Models of community treatments in schizophrenia: do they travel?
OBJECTIVE
To explore the stability of conclusions from mental health services research across differing care systems. Contradictory results in different countries for similar studies of programmes for patients with schizophrenia have usually been attributed to poor replication. This paper explores whether these differing results can illuminate aspects of schizophrenia by examining the interaction of the disorder with the care context as an alternative explanation.


METHODS
The findings of a large UK random controlled trial of intensive case management with such patients is compared to previous UK and US studies.


RESULTS
Reduction of case-load size of psychotic patients did not significantly reduce their need for hospitalization in the context of locally available co-ordinated care.


CONCLUSIONS
There is more to be gained in understanding complex disorders such as schizophrenia by interpreting the impact of context on treatment study outcomes than by simply dismissing contradictory findings as failures of implementation of either research or clinical practice.
Department of Community Psychiatry, St George's Hospital Medical School, London, UK.
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Burns
D000293:Adolescent; D000328:Adult; D000368:Aged; D019090:Case Management; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000628:therapy*; D016896:Treatment Outcome; D006113:United Kingdom