© 1998 Evidence-Based Mental Health
Treatment of severe and persistent mental illness in a community residential alternative was effective
Fenton WS, Mosher LR, Herrell JM, et al. Randomized trial of general hospital and residential alternative care for patients with severe and persistent mental illness.Am J Psychiatry 1998 Apr;155:516–22
Question In voluntary patients with severe, persistent mental illness, is treatment in an acute residential alternative as effective as in a hospital psychiatric ward?
6 month randomised controlled trial.
A local public health authority in Maryland, USA.
119 patients (mean age 37 y, 52% men) who were judged by clinicians to need inpatient hospital care but not acute medical care or detoxification, had Medicaid or Medicare funding, and agreed to accept voluntary placement. Patients who had acute psychosis, depression, suicidal or homicidal tendencies, or substance abuse were included. Follow up was 100% at discharge and 95% at 6 months.
Patients were randomised to a community residential alternative (n=69) or a psychiatric ward of a general hospital (n=50). The community residential alternative was a home with 8 beds; a supportive environment was provided for patients who continued to see outpatient treatment providers and community supports. Hospital care included medical assessment, individual psychotherapy, group therapy, and pharmacological management.
Main outcomes were changes in patient symptom severity, patient satisfaction with treatment, and number of discharges to the
University of Toronto Toronto, Ontario, Canada
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