INPATIENT TREATMENT AND CARE ARRANGEMENTS TO REPLACE OR AVOID IT - SEARCHING FOR AN EVIDENCE-BASED BALANCE

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.