AN EVALUATION OF COMMUNITY-BASED PSYCHIATRIC-CARE FOR PEOPLE WITH TREATED LONG-TERM MENTAL-ILLNESS

Background. We evaluated integrated, multidisciplinary, community-base d care for a cohort of people with treated long-term mental illness ov er two years in a field trial Set in a semi-rural setting. The aim was to organise local psychiatric services on an extramural basis with ge neral practitioner teems as the key element. Method. Trained research workers used a structured interview to collect standardised baseline a nd three-monthly socio-demographic, clinical, social, family adjustmen t and burden, and treatment measures from patients, informants, and ke y-workers. Analysis included descriptive statistics and, for longitudi nal data, analysis of best-fitted straight lines. Results. We studied 34 patients (14 with schizophrenia, 11 with major affective disorders, and 9 with minor (non-major) affective disorders and anxiety disorder s) who had a mean of 12 years continuous illness. Ar baseline, they we re mainly characterised by research workers as mildly ill with fair so cial adaptive functioning, and by lay informants as having moderate ta rget symptom severity and disturbance of social performance. Over two years, there were statistically significant, slight improvements in cl inical global impressions ratings by research workers, and in informan ts ratings of target symptoms and social performance. Most patients co ntinued to receive prescriptions for psychotropic drugs throughout fol low-up, and they had a mean of 47 therapeutic contacts, mainly from nu rses. Two patients were admitted to psychiatric hospital. There were f ew differences between patients in different diagnostic groups. Conclu sions. Integrated, multidisciplinary, community-based psychiatric care for people with treated long-term mental illness is feasible in a sem i-rural setting: patients receiving pharmacotherapy and regular psycho social treatments remained relatively stable on clinical and social me asures over two years. The unique way in which the service was monitor ed, by making regular, systematic assessments of patients and caters, selves as an example for other services.