Overview of the Community Mental Health Centers Program from an evaluation perspective

Dowell, David A.; Ciarlo, James A.

doi:10.1007/bf00877603

Cited by 41 publications

(8 citation statements)

References 46 publications

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“…CMHTs have been criticized for their ambiguous and over-ambitious aims, and their tendency to neglect people with the most challenging health and social care needs (Sayce et al 1991, Patmore & Weaver 1991. This follows similar conclusions from the American community mental health centre movement (Dowel1 & Ciarlo 1983). The preferred solution has been to exhort CMHTs to strengthen their operational management, so that decision-making and the allocation of cases is not left to the predilections of individ-1991, Mental Health Foundation 1994.…”

Section: Introductionsupporting

confidence: 55%

The challenge of managing community mental health teams

Psychol

Standen

2007

Health &Amp; Social Care in the Community

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Although community mental health teams (CMHTs) have become the main vehicle for coordinating health and social care for people with severe and long-term mental health problems, little research exists on their management. This paper reviews the available literature with reference to the wider literature on innovation and organizational behaviour and examines strategies for improving CMHT management at macro and team level. The challenges of researching the topic are described with recommendations for further research based on social constuctivist theorizing and triangulated methodology.

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Section: Introductionsupporting

confidence: 55%

The challenge of managing community mental health teams

Psychol

Standen

2007

Health &Amp; Social Care in the Community

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“…Studies have suggested that CMHT management reduces time spent in hospital (Merson 1992b, Creed 1996) but it is uncertain, however, whether this policy leads to other benefits for seriously mentally ill people. It also remains unclear whether these policies benefit carers and society, particularly with respect to how mentally ill people function or behave in day to day life (Dowell 1993). Other controversies have surrounded the question of the quality of life of people with schizophrenia living in the community.…”

Section: Introductionmentioning

confidence: 99%

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

Malone

Marriott

Newton‐Howes

et al. 2007

Cochrane Database of Systematic Reviews

123

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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.

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“…The evidence from studies of community mental health centers (CMHCs) during the 1970s and early 1980s shows that, although services to the severely mentally ill grew during those years, the growth in service to the severely ill was slower than services to other populations (Dowell and Ciarlo 1989). An analysis of longitudinal data on &dquo;appropriateness&dquo; of hospitalization showed an increase in inappropriate admissions over time (Faden and Goldman 1979).…”

Section: Mental Health Carementioning

confidence: 99%

Incentives, Optimality, and Publicly Provided Goods: the Case of Mental Health Services

Frank

Gaynor

1995

Public Finance Quarterly

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In this article, the authors investigate the incentives present in intergovernment transfers for public mental health care. This represents an important issue because of the large portion of mental health care that is provided by local governments, the central role of states in financing care via intergovernment transfers, and recent innovations adopted by some states altering the traditional terms of these transfers. Using a relatively simple model, the authors show that when a state government provides both financing and a free input into local government production, there will be excessive use of that input. If local government and society differ in their preferences, setting the price of the input at marginal cost will not induce optimal behavior. The optimal prices are proportional to the sum of the elasticities of the provider's expected supply of services with respect to the subsidy (tax). These results are analogous to those for optimal commodity taxation. Examination of the transfer contracts for Wisconsin, Ohio, and for Texas reveals that these contracts may not be optimal. These departures from optimal decisions may be partially due to the practical issues related to implementation of optimal transfer arrangements, such as setting subsidy or tax levels or imposing budget reductions.

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Overview of the Community Mental Health Centers Program from an evaluation perspective

Cited by 41 publications

References 46 publications

The challenge of managing community mental health teams

The challenge of managing community mental health teams

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

Incentives, Optimality, and Publicly Provided Goods: the Case of Mental Health Services

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