The British Journal of Psychiatry (2009) 195: 109-117. doi: 10.1192/bjp.bp.108.058347
© 2009 The Royal College of Psychiatrists
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REVIEW ARTICLE

Residential alternatives to acute psychiatric hospital admission: systematic review

Brynmor Lloyd-Evans, MSc

Department of Mental Health Sciences, University College London

Mike Slade, PhD

King's College London, Health Services and Population Research Department, Institute of Psychiatry, London

Dorota Jagielska, MA and Sonia Johnson, MD

Department of Mental Health Sciences, University College London, UK

Correspondence: Brynmor Lloyd-Evans, Department of Mental Health Sciences, University College London, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ, UK. Email: b.lloyd-evans{at}ucl.ac.uk

Declaration of interest

None.

Background

Reducing use of hospital wards and improving their quality are central aims of mental health service policy. However, no comprehensive synthesis is available of evidence on residential alternatives to standard acute psychiatric wards.

Aims

To assess the effectiveness and cost-effectiveness of and satisfaction with residential alternatives to standard acute in-patient mental health services.

Method

A systematic search identified controlled studies comparing residential alternatives with standard in-patient services. Studies were described and assessed for methodological quality. Results from higher quality studies are presented and discussed.

Results

Twenty-seven relevant studies were identified. Nine studies of moderate quality provide no contraindication to identified alternative service models and limited preliminary evidence that community-based alternatives may be cheaper and individuals more satisfied than in standard acute wards.

Conclusions

More research is needed to establish the effectiveness of service models and target populations for residential alternatives to standard acute wards. Community-based residential crisis services may provide a feasible and acceptable alternative to hospital admission for some people with acute mental illness.


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