Modern Community Care – What do we know that is effective?
DOI:
https://doi.org/10.25752/psi.4010Keywords:
Community Psychiatry, Mental Health Services, Assertive Community Treatment.Abstract
Community care has been seen a remarkable expansion in research in the last thirty years. Such research is beset with difficulties including fixing models long enough to get clear comparisons, the absence of consistency in description (particularly of comparator services) and the inevitable contamination from the ‘Pioneer’ effect of highly motivated teams. Assertive Community Treatment (ACT) teams are the most intensively researched but the evidence is contradictory. ACT is a complex intervention and a meta‐regression analysis is reported here that distinguished between the studies in terms of their component parts to identify effective and redundant ingredients. This analysis clari‐ fied the overwhelming impact of variation in comparator services. It also confirmed that the core ingredients in traditional generic CMHTs (multidisciplinary working, home‐based care and combined health and social care) ensured an equally effective outcome to the more intensively staffed and carefully prescribed ACT teams. Community mental health services need not follow one prescriptive model. Developing local services should be guided by the research into how effective aspects of care can be in‐ corporated into locally meaningful structures rather than importing complex systems from other health care cultures.Downloads
Published
Issue
Section
License
Articles are published under the license CC-BY-3.0 by Creative Commons, in full open-access, without any cost or fees of any kind to the author or the reader. In this scheme, the authors retain copyright and grant the journal right of first publication, allowing the free sharing of work, provided it is correctly attributed the authorship and initial publication in this journal. Readers and end-users are allowed to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship. The authors are permitted to take on additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, post it to an institutional repository or as a book), with an acknowledgment of its initial publication in this journal. Authors are permitted and encouraged to publish and distribute their work online (eg, in institutional repositories or on their website) as it can lead to productive exchanges, as well as increase the impact and citation of published work.