Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality.
BACKGROUND
Closure of asylums and institutions for the mentally ill, coupled with government policies focusing on reducing the number of hospital beds for people with severe mental illness in favour of providing care in a variety of non-hospital settings underpins the rationale behind care in the community. A major thrust towards community care has been the development of community mental health teams (CMHT).


OBJECTIVE
To evaluate the effects of community mental health team (CMHT) treatment for anyone with serious mental illness.


METHODS
Electronic searches of Biological Abstracts (1982-1997), the Cochrane Library (1998, Issue 2), EMBASE (1980-1997), MEDLINE (1966-1997), PsycLIT (1974-1997) and SCISEARCH (1997) were undertaken. The Journal of Personality Disorders was hand searched, and contact was made with colleagues at ENMESH, ISSPD and in forensic psychiatry.


METHODS
All randomised or quasi-randomised controlled trials of CMHT management versus non-team standard care.


METHODS
The selection of trials, assessment of quality and data extraction was undertaken independently and in parallel by two reviewers. Where possible the data were entered into RevMan and an intention-to-treat analysis undertaken. Tests of heterogeneity were undertaken.


RESULTS
CMHT management may be associated with fewer deaths by suicide and in suspicious circumstances (OR 0.32 CI 0.09-1.12). It causes less people to be dissatisfied with their care (OR 0.34 CI 0.2-0.59) and to leave the studies early (OR 0.61 CI 0.45-0.83). No clear difference was found in admission rates, overall clinical outcomes and duration of in-patient hospital treatment, although this was partly a consequence of poorly presented data.


CONCLUSIONS
Community mental health team management is not inferior to non-team standard care in any important respects and is superior in promoting greater acceptance of treatment. It may also be superior in reducing hospital admission and avoiding death by suicide.
Tyrer
P
P
Paterson Centre, 20 South Wharf Road, Paddington, London, UK, W2 1PD. p.tyrer@ic.ac.uk
Coid
J
J
Simmonds
S
S
Joseph
P
P
Marriott
S
S
D003156:Community Mental Health Services; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D010348:Patient Care Team; D010554:Personality Disorders / Q000628:therapy*