Effectiveness and cost-effectiveness of admissions to women's crisis houses compared with traditional psychiatric wards: pilot patient-preference randomised controlled trial.
BACKGROUND
Women's crisis houses have been developed in the UK as a less stigmatising and less institutional alternative to traditional psychiatric wards.


OBJECTIVE
To examine the effectiveness and cost-effectiveness of women's crisis houses by first examining the feasibility of a pilot patient-preference randomised controlled trial (PP-RCT) design (ISRCTN20804014).


METHODS
We used a PP-RCT study design to investigate women presenting in crisis needing informal admission. The four study arms were the patient preference arms of women's crisis house or hospital admission, and randomised arms of women's crisis house or hospital admission.


RESULTS
Forty-one women entered the randomised arms of the trial (crisis house n = 19, wards n = 22) and 61 entered the patient-preference arms (crisis house n = 37, ward n = 24). There was no significant difference in outcomes (symptoms, functioning, perceived coercion, stigma, unmet needs or quality of life) or costs for any of the groups (randomised or preference arms), but women who obtained their preferred intervention were more satisfied with treatment.


CONCLUSIONS
Although the sample sizes were too small to allow definite conclusions, the results suggest that when services are able to provide interventions preferred by patients, those patients are more likely to be satisfied with treatment. This pilot study provides some evidence that women's crisis houses are as effective as traditional psychiatric wards, and may be more cost-effective.
Howard
L
L
Health Service and Population Research Department, Institute of Psychiatry, Box PO29, De Crespigny Park, London SE5 8AF, UK. louise.howard@kcl.ac.uk.
Flach
C
C
Leese
M
M
Byford
S
S
Killaspy
H
H
Cole
L
L
Lawlor
C
C
Betts
J
J
Sharac
J
J
Cutting
P
P
McNicholas
S
S
Johnson
S
S
D000208:Acute Disease; D000328:Adult; D003155:Community Mental Health Centers / Q000191:economics*; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006778:Hospitals, Psychiatric; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010865:Pilot Projects; D011788:Quality of Life; D057545:Social Stigma; D013222:State Medicine; D014932:Women's Health Services / Q000191:economics