Day hospital versus admission for acute psychiatric disorders

Marshall, Max; Crowther, Ruth; Almaraz-Serrano, AM; Creed, F.; Sledge, William H.; Kluiter, H.; Roberts, Chris; Hill, Elizabeth; Wiersma, Durk

doi:10.1002/14651858.cd004026

Cited by 59 publications

(69 citation statements)

References 98 publications

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“…59 This has led to the development of transition-focused interventions, several of which embed recovery principles in the use of peer support and the emphasis on community engagement, 60,61 or in the use of rehabilitation-focused partial hospitals that facilitate earlier discharge and reduce admissions. 62 Such interventions show considerable promise in reducing rates of rehospitalization and improving community participation. 63 However, should hospitals more effectively engage in efforts toward mental health reform, the challenges of transition out of hospital may be considerably reduced.…”

Section: Locating the Ward In A Recovery-oriented Systemmentioning

confidence: 99%

Mental Health Reform at a Systems Level: Widening the Lens on Recovery-Oriented Care

2014

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This paper is an initial attempt to collate the literature on psychiatric inpatient recoverybased care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recoveryoriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada. W W W Réforme de la santé mentale au niveau des systèmes : élargir nos vues sur les soins orientés vers le rétablissementCet article est une première tentative de colliger la littérature sur les soins axés sur le rétablissement de patients psychiatriques hospitalisés et, plus généralement, de situer le secteur des soins des patients hospitalisés dans le dialogue sur la réforme de la santé mentale qui, jusqu'ici, a porté presque exclusivement sur les pratiques ambulatoires et communautaires. Nous alléguons que jusqu'à ce qu'une base de données probantes soit établie pour les pratiques axées sur le rétablissement dans les services d'hospitalisation, les efforts en vue d'améliorer les systèmes axés sur le rétablissement stagneront. Notre étude de portée a été menée conformément aux lignes directrices des éléments de rapport préférentiels pour les revues systématiques et les méta-analyses de 2009 (PRISMA). Sur les 27 articles sélectionnés pour la revue, la plupart étaient des études descriptives ou de résultats non contrôlés. Les études abordant les stratégies d'amélioration de la qualité des soins offrent une évidence modeste pour le dialogue réflectif avec d'anciens patients hospitalisés, le jeu de rôle et le mentorat, et le jumelage de la formation générale en soins axés sur le rétablissement avec la formation en interventions spécifiques, comme le programme de prise en charge de la maladie et de rétablissement. En ce qui concerne d'autres domaines de la médecine, l'évidence à la question des soins axés sur le rétablissement dans les services d'hospitalisation et à la manière de les mettre en oeuvre est sous-développée. L'attention portée à...

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Section: Locating the Ward In A Recovery-oriented Systemmentioning

confidence: 99%

Mental Health Reform at a Systems Level: Widening the Lens on Recovery-Oriented Care

2014

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“…3 Additionally, home treatment is generally preferred by patients. 2 Similarly, we know that certain carefully selected individuals with severe mental illness improve more quickly in a day hospital than if cared for as an in-patient 4 and that acute day hospitals provide greater patient satisfaction than in-patient care, at least in the short-term. 5 One of Marshall's 6 proposals for developing day hospital care was to combine it with outreach services for people who fail to attend.…”

Section: Discussionmentioning

confidence: 99%

Local implementation of the crisis model: the Buckinghamshire community acute service

2009

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Aims and MethodBuckinghamshire crisis and home treatment team was struggling to meet its commissioned care episodes and found itself detached from community mental health teams (CMHTs) and acute day hospitals. An operations management consultant, using ‘lean’ principles developed in industry, worked alongside staff to redesign the service.ResultsImprovements in staff capacity and ability contributed to more care episodes and reduced ward-stay times, compensating for the impact of a ward closure. Re-examination of individuals needs through case-review led to the development of ‘patient typing’, facilitating clear care pathways according to need. Finally, two proven modalities of community-based service were fused together.Clinical ImplicationsPlacing value to patients, carers and referrers ahead of old demarcations and practices has enabled a more flexible and responsive service to develop and grow.

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“…ADC is a less restrictive alternative to in-patient admission for people who are acutely mentally ill. ACD delivers personalised, intensive and structured acute health care interventions outside the hospital setting. A recent systematic review 26 concluded that ADC is at least as effective as traditional methods and provides a suitable option in situations where demand for in-patient care is high and facilities exist that can be converted to these uses. However, it is less attractive where the demand for in-patient care is low and can be covered by other options.…”

Section: Alternatives To Acute In-patient Carementioning

confidence: 99%

“…However, it is less attractive where the demand for in-patient care is low and can be covered by other options. 26 Another study 27 indicated that ADC was more useful for female, educated patients with moderate to severe symptoms than those with the most severe symptoms (regardless of gender and education), who may benefit from acute hospital care. Because of the high demand for beds in the Western Sydney LHD, ADC services could be a beneficial addition to services in the area, diverting demand from overstretched (and more expensive) acute inpatient services.…”

Section: Alternatives To Acute In-patient Carementioning

confidence: 99%

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

Fernández

Gillespie

Smith‐Merry

et al. 2017

Aust. Health Review

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Objective Australian mental health care remains hospital centric and fragmented; it is riddled with gaps and does little to promote recovery. Reform must be built on better knowledge of the shape of existing services. Mental health atlases are an essential part of this knowledge base, enabling comparison with other regions and jurisdictions, but must be based on a rigorous classification of services. The main aim of this study is to create an integrated mental health atlas of the Western Sydney LHD in order to help decision makers to better plan informed by local evidence. Methods The standard classification system, namely the Description and Evaluation of Services and Directories in Europe for Long-term Care model, was used to describe and classify adult mental health services in the Western Sydney Local Health District (LHD). This information provided the foundation for accessibility maps and the analysis of the provision of care for people with a lived experience of mental illness in Western Sydney LHD. All this data was used to create the Integrated Mental Health Atlas of Western Sydney LHD. Results The atlas identified four major gaps in mental health care in Western Sydney LHD: (1) a lack of acute and sub-acute community residential care; (2) an absence of services providing acute day care and non-acute day care; (3) low availability of specific employment services for people with a lived experience of mental ill-health; and (4) a lack of comprehensive data on the availability of supported housing. Conclusions The integrated mental health atlas of the Western Sydney LHD provides a tool for evidence-informed planning and critical analysis of the pattern of adult mental health care. What is known about the topic? Several reports have highlighted that the Australian mental health system is hospital based and fragmented. However, this knowledge has had little effect on actually changing the system. What does this paper add? This paper provides a critical analysis of the pattern of adult mental health care provided within the boundaries of the Western Sydney LHD using a standard, internationally validated tool to describe and classify the services. This provides a good picture of the availability of adult mental health care at the local level that was hitherto lacking. What are the implications for practitioners? The data presented herein provide a better understanding of the context in which mental health practitioners work. Managers and planners of services providing care for people with a lived experience of mental illness can use the information herein for better planning informed by local evidence.

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Day hospital versus admission for acute psychiatric disorders

Cited by 59 publications

References 98 publications

Mental Health Reform at a Systems Level: Widening the Lens on Recovery-Oriented Care

Mental Health Reform at a Systems Level: Widening the Lens on Recovery-Oriented Care

Local implementation of the crisis model: the Buckinghamshire community acute service

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

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