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The future of specialist community teams in the care of those with severe mental illness*

Published online by Cambridge University Press:  18 May 2011

Peter Tyrer
Peter Tyrer*
Affiliation:
Department of Psychological Medicine, Division of Neuroscience and Mental Health, Imperial College London (United Kingdom)
*
Address for correspondence: Professor P. Tyrer, The Claybrook Centre, Charing Cross Campus, St. Dunstan's Road, London W6 8RP (United Kingdom). E-mail: P.tyrer@imperial.ac.uk
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Summary

Aims – Specialist interventions in community psychiatry for severe mental illness are expanding and their place needs to be re-examined. Methods – Recent literature is reviewed to evaluate the advantages and disadvantages of specialist teams. Results – Good community mental health services reduce drop out from care, prevent suicide and unnatural deaths, and reduce admission to hospital. Most of these features have been also demonstrated by assertive community outreach and crisis resolution teams when good community services are not available. In well established community services assertive community teams do not reduce admission but both practitioners and patients prefer this service to other approaches and it leads to better engagement. Crisis resolution teams appear to be more successful than assertive community teams in preventing admission to hospital, although head- to-head comparisons have not yet been made. All specialist teams have the potential of fragmenting services and thereby reducing continuity of care. Conclusions – The assets of improved engagement and greater satisfaction with assertive, crisis resolution and home treatment teams are clear from recent evidence, but to improve integration of services they are probably best incorporated into community mental health services rather than standing alone.

Declaration of Interest: The author has been the sole consultant in two assertive outreach teams since 1994 and might there- fore be expected to be in favour of this genre of service. He has received grants for evaluation of different services models from the Department of Health (UK) and the Medical Research Council (UK).

Keywords

community mental health teamscrisis resolutionassertive community treatmentpsychiatric services
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 16 , Issue 3 , September 2007 , pp. 225 - 230
Copyright
Copyright © Cambridge University Press 2007

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Footnotes

*

Based on a paper presented at the XLIV Congresso della Società Italiana di psichiatria in Montesilvano, Italy (15-20 October, 2006).

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