Home and Community Care Digest
Higher Satisfaction, Same Risk of Death: The Impact of Community Mental Health Teams (CMHTs) on Patients' Outcomes
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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