Community Care of the Acutely Mentally Ill

Abstract

Deinstitutionalisation is a two-part process: the first involves discharging patients from hospital to the community, which has been done in many countries. The second part—the provision of adequate resources for good community care—has still to materialise almost everywhere. In New South Wales, the inpatient mental hospital population dropped by two-thirds in 20 years, yet the total number of hospital staff increased considerably during this time; on the other hand, in the community, where most of the patients are, there are relatively few staff. This has important consequences: it means that for many patients, their episode of illness has to progress unchecked until it is of sufficient severity for them to be admitted to hospital. When that happens, there will then be enough staff to give them good quality care, so that their symptoms can subside, but afterwards there will again be hardly anyone available to help maintain them and to prevent relapse.

Availability and acceptability of home treatment for acute psychiatric disorders

“…The team might make several visits per day to patients who otherwise would have been admitted to hospital, continuing the intensive support for the duration of the crisis (Hoult, 1986).…”

Community treatment teams in New Zealand – are they suitable for Britain?

“…There is a paucity of research on extended hours services and community treatment teams but Stein & Test (1980) and Hoult ( 1986)show clinical and social outcomes by this mode of community treatment are as good as, or better than, outcomes achieved by hospital treatment and traditional follow-up. Their work has deficiencies and its critics (Tantam, 1985).…”

“…In early 1988 the Extended Hours Team (EHT) was born. It is based on the model used in North Sydney, Australia (Hoult, 1986) and Madison, Wisconsin (Stein & Test, 1980). At the time of conception of the EHT, cost cutting was the rule which led to a diffi cult gestation but a surprisingly easy delivery and subsequent development over the first year.…”

Community Treatment Orders in Victoria, Australia

“…This is composed of psychiatric hospitals, units in general hospitals and community mental health clinics. In recent years mobile Community Assessment and Treatment Teams have been established along previously described models (Stein & Test, 1980;Hoult, 1986). The aim of these teams is both the treatment of the acute episode in the community with avoidance of hospitalisation and the follow-up of patients who have previously had relapsing conditions.…”