title: Alternatives to standard acute in-patient care in England: roles and populations served.
abstract: BACKGROUND
  Key questions regarding residential alternatives to standard acute psychiatric care, such as crisis houses and short-stay in-patient units, concern the role that they fulfil within local acute care systems, and whether they manage people with needs and illnesses of comparable severity to those admitted to standard acute wards.
  
  
  OBJECTIVE
  To study the extent to which people admitted to residential alternatives and to standard acute services are similar, and the role within local acute care systems of admission to an alternative service.
  
  
  METHODS
  Our approach combined quantitative and qualitative methods. Consecutive cohorts of patients in six residential alternatives across England and six standard acute wards in the same areas were identified, and clinical and demographic characteristics, severity of symptoms, impairments and risks compared. Semi-structured interviews with key stakeholders in each local service system were used to explore the role and functioning of each alternative.
  
  
  RESULTS
  Being already known to services (OR = 2.6, 95% CI 1.3-5.2), posing a lower risk to others (OR = 0.49, 95% CI 0.31-0.78) and having initiated help-seeking in the current crisis (OR = 2.2, 95% CI 1.2-4.3) were associated with being admitted to an alternative rather than a standard service. Stakeholder interviews suggested that alternatives have a role that is similar but not identical to standard hospital services. They can divert some, but not all, patients from acute admission.
  
  
  CONCLUSIONS
  Residential alternatives are integrated into catchment area mental health systems. They serve similar, but not identical, clinical populations to standard acute wards and provide some, but not all, of the functions of these wards.
authors.affiliation: Department of Mental Health Sciences, 2nd floor, Charles Bell House, 67-73 Riding House Street, London W1W 7EY, UK. s.johnson@ucl.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Johnson
authors.forename: B
authors.initials: B
authors.lastname: Lloyd-Evans
authors.forename: N
authors.initials: N
authors.lastname: Morant
authors.forename: H
authors.initials: H
authors.lastname: Gilburt
authors.forename: G
authors.initials: G
authors.lastname: Shepherd
authors.forename: M
authors.initials: M
authors.lastname: Slade
authors.forename: D
authors.initials: D
authors.lastname: Jagielska
authors.forename: M
authors.initials: M
authors.lastname: Leese
authors.forename: S
authors.initials: S
authors.lastname: Byford
authors.forename: D P J
authors.initials: DP
authors.lastname: Osborn
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002391:Catchment Area, Health; D016000:Cluster Analysis; D015331:Cohort Studies; D003155:Community Mental Health Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006276:Health Facility Size; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D009937:Organizational Objectives; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D036301:Qualitative Research; D012044:Regression Analysis; D012720:Severity of Illness Index; D055815:Young Adult