Clinical and Cost-Effectiveness of Acute and Subacute Residential Mental Health Services: A Systematic Review
Abstract
Objective
Methods
Results
Conclusions
Methods
Search strategy
Data extraction and synthesis
Results
Acute residential services
Study and country | Study design, sample N, and assessment timesa | Residential service | Comparison service | Outcomes and measure usedb | Results |
---|---|---|---|---|---|
Hawthorne et al., 2005 (1); U.S. | RCT; N=99; admission, discharge, and 2-month follow-up | Short-term acute residential unit (START) | Psychiatric inpatient unit | Symptoms, PANSS; functioning, SF36;service satisfaction, PCS | Improvements in symptoms at discharge and follow-up for both groups; similar lengths of stay; higher service satisfaction for residential unit |
Sheridan et al., 1989 (2); U.S. | RCT; N=75; admission and discharge | Emergency housing program with outpatient psychiatric services | Psychiatric inpatient unit | Planned discharge | Most residential clients discharged to the community rather than to an inpatient unit |
Lloyd-Evans et al., 2010 (3); U.K. | Mixed methods: C-S and qualitative; N=320; discharge | 3 community-based residential crisis services and 1 alternative inpatient ward (tidal model) | 4 psychiatric inpatient units | Satisfaction with service; level of care | Higher levels of service satisfaction among clients of residential units |
Hawthorne et al., 2009 (4); U.S. | RCT; N=93; discharge | START | Psychiatric inpatient unit | Treatment environment | Greater satisfaction on several dimensions with residential treatment environment |
Fenton et al., 2000 (5); U.S. | RCT; N=119; admission, discharge, and 6-month follow-up | McAuliffe House, a residential crisis program | Psychiatric inpatient unit | Psychiatric symptoms, PANSS; quality of life, QoLS; successful discharge; costs of service | Improvement in symptoms for both groups; user satisfaction higher for residential unit; residential unit less costly |
Fenton et al., 1998 (6); U.S. | RCT; N=119; admission, discharge, and 6-month follow-up | McAuliffe House, a residential crisis program | Psychiatric inpatient unit | Psychiatric symptoms, PANSS; quality of life, QoLS; successful discharge | Improvements in symptoms and quality of life for both groups; 87% of residential unit clients discharged to the community |
Greenfield et al., 2008 (7); U.S. | RCT; N=393; admission and 1-, 6-, and 12-month follow-ups | Crisis residential program | Psychiatric inpatient unit | Psychiatric symptoms, BPRS and HSC-40; level of functioning, UCDI; self-esteem, RSES; quality of life, QoLI; service satisfaction, SSS-RF; costs of service | Greater symptom improvement for residential clients; functioning and life enrichment similar for both groups; no difference in symptoms at 12 months; higher service satisfaction for residential unit clients |
Howard et al., 2010 (8); U.K. | PP-RCT; N=102; admission and 12-week follow-up | 2 crisis houses, Drayton Park and Croydon House | 2 psychiatric inpatient units | Psychiatric symptoms, BPRS | Clinical improvements for clients in both treatment groups; satisfaction with services higher for women in the residential services; no difference in costs between the services |
Level of functioning, GAF; quality of life, EQ–5D; unmet needs, CAN; service satisfaction, VSSS; costs of services | |||||
Slade et al., 2010 (9); U.K. | R-M; N=433; admission and discharge | 6 residential units, including a clinical crisis unit, a short-stay ward, and beds on a crisis team service | 6 psychiatric inpatient units | Psychiatric symptoms, HoNOS and TAG; functioning, GAF; costs of service | Improvements in symptoms and functioning for both groups; improvements and length of stay greater for inpatients; residential unit less costly |
Adams and El-Mallakh, 2009 (10); U.S. | R-M; N=261; admission and discharge | Crisis stabilization unit | None | Psychiatric symptoms, BPRS and BDI | Symptoms improved at discharge |
Hawthorne et al., 1999 (11); U.S. | R-M; N=554; admission, discharge, and 4-month follow-up | 5 short-term residential facilities | 2 psychiatric inpatient units | Symptoms, BASIS32; functioning, SF36; length of stay; satisfaction with service, CSQ; costs of service | Improvements in symptoms and functioning at discharge for both groups; length of stay similar for both services, except longer for depressed clients in residential units; residential service less costly |
Byford et al., 2010 (12); U.K. | Prospective; N=398; 12 months after discharge | 5 alternative acute residential units | 6 psychiatric inpatient units | Mental health service use for 12 months after discharge; costs of service | Readmission data similar for both groups; residential units less costly because of shorter stays |
