Do care patterns change over time in a newly established mental health service? A report from the UK700 trial.
OBJECTIVE
Data on the process of mental health care is scant. Most studies focus on services at their inception when activity may be atypical and then usually present data only mean values for the reported variables over the whole study period. We aimed to test whether care delivery changes over time, and to describe any changes at the individual patient and team levels.


METHODS
Process data on 272 patients in three new intensive case management (ICM) teams were collected over 2 years. Interventions were prospectively recorded using clinician-derived categories. Changes over time are described at both patient and team level.


RESULTS
The number of contacts and the proportion of face-to-face activity were remarkably constant after the first month at the patient level. The proportion of 'psychiatric' interventions (main focus on medication or a specific 'mental health' intervention performed) increased greatly after the first 6 months. The care activity received by individual patients varied considerably. Overall, teams varied significantly in the extent to which their activity rates were sustained over time.


CONCLUSIONS
New ICM teams deliver highly individualised care with more marked differences in treatment patterns between patients in the same team than mean differences between teams. The early 'engagement' period is marked by a greater focus on social care. There is evidence of differences in sustainability of the services by site.
Fiander
M
M
Department of Mental Health, St. George's Hospital Medical School, London, UK.
Burns
T
T
Ukoumunne
O C
OC
Fahy
T
T
Creed
F
F
Tyrer
P
P
Byford
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D019090:Case Management / Q000639:trends*; D003131:Combined Modality Therapy; D003156:Community Mental Health Services / Q000639:trends*; D005260:Female; D005544:Forecasting; D006297:Health Services Accessibility / Q000639:trends; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D007206:Individuality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000639:trends; D011618:Psychotic Disorders / Q000453:epidemiology / Q000628:therapy*; D012017:Referral and Consultation / Q000639:trends; D013222:State Medicine / Q000639:trends*; D006113:United Kingdom