google Scholar
Sytema, S., Micciolo, R. & Tansella, M. (1997) Continuity of care for patients with schizophrenia and related disorders: a comparative South-Verona and Groningen case register study. Psychological Medicine, 27, 1355–1362.Google Scholar
Tansella, M. & Thornicroft, G. (1998) A conceptual framework for mental health services: the Matrix Model. Psychological Medicine, 28, 503–508.Google Scholar
Thornicroft, G., Strathdee, G., Phelan, M., et al (1998) Rationale and design. PRiSM Psychosis Study I. British Journal of Psychiatry, 173, 363–370.CrossRefGoogle ScholarPubMed
Tyrer, P., Morgan, J., Van Horn, E., et al (1995) A randomised controlled study of close monitoring of vulnerable psychiatric patients. Lancet, 345, 756–759.CrossRefGoogle ScholarPubMed
Warner, R. (1994) Recovery from Schizophrenia. London: Routledge.Google Scholar
Warr, P. (1987) Work, Unemployment and Mental Health. Oxford: Oxford University Press.Google Scholar
Wing, J., (ed.) (1989) Health Services Planning and Research. Contributions from Psychiatric Case Registers. London: Gaskell.Google Scholar
Wykes, T., Leese, M., Taylor, R., et al (1998) Effects of community services on disability and symptoms. PRiSM Psychosis Study 4. British Journal of Psychiatry, 173, 385–390.Google Scholar
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