Fenton et al., 2002 (13); U.S. | RCT; N=119; admission, discharge, and 6-month follow-up | McAuliffe House, a residential crisis program | Psychiatric inpatient unit | Psychiatric symptoms, PANSS; costs of service | Symptom improvements for both groups; no difference in readmissions; residential unit less costly |
Sledge et al., 1996 (14); U.S. | RCT; N=197; admission and 2-, 5-, and 10-month follow-ups | Day hospital and crisis respite program | Psychiatric inpatient unit | Costs of service | Residential unit less costly |
Haycox et al., 1999 (15); U.S. | R-M; N=177; admission and 6- and 12-month follow-ups | 2 residential units attached to community mental health centers | 2 psychiatric inpatient units | Costs of service; readmissions; use of community services | Fewer readmissions and greater use of community mental health services for clients of acute residential units; overall cost of acute services may be less when long-term client outcomes are included |
Ryan et al., 2011 (16); U.K. | R-M; N=43; admission and discharge | Amethyst House, crisis house | None | Symptoms, GAF, HoNOS, and TAG; functioning, GAF and HoNOS | Improvements in symptoms and functioning at discharge |
Sledge et al., 1996 (31); U.S. | RCT; N=197; admission and 2-, 5-, and 10-month follow-ups | Day hospital and crisis respite program | Psychiatric inpatient unit | Psychotic symptoms, BPRS and SCID; functioning, GAS; social adjustment, SAS; quality of life, QoLI; satisfaction with service | Improvement in symptoms and functioning for both groups; no significant difference in satisfaction with service |
Boardman et al., 1999 (32); U.K. | R-M; N=177; admission and 6- and 12-month follow-ups | 2 community mental health residential units | 2 psychiatric inpatient units | Functioning, GAF; symptoms, HoNOS and HRSD; quality of life, LQLP; service satisfaction, VSSS | Greater improvements in symptoms and functioning for residential clients;service satisfaction higher for residential clients |
Dott et al., 1996 (33); U.S. | R-M; N=78; admission and discharge | Residential short-term crisis unit | Psychiatric inpatient unit | Quality of life, Q-LES-Q | Improvements in quality of life for both groups |
Bittle, 1986 (34); U.S. | Prospective; N=760; readmission data over 3.75 years | Acute care treatment services program, 2 residential cottages attached to a hospital | Psychiatric inpatient units | Readmissions | No difference in clients readmitted once; more inpatients readmitted ≥3 times |
Osborn et al., 2010 (35); U.K. | C-S; N=314; discharge | 3 community-based residential services and an alternative inpatient ward—tidal model | 4 psychiatric inpatient units | Satisfaction with service, SSS-RF, CSQ, and WAS | Higher levels of service satisfaction among clients of residential units |
Gilburt et al., 2010 (36); U.K. | Qualitative; N=40; during treatment | 6 alternative acute residential units | None | Preferences for mental health treatment | Clients reported positive impressions of the residential unit service |
Johnson et al., 2004 (37); U.K. | Qualitative; N=50; during treatment | Drayton Park, crisis residential unit for women | Psychiatric inpatient unit | Experience of service; satisfaction with service | Clients spoke highly of the service and preferred it over the inpatient ward |
Clinical effectiveness.
Satisfaction.
Cost-effectiveness.
Subacute residential services
Study and country | Study design, sample N, and assessment timesa | Residential service | Comparison service | Outcomes and measure usedb | Results |
---|---|---|---|---|---|
Borge et al., 2008 (17); Norway | RCT; N=73; admission, discharge, and 12-month follow-up | 10-week residential treatment for social phobia, with cognitive or interpersonal therapy | None | Social phobia symptoms, ADIS-IV; anxiety, BAI | Significant improvements in symptoms for both treatment groups |
Meiser-Stedman et al., 2006 (18); U.K. | R-M; N=261; admission, discharge, and 2-year follow-up | Residential unit for women | None | Psychiatric symptoms, BDI and BPRS; functioning, GAF; unmet need, CAN-SAS | Improvements in symptoms and functioning at discharge |
Bedell and Ward, 1989 (19); U.S. | Longitudinal; N=144; records of admissions and discharges over 42 months | Intensive acute residential unit | Inpatient unit | Length of stay; subsequent readmissions; costs of service | Length of stay significantly shorter for residential unit clients; fewer hospital readmissions for residential unit clients; residential unit less costly |
Discussion
Limitations of this review
Recovery-based care
Implications for current health care policy
Future research
Conclusions
Acknowledgments and disclosures
References
Information & Authors
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Cover: Paul Cadmus, by Luigi Lucioni, 1928. Oil on canvas, 16 × 12⅛ inches. Brooklyn Museum, Dick S. Ramsay Fund, 2007.28.
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