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From efficacy to effectiveness in community mental health services

PRiSM Psychosis Study 10

Published online by Cambridge University Press:  02 January 2018

Graham Thornicroft ,
Til Wykes ,
Frank Holloway ,
Sonia Johnson  and
George Szmuckler
Graham Thornicroft*
Affiliation:
Section of Community Psychiatry (PRiSM), Institute of Psychiatry, London
Til Wykes
Affiliation:
Department of Psychology, Institute of Psychiatry, London
Frank Holloway
Affiliation:
Maudsley Hospital, Denmark Hill, London
Sonia Johnson
Affiliation:
Department of Psychiatry & Behavioural Sciences, University College London Medical School, London
George Szmuckler
Affiliation:
Section of Community Psychiatry (PRiSM), Institute of Psychiatry, London
*
Professor Graham Thornicroft, Section of Community Psychiatry (PRiSM), Institute of Psychiatry, De Crespigny Park, London SE5 8AF. Tel: 0171 919 2610; Fax: 0171 277 1462
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Abstract

Background

The PRiSM Psychosis Study investigated the outcomes of community mental health services for epidemiologically representative cases of psychosis in London.

Method

The results presented in the preceding nine papers are interpreted.

Results

(a) The health and social gains reported in experimental studies of community health services are replicable in ordinary clinical settings, and are more effective than hospital-oriented services which they replace, (b) Dilution does occur - these gains are less pronounced than in experimental (efficacy) studies, (c) Both models of community services produced a range of improved outcomes, (d) Some limited extra advantages (in terms of met needs, improved quality of life, and social networks) were found in the intensive sector, (e) There is no consistent evidence that community-oriented services (which include in-patient beds) fail service users, their families or the wider public. On balance the results weigh slightly in favour of the two-team model (for acute and continuing care) in terms of clinical effectiveness, but the general model is almost as effective and is less expensive.

Conclusions

The evidence supports a community-oriented rather than a hospital-oriented approach and there is little difference between the community mental health team models.

Type
PRiSM Psychosis Study
Information
The British Journal of Psychiatry , Volume 173 , Issue 5 , November 1998 , pp. 423 - 427
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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