New Research Suggests Compulsory Community Treatment Doesn't Work, UK

Main Category: Mental Health
Also Included In: Psychology / Psychiatry
Article Date: 01 Nov 2007 - 1:00 PDT

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An editorial in the November 2007 issue of the British Journal of Psychiatry highlights 2 recent studies from Australia - as well as a systematic review of existing research - which have found that compulsory community treatment for people with mental disorders is unlikely to reduce 'revolving door' care.

In Britain the government has included supervised community treatment in the new Mental Health Act (2007) to address the issue of the 'revolving door'. This new research casts doubt on the effectiveness of the policy.

The clearest indicator of whether compulsory community treatment helps revolving door patients is the number of days spent in hospital (bed-days), rather than admissions. Compulsory or supervised community treatment can only be the least restrictive alternative if people spend less time in hospital.

2 recent population studies based on the Victorian Psychiatric Case Register in Australia, as well as a systematic review of all previous research (5 studies) using properly matched or randomised controls, have failed to show a significant reduction in bed-days between patients receiving compulsory community treatment and controls.

The authors of the editorial conclude that there is limited evidence that compulsory community treatment will address the issue of the 'revolving door', at least in the short term, even though this is the Department of Health's main justification for supervised community treatment in England and Wales (Department of Health, 2006).

This finding illustrates how health policy remains determined by social or political factors as much as by evidence, they say.

At the very least, researchers, funding bodies and policy makers should collaborate in evaluating the effects of the proposed legislation.

Studies should ideally include a range of patient, family and health service outcomes using mixed methods, rather than focus on admission rates and lengths of stay in hospital.

In the meantime, the authors add, it might be more appropriate to acknowledge openly the limits of our knowledge, rather than rely on the illusion that evidence exists.

Royal College of Psychiatrists

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