Home based care and standard hospital care for patients with severe mental illness: a randomised controlled trial.
OBJECTIVE
To compare the efficacy of home based care with standard hospital care in treating serious mental illness.


METHODS
Randomised controlled trial.


METHODS
South Southwark, London.


METHODS
189 patients aged 18-64 living in catchment area. 92 were randomised to home based care (daily living programme) and 97 to standard hospital care. At three months' follow up 68 home care and 60 hospital patients were evaluated.


METHODS
Use of hospital beds, psychiatric diagnosis, social functioning, patients' and relatives' satisfaction, and activity of daily living programme staff.


RESULTS
Home care reduced hospital stay by 80% (median stay six days in home care group, 53 days in hospital group) and did not increase the number of admissions compared with hospital care. On clinical and social outcome there was a non-significant trend in favour of home care, but both groups showed big improvements. On the global adjustment scale home care patients improved by 26.8 points and the hospital group by 21.6 points (difference 5.2; 95% confidence interval -1.5 to 12). Other rating scales showed similar trends. Home care patients required a wide range of support in areas such as housing, finance, and work. Only three patients dropped out from the programme.


CONCLUSIONS
Home based care may offer some slight advantages over hospital based care for patients with serious mental illness and their relatives. The care is intensive, but the low drop out rate suggests appreciation. Changes to traditional training for mental health workers are required.
Muijen
M
M
Institute of Psychiatry, London.
Marks
I
I
Connolly
J
J
Audini
B
B
D000328:Adult; D003156:Community Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D003266:Continuity of Patient Care; D005260:Female; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation / Q000628:therapy*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D011569:Psychiatric Status Rating Scales; D006113:United Kingdom