H. Kluiter, INPATIENT TREATMENT AND CARE ARRANGEMENTS TO REPLACE OR AVOID IT - SEARCHING FOR AN EVIDENCE-BASED BALANCE, Current opinion in psychiatry, 10(2), 1997, pp. 160-167
In several countries, it seems to be policy to strive for a mental hea
lth system dominated by variants of community care replacing hospital
care and culminating in closure of hospitals. Scientific evidence show
s that no form of community care for the seriously mentally ill can do
without the hospital, but also indicates compellingly that hospital c
are can be replaced or avoided by community alternatives, although onl
y partially so. The randomized controlled trials that have produced su
ch evidence are reviewed. Emphasis is placed on the convergence of fin
dings across trials, their generalisability and the degree to which co
mmunity alternatives succeeded in avoiding or replacing inpatient trea
tment. The results of the review are confronted with the justified dem
and for an evidence-based mental health system.