Balancing hospital and community treatment: effectiveness of an extended-hours community mental health team in a semi-rural region of australia.
OBJECTIVE
To examine the effectiveness of the introduction of a community mental health team on consumer psychosocial outcomes.


METHODS
Longitudinal panel design.


METHODS
District general hospital in a semi-rural region of Australia.


METHODS
Two matched groups (n = 37 in each group)


METHODS
These included: Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), Rosenberg Self-Esteem, Life Skills Profile as well as self-report.


RESULTS
The study found that the introduction of the new service resulted in few significant differences in consumer outcomes.


CONCLUSIONS
The paper argues that because the state was the only specialist mental health service provider and it was unable to offer assertive community treatment, hospital care remained central. Evidence that a substantial proportion of consumers and carers preferred hospital to community care is placed against this background. The paper argues that in regions like these, where community-based services are likely to remain underdeveloped, it may be best to maintain quality hospital services and to target community services more precisely on what is achievable rather than developing community services at the expense of hospital care.


BACKGROUND
Studies on the efficacy of assertive community treatment suggest that it can lead to improved consumer outcomes. However, these studies are usually in urban settings and involve experimental teams. In many rural and regional areas community treatment teams offer standard rather than assertive community care. It is therefore important to investigate the effectiveness of community treatment teams in rural and regional Australia.


CONCLUSIONS
This study suggests that in rural and regional areas characterised by limited resources, it is too much to expect community treatment teams to have a measurable impact on consumer outcomes. In these settings hospital care remains at the heart of the service. This means that regions such as these need to focus their community services on what is achievable given the level of resources and social ecology. For example, they may need to consider offering either crisis intervention or rehabilitation services and to rely on innovations, such as telehealth or strategic alliances with other service providers to fill the gap.
Habibis
Daphne
D
School of Sociology and Social Work, University of Tasmania, Tasmania, Australia.
Hazelton
Mike
M
Schneider
Rosemary
R
Davidson
John
J
Bowling
Alison
A
D001294:Attitude to Health; D019090:Case Management / Q000458:organization & administration; D003156:Community Mental Health Services / Q000458:organization & administration*; D003159:Community-Institutional Relations; D003419:Crisis Intervention / Q000458:organization & administration; D006302:Health Services Research; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D008137:Longitudinal Studies; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D015397:Program Evaluation; D011569:Psychiatric Status Rating Scales; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration*; D012649:Self Concept; D013648:Tasmania; D013997:Time Factors