This systematic review examined the effects of CMHTs compared to standard hospital treatment for patients with serious mental illness. Results indicate that there is no difference in death rates (by suicide and under suspicious circumstances) between patients that received CMHT care versus those that received standard care. Nevertheless, patients in the CMHT group were more satisfied with CMHT services compared with those who received standard care. Hospital admissions in the CMHTs group were also fewer than in standard care. Differences between groups were not found for other outcomes such as admissions to accident and emergency services, contact with primary care, and contact with social services. Based on this study, CMHTs did not outperform non-team standard care in reducing hospital admissions and avoiding death by suicide, however, it might have large effects in terms of saving lives at the population level.

Background: Public policy continues to support shifting people with severe mental illness out of hospital beds in favor of providing care in various non-hospital settings because of the hope that community care will improve opportunities for patients with severe mental illness to live independently in their own homes and function as autonomous members of society. Community mental health teams (CMHTs) have been developed as a mechanism to provide community care. Previous studies have suggested that CMHTs reduce time spent by patients with severe mental illness in hospital; however, it is still unclear whether CMHTs lead to other benefits for patients with serious mental illness. This Cochrane review examined the effects of CMHTs compared to standard hospital treatment for patients with serious mental illness.

Methods: This study systematically reviewed randomized controlled trials that compared the effects of CMHTs with standard care for patients with serious mental illness (i.e. presence of schizophrenia, schizoaffective disorder, major depression, and bipolar disorder accompanied by significant functional impairment, disruption of normal life tasks, periods of hospitalization, and need for psychotropic medication). Interventions consisted of care management from a multi-disciplinary and community-based team (CMHT) compared to standard treatment, which consisted of non-team community care, outpatient care, or admission to hospital. Primary outcomes were number of deaths (by suicide and under suspicious circumstances), acceptability of management, and participant and care-giver satisfaction.

Findings: Three studies, including a total of 587 patients, were pooled for the analysis. Findings indicate that while CMHTs did not result in a statistically significant difference in number of deaths by suicide or under suspicious circumstance, there were fewer such deaths in this group when compared to those in the standard treatment group. More patients in the CMHT group were satisfied with services compared with those receiving standard care. In addition, the CMHT group had lower rates of hospital admission than standard care, although admissions to accident and emergency services, contact with primary care, and contact with social services did not differ.

Conclusions: Community mental health teams achieved similar patient outcomes in key areas to nonteam standard care and outperformed in client satisfaction. Even if the decrease in death rate is not statistically significant, CMHT management might have large effects in terms of saving lives at the population level and would be one of the few interventions for those with serious mental illnesses.

Reference: Malone D, Marriott S, Newton-Howes G, Simmonds S, Tyrer P. Community Mental Health Teams (CMHTs) for People with Severe Mental Illnesses and Disordered Personality. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD000270. DOI: 10.1002/14651858.CD000270.pub2.

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