Comparison of community based service with hospital based service for people with acute, severe psychiatric illness

Abstract

Objective - To compare the burden on relatives and outcome of people treated for severe acute psychiatric illness by a community service and a traditional hospital based service. Design - Follow up of patients aged 16-65 who required admission to hospital or home treatment for psychiatric illness during January 1990 to February 1991. Setting - Two Birmingham electoral wards, Sparkbrook and Small Health; Sparkbrook has a community based service and Small Heath a traditional hospital based service. Subjects - 69 patients from Sparkbrook and 55 from Small Heath. Main outcome measures - Scores on present state examination, social behaviour assessment schedule, and general health questionnaire. Results - 24 (35%) of Sparkbrook patients received some treatment in hospital during the initial assessment than relatives of Small Heath patients (mean score 0.11 v 0.29, p < 0.01). Relatives were also more satisfied with the support they received and the treatment received by patients. More patients from Sparkbrook than Small Heath were in contract with a psychiatrist (81% (95% confidence interval 71% to 91%) v 62% (44% to 68%)) and community nurse (56% (44% to 68%) v 14% (13% to 24%)) one year after the initial episode. Sparkbrook patients spent significantly fewer days in hospital during the initial episode (8 days v 59 days) and the first year (20.6 v 67.9 days). Conclusion - The community based service is as effective as the hospital based service and is preferred by relatives. It is more effective in keeping people in long term contact with psychiatrists.