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The British Journal of Psychiatry 173: 376-384 (1998)
© 1998 The Royal College of Psychiatrists

Frequency and predictors of adverse events. PRiSM Psychosis Study. 3

S Johnson, M Leese, L Brooks, P Clarkson, H Guite, G Thornicroft, F Holloway and T Wykes
Department of Psychiatry and Behavioural Sciences, University College London Medical School.

BACKGROUND: Community care has been criticised as a hazardous policy associated with high rates of adverse events. There is little research evidence as to the truth of this claim. METHOD: Best available evidence from public records, interviews, case notes, key workers and general practitioners was assembled to establish: (a) which of the 514 subjects initially identified as having psychotic illnesses had died during an average follow-up of 4.9 years; (b) care currently received by all 286 subjects originally selected for interview; and (c) rates of major adverse events and of admission for these 286 individuals. RESULTS: Twenty-eight natural and II unnatural deaths had occurred. Among subjects still living at the end of the follow-up, 84% were in contact with specialist mental health services and 11% only with primary care services. Rates of serious violence, imprisonment and homelessness were relatively low. Forty-one per cent had been admitted at least once during a mean follow-up of 3.2 years and 20% at least once under the Mental Health Act. After adjustment, there were no significant differences between standard and intensive care sectors. CONCLUSIONS: Rates of adverse events and 'slipping through the net' are relatively low among individuals receiving community-based services, whether intensive or standard care.


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