Background. There has been a widespread development of
aimed to deliver coordinated comprehensive mental health care, yet there
little published evidence
on the quality of care and economics of providing such care for
people with severe mental illness.
Method. This is a clustered randomized controlled economic
comparison of the quality of care for
patients with chronic schizophrenia by a multi-disciplinary community team
with close links with
primary care, and a traditional psychiatric service in a
district general hospital psychiatric unit.
Results. Two years after it was established, patients with
to the community team had more
of their needs met; they had fewer unmet needs; and they were more satisfied
with the care they had
received. They had more service contacts and received more interventions.
The community team
resulted in savings in the use of some hospital resources but these were
not sufficient to offset the
cost of the new service. The community team successfully directed care
patients with more needs,
whereas no such relationship was evident for the traditional hospital-based
service. Four years after
the team was established, it met a greater proportion of needs for
underactivity, daily living skills,
use of public amenities and managing finances.
Conclusions. Better quality care was provided at 2 and 4
years after its establishment by the multi-disciplinary community service
than the traditional hospital-based
service. Resources were targeted
more efficiently by the community service.