Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality

Abstract

Background Closure of asylums and institutions for the mentally ill, coupled with government policies focusing on reducing the number of hospital beds for people with severe mental illness in favour of providing care in a variety of non-hospital settings, underpins the rationale behind care in the community. A major thrust towards community care has been the development of community mental health teams (CMHT). Objectives To evaluate the effects of community mental health team (CMHT) treatment for anyone with serious mental illness compared with standard non-team management. Search methods We searched The Cochrane Schizophrenia Group Trials Register (March 2006). We manually searched the Journal of Personality Disorders, and contacted colleagues at ENMESH, ISSPD and in forensic psychiatry. Selection criteria We included all randomised controlled trials of CMHT management versus non-team standard care. Data collection and analysis We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a fixed effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a fixed effects model. Main results CMHT management did not reveal any statistically significant difference in death by suicide and in suspicious circumstances (n=587, 3 RCTs, RR 0.49 CI 0.1 to 2.2) although overall, fewer deaths occurred in the CMHT group. We found no significant differences in the number of people leaving the studies early (n=253, 2 RCTs, RR 1.10 CI 0.7 to 1.8). Significantly fewer people in the CMHT group were not satisfied with services compared with those receiving standard care (n=87, RR 0.37 CI 0.2 to 0.8, NNT 4 CI 3 to 11). Also, hospital admission rates were significantly lower in the CMHT group (n=587, 3 RCTs, RR 0.81 CI 0.7 to 1.0, NNT 17 CI 10 to 104) compared with standard care. Admittance to accident and emergency services, contact with primary care, and contact with social services did not reveal any statistical difference between comparison groups. Authors’ conclusions Community mental health team management is not inferior to non-team standard care in any important respects and is superior in promoting greater acceptance of treatment. It may also be superior in reducing hospital admission and avoiding death by suicide. The evidence for CMHT based care is insubstantial considering the massive impact the drive toward community care has on patients, carers, clinicians and the community at large.

Effectiveness of Integrated Care Including Therapeutic Assertive Community Treatment in Severe Schizophrenia Spectrum and Bipolar I Disorders

“…1 It is particularly concerning that patients with schizophrenia spectrum disorders and bipolar disorders tend to have high rates of nonadherence and service disengagement varying between 23% and 30% even in specialized early psychosis programs. 2,3 Various diagnosis-nonspecific outpatient care models have been developed to treat patients with severe mental illness (eg, community mental health teams, 4 intensive case management, 5 and assertive community treatment). [6][7][8][9] Most previous assertive community treatment studies 10 have included patients with various psychiatric disorders.…”

People Living in Community with a Severe Mental Illness: Utilization and Satisfaction with Care and Support

“…Studies comparing satisfaction with different treatment models in psychiatric services have shown greater satisfaction with assistance provided by community mental health teams as compared to standard care (Malone et al, 2010). However, no studies have been found to focus on satisfaction with care received from different service providers by people with SMI living in a community.…”

Ação dos profissionais de um centro de atenção psicossocial diante de usuários com tentativa e risco de suicídio

“…From this perspective, it appears that hospital admissions can be avoided provided there is a service that respects and responds to the specific needs of these individuals. 11 The following statements illustrate the accurate and contextualized perception of the teams regarding the suicide attempts, which underline the importance of interdisciplinary work, bringing health interventions closer to the experienced reality.…”

“…Therefore, a partnership must be established between the subject, their family and the professional, considering that this rehabilitation process also involves the local community. [7][8][9][10][11][12][13][14][15] To achieve this, the professionals reported an extremely important component, the construction or recovery of attachment, both with the client as well as with their relatives, in this specific time of psychological suffering, as can be observed in the following statements:…”

“…However, when the individual who attempted to harm themselves has already received primary health care in his/ her community, the length of stay in the hospital can be reduced, 11 which means that the health interventions performed by the team necessitate reestablishing the person with mental suffering into their community setting in a humanized and holistic way.…”