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Home-Based Versus Out-Patient/In-Patient Care for People with Serious Mental Illness

Phase II of a Controlled Study

Published online by Cambridge University Press:  02 January 2018

B. Audini ,
I. M. Marks ,
R. E. Lawrence ,
J. Connolly  and
V. Watts
B. Audini
Affiliation:
Research Unit, Royal College of Psychiatrists
I. M. Marks*
Affiliation:
Institute of Psychiatry and Bethlem-Maudsley Hospital
R. E. Lawrence
Affiliation:
West Lambeth Community Care Trust, London
J. Connolly
Affiliation:
Bethlem-Maudsley Hospital
V. Watts
Affiliation:
Maudsley Hospital, London
*
Professor I. M. Marks, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF
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Abstract

Background.

The effect of a randomised controlled withdrawal of home-based care was studied for half of a sample of seriously mentally ill (SMI) patients from an inner London catchment area, compared with the effects of continuing home-based care.

Method.

Patients, aged 18–64, had entered the trial at month 0 when facing emergency admission for SMI. After at least 20 months home-based care (Phase I), patients were randomised at month 30 into Phase II (months 30–45) to have either further home-based care (DLPII, n = 33) or be transferred to out-/in-patient care (DLP-control, n = 33). They were assessed at 30, 34, and 45 months. Phase I control patients (n = 10) were assessed again at month 45. Measures used were number and duration of in-patient admissions, independent ratings of clinical and social function, and patients' and relatives' satisfaction.

Results.

The slim clinical and social gains from home-based v. out-/in-patient care during Phase I were largely lost in Phase II. Duration of crisis admissions increased from Phase I to Phase II in both DLPII and DLP-control patients. During Phase II, patients' and relatives' satisfaction remained greater for home-based than out-/in-patient care patients. At 45 months, compared with the Phase I controls, DLPII patients and relatives were more satisfied with care. Such satisfaction was independent of clinical/social gains.

Conclusions.

The loss of Phase I gains were perhaps due to attenuation of home-based care quality and to benefits of Phase I home-based care lingering into Phase II in DLP-controls. The Phase II home-based care team suffered from low morale.

Type
Papers
Information
The British Journal of Psychiatry , Volume 165 , Issue 2 , August 1994 , pp. 204 - 210
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Endicott, J., Spitzer, R. L., Fleiss, J. L., et al (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766–771.Google Scholar
Larsen, D. H., Attkison, C. C., Hargreaves, W. A., et al (1979) Assessment of client/patient satisfaction: development of a general scale. Evaluation and Program Planning, 2, 197–207.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799–812.CrossRefGoogle Scholar
Test, M. A., Knoedler, W. H., Allness, D. J., et al (1991) Long-term community care through an assertive continuous treatment team. Advances in Neuropsychiatry, 1, 239–246.Google Scholar
Weissman, M. M., Paykel, E. S., Siegel, R., et al (1971) The social role performance of depressed women: comparisons with a normal group. American Journal of Orthopsychiatry, 41, 390–405.CrossRefGoogle ScholarPubMed
Weissman, M. M., Klerman, G. L., Paykel, E. S., et al (1974) Treatment effects on the social adjustment of depressed patients. Archives of General Psychiatry, 30, 771–778.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
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