COMPARISON OF COMMUNITY-BASED SERVICE WITH HOSPITAL-BASED SERVICE FORPEOPLE WITH ACUTE, SEVERE PSYCHIATRIC-ILLNESS

Objective-To compare the burden on relatives and outcome of people tre ated for severe acute psychiatric illness by a community service and a traditional hospital based service. Design-Follow up of patients aged 16-65 who required admission to hospital or home treatment for psychi atric illness during january 1990 to February 1991. Setting-Two Birmin gham electoral wards, Sparkbrook and Small Heath; Sparkbrook has a com munity based service and Small Heath a traditional hospital based serv ice. Subjects-69 patients from Sparkbrook and 55 from Small Heath. Mai n outcome measures-Scores on present state examination, social behavio ur assessment schedule, and general health questionnaire. Results-24 ( 35%) of Sparkbrook patients received some treatment in hospital during the initial episodes. Relatives of Sparkbrook patients were less dist ressed by their burden at the initial assessment than relatives of Sma ll Heath patients (mean score 0.11 v 0.29, p<0.01). Relatives were als o more satisfied with the support they received and the treatment rece ived by patients. More patients from Sparkbrook than Small Heath were in contact with a psychiatrist (81% (95% confidence interval 71% to 91 %) v 62% (44% to 68%)) and community nurse (56% (44% to 68%) v 14% (13 % to 24%)) one year after the initial episode. Sparkbrook patients spe nt significantly fewer days in hospital during the initial episode (8 days v 59 days) and the first year (20.6 v 67.9 days). Conclusion-The community based service is as effective as the hospital based service and is preferred by relatives. It is more effective in keeping people in long term contact with psychiatrists.