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Home-Based Versus Out-Patient/In-Patient Care for People with Serious Mental Illness

Phase II of a Controlled Study

Published online by Cambridge University Press:  02 January 2018

B. Audini ,
I. M. Marks ,
R. E. Lawrence ,
J. Connolly  and
V. Watts
B. Audini
Affiliation:
Research Unit, Royal College of Psychiatrists
I. M. Marks*
Affiliation:
Institute of Psychiatry and Bethlem-Maudsley Hospital
R. E. Lawrence
Affiliation:
West Lambeth Community Care Trust, London
J. Connolly
Affiliation:
Bethlem-Maudsley Hospital
V. Watts
Affiliation:
Maudsley Hospital, London
*
Professor I. M. Marks, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF
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Abstract

Background.

The effect of a randomised controlled withdrawal of home-based care was studied for half of a sample of seriously mentally ill (SMI) patients from an inner London catchment area, compared with the effects of continuing home-based care.

Method.

Patients, aged 18–64, had entered the trial at month 0 when facing emergency admission for SMI. After at least 20 months home-based care (Phase I), patients were randomised at month 30 into Phase II (months 30–45) to have either further home-based care (DLPII, n = 33) or be transferred to out-/in-patient care (DLP-control, n = 33). They were assessed at 30, 34, and 45 months. Phase I control patients (n = 10) were assessed again at month 45. Measures used were number and duration of in-patient admissions, independent ratings of clinical and social function, and patients' and relatives' satisfaction.

Results.

The slim clinical and social gains from home-based v. out-/in-patient care during Phase I were largely lost in Phase II. Duration of crisis admissions increased from Phase I to Phase II in both DLPII and DLP-control patients. During Phase II, patients' and relatives' satisfaction remained greater for home-based than out-/in-patient care patients. At 45 months, compared with the Phase I controls, DLPII patients and relatives were more satisfied with care. Such satisfaction was independent of clinical/social gains.

Conclusions.

The loss of Phase I gains were perhaps due to attenuation of home-based care quality and to benefits of Phase I home-based care lingering into Phase II in DLP-controls. The Phase II home-based care team suffered from low morale.

Type
Papers
Information
The British Journal of Psychiatry , Volume 165 , Issue 2 , August 1994 , pp. 204 - 210
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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