Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-02T21:11:00.407Z Has data issue: false hasContentIssue false

Effects of community services on disability and symptoms

PRiSM Psychosis Study 4

Published online by Cambridge University Press:  02 January 2018

Til Wykes*
Affiliation:
Department of Psychology, Institute of Psychiatry, London
Morven Leese
Affiliation:
Section of Community Psychiatry (PRiSM), Institute of Psychiatry, London
Ruth Taylor
Affiliation:
Section of Community Psychiatry (PRiSM), Institute of Psychiatry, London
Michael Phelan
Affiliation:
Charing Cross Hospital, Fulham Palace Road, London
*
Til Wykes, Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF

Abstract

Background

Community care for people with psychosis can be provided via several different service models. The study compared two models: standard community treatment with high patient:staff ratios, and intensive community treatment in which there was more of an emphasis on community involvement and lower patient:staff ratios.

Method

All people fulfilling diagnostic criteria for psychosis and living in two defined geographical areas in south London were identified. These people were provided with either an intensive or standard service depending on their address. Their social behaviour and symptoms were measured at the beginning of the study and after two years.

Results

There is little evidence of any effects of the two service models on levels of symptoms. However, the standard service did seem to be advantageous in reducing social disability for those with medium or low levels of disability.

Conclusions

The effect of intensive community services was the opposite to that predicted. Despite improvements in outcomes (e.g. hospital admission), there were no advantages for this type of service in the measures of disability or symptoms. In fact, the standard service was effective in reducing disability, whereas in the intensive service there was no change.

Type
PRiSM Psychosis Study
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Audini, B., Marks, I. M., Lawrence, R. T., et al (1994) Home-based versus out-patient/in-patient care for people with serious mental illness. Phase II of a controlled study. British Journal of Psychiatry, 165, 204210.CrossRefGoogle ScholarPubMed
Becker, T., Holloway, F., McCrone, P., et al (1998) Evolving service interventions in Nunhead and Norwood. PRiSM Psychosis Study 2. British Journal of Psychiatry, 173, 371375.CrossRefGoogle ScholarPubMed
Bond, G. R., McGrew, J. H. & Feketee, D. M. (1995) Assertive outreach for frequent users of psychiatric services: a meta-analysis. Journal of Mental Health Administration, 22, 416.Google ScholarPubMed
Burns, T., Beadsmore, A., Bhat, A. V., et al (1993) A trial of home-based psychiatric services. I: Clinical and social outcome. British Journal of Psychiatry, 163, 4954.CrossRefGoogle ScholarPubMed
Creed, F. H., Black, D., Anthony, P., et al (1991) Day hospital for acute psychiatric illness. British Medical Journal, 300, 10331037.CrossRefGoogle Scholar
Dean, C. & Gadd, E. (1989) Home treatment service for acute psychiatric illness. British Medical Journal, 301, 10211023.CrossRefGoogle Scholar
Department of Health (1990) Community Care in the Next Decade and Beyond. CM849. London: HMSO.Google Scholar
Endicott, J., Spitzer, R. L., Fleiss, J. L., et al (1976) The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766771.CrossRefGoogle Scholar
Estroff, S., Zimmer, C., Lachicotte, W., et al (1994) The influence of social networks and social support on violence by persons with severe mental illness. Hospital and Community Psychiatry, 45, 669678.Google Scholar
Flannery, R., Hanson, N., Penk, W., et al (1997) Hospital downsizing and patients' assault on staff. Psychiatric Quarterly, 68, 6776.CrossRefGoogle ScholarPubMed
Harvey, C. A. (1996) The Camden schizophrenia surveys. I: The psychiatric, behavioural and social characteristics of the severely mentally ill in an inner London health district. British Journal of Psychiatry, 168, 410417.CrossRefGoogle Scholar
Holloway, F. (1991) Case management for the mentally ill: looking at the evidence. International Journal of Social Psychiatry, 37, 213.CrossRefGoogle ScholarPubMed
Holloway, F. Oliver, N., Collins, E., et al (1995) Case management: a critical review of the outcome literature. European Psychiatry, 10, 113128.CrossRefGoogle ScholarPubMed
Johnson, S., Leese, M., Brooks, L. et al (1998) Frequency and predictors of adverse events. PRiSM Psychosis Study 3. British Journal of Psychiatry, 173, 376384.CrossRefGoogle ScholarPubMed
Leff, J. (1993) The TAPS Project: evaluating community placement of long-stay psychiatric patients. British Journal of Psychiatry, 162 (suppl. 19).Google Scholar
Marshall, M. & Lockwood, A. (1988) Assertive community treatment for people with severe mental disorders. In Cochrane Library, Issue 3. Oxford: Update Software.Google Scholar
Marshall, M. Gray, A., Lockwood, A., et al (1998) Case management for severe mental disorders. In Cochrane Library, Issue 3. Oxford: Update Software.Google Scholar
McGuffin, P., Farmer, A. & Harvey, I. (1991) A polydiagnostic application of operational criteria in studies of psychotic illness: development and reliability of the OPCRIT system. Archives of General Psychiatry, 48, 764770.CrossRefGoogle ScholarPubMed
Muijen, M., Marks, I. M., Connelly, J., et al (1992) Home based care and standard hospital care for patients with severe mental illness: a randomised control trial. British Medical Journal, 304, 749754.CrossRefGoogle Scholar
Mueser, K., Bond, G., Drake, R., et al (1998) Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin, 24, 3774.CrossRefGoogle ScholarPubMed
Thornicroft, G., Strathdee, G., Phelan, M., et al (1998) Rationale and design. PRiSM Psychosis Study I. British Journal of Psychiatry, 173, 363370.CrossRefGoogle ScholarPubMed
Ventura, J., Green, M., Shaner, A., et al (1993) Training and quality assurance with the brief psychiatric rating scale: ‘the drift busters’. International Journal of Methods in Psychiatry, 3, 221244.Google Scholar
Wing, J., Cooper, J. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Illness. Cambridge: Cambridge University Press.Google Scholar
World Health Organization (1992) Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Geneva: WHO. Division of Mental Health.Google Scholar
Wykes, T. (1994) Predicting symptomatic and behavioural outcomes of community care. British Journal of Psychiatry, 165, 486492.CrossRefGoogle ScholarPubMed
Wykes, T. & Sturt, E. (1986) The measurement of social behaviour in psychiatric patients: an assessment of the reliability and validity of the Social Behaviour Schedule. British Journal of Psychiatry, 148, 111.CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.