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International differences in home treatment for mental health problems

Results of a systematic review

St George's Hospital Medical School London, UK

MARTIN KNAPP, PhD

London School of Economics and Institute of Psychiatry, London, UK

JULIET HENDERSON, BA(Hons)

London School of Economics, London, UK

Correspondence: Jocelyn Catty, Research Fellow, Social and Community Psychiatry, St George's Hospital Medical School, Jenner Wing, Cranmer Terrace, London SW17 0RE, UK. Tel: 020 8725 3489; fax: 020 8725 3538; e-mail: jcatty{at}sghms.ac.uk

Declaration of interest None.

Background It is perceived that North American home treatment studies reveal greater success in reducing days in hospital than do European studies. There are difficulties in extrapolating findings internationally.

Aims We aimed to determine whether North American studies find greater reductions in days in hospital and whether experimental service patients in North American studies spend less time in hospital.

Method The results of a systematic review were analysed with respect to study location. Service components ascertained through follow-up were utilised to interpret the meta-analyses conducted.

Results Most of the 91 studies found were from the USA and UK. North American studies found a difference of one hospital day (per patient per month) more than European studies but there was no difference in experimental data between the two locations.

Conclusions North American studies demonstrate greater differences in days in hospital but patients in their experimental services seem to spend no fewer days in hospital, implying a disparity in control services.

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