The association between community mental health nursing and hospital admissions for people with serious mental illness: a systematic review

Abstract

Background: Relapse prevention is an important objective in the management of serious mental illness (SMI). While community mental health nurses (CMHN) might be well-placed to support people with SMI in averting relapse, no systematic reviews have examined this association. Aim: To review the evidence from studies reporting an association between CMHN exposure and hospitalisation of persons living with SMI (a proxy for relapse). Methods: Searches were undertaken in ten bibliographic databases and two clinical trial registries. We included studies of patients with SMI, where CMHN was the exposure, and the outcome was relapse (i.e. readmission to a psychiatric inpatient facility). Quality assessment of included studies was completed using two risk-of-bias measures. Results: Two studies met the inclusion criteria. Studies were rated as being of low-moderate methodological quality. There was insufficient evidence to conclude that community mental health nursing reduced the risk of admission to psychiatric inpatient facilities. Conclusions: The review found no evidence that CMHN was associated with higher or lower odds of admission to psychiatric inpatient facilities among patients with SMI. The findings of the review point to a need for further research to investigate the impact of CMHN exposure and relapse in people with SMI. Systematic review registration: PROSPERO CRD42017058694

Gilles Deleuze's societies of control: Implications for mental health nursing and coercive community care

“…The phenomenon of deinstitutionalisation, instigated by the rise of the mental patients civil rights movement, the mobilisation of mental health advocacy organisations and, to some extent, the rise of neoliberal policies, has contributed to the development of new forms of community-based treatment for people with mental disorders (Nakhost et al, 2018). Several therapeutic approaches and models have emerged in recent decades to enable the care and monitoring of sick people in their own living environment (Leach et al, 2020;Molodynski et al, 2016). These include the assertive community treatment model (ACT; Weinstein et al, 2011) and forensic assertive community treatment (FACT) teams for forensic mental health follow-up (Lamberti et al, 2014;Marquant et al, 2016), which are an increasingly common mechanism in the community.…”

“…The mental health nursing role within these different community teams is central and significant (Cuddeback & Shattell, 2010;Leach et al, 2020;Wallace et al, 2005;Waynor & Dolce, 2015), as it is in compulsory community care (O'Brien et al, 2009;Paradis-Gagné et al, 2021). However, nursing research on issues related to treatment under coercion has been limited, particularly at the theoretical and philosophical levels.…”

The Association between the Mental Health Nurse-to-Registered Nurse Ratio and Patient Outcomes in Psychiatric Inpatient Wards: A Systematic Review

“…One previous systematic review examined the association between mental health-nursing skill mix and relapse [ 27 ]. The review, focused on community mental health nurses and included two studies, involving 356 patients.…”

“…The review, focused on community mental health nurses and included two studies, involving 356 patients. The studies were rated as having a low–moderate risk of bias [ 27 ]. The authors reported that there was not enough evidence to conclude that community mental health nursing reduced the risk of admission to psychiatric inpatient facilities.…”

“…In the [ 27 ] review, admission and not mortality was used as the primary outcome of interest; this is because death is a comparatively rare outcome in mental health settings. Demonstrating an association between skill mix and mortality would require an unfeasibly large sample size.…”