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Balancing hospital and community treatment: effectiveness of an extended-hours community mental health team in a semi-rural region of australia.

OBJECTIVE
To examine the effectiveness of the introduction of a community mental health team on consumer psychosocial outcomes.


DESIGN
Longitudinal panel design.


SETTING
District general hospital in a semi-rural region of Australia.


NUMBERS
Two matched groups (n = 37 in each group)


MAIN OUTCOME MEASURE
These included: Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), Rosenberg Self-Esteem, Life Skills Profile as well as self-report.


RESULTS
The study found that the introduction of the new service resulted in few significant differences in consumer outcomes.


CONCLUSIONS
The paper argues that because the state was the only specialist mental health service provider and it was unable to offer assertive community treatment, hospital care remained central. Evidence that a substantial proportion of consumers and carers preferred hospital to community care is placed against this background. The paper argues that in regions like these, where community-based services are likely to remain underdeveloped, it may be best to maintain quality hospital services and to target community services more precisely on what is achievable rather than developing community services at the expense of hospital care.


WHAT IS ALREADY KNOWN
Studies on the efficacy of assertive community treatment suggest that it can lead to improved consumer outcomes. However, these studies are usually in urban settings and involve experimental teams. In many rural and regional areas community treatment teams offer standard rather than assertive community care. It is therefore important to investigate the effectiveness of community treatment teams in rural and regional Australia.


WHAT THIS STUDY ADDS
This study suggests that in rural and regional areas characterised by limited resources, it is too much to expect community treatment teams to have a measurable impact on consumer outcomes. In these settings hospital care remains at the heart of the service. This means that regions such as these need to focus their community services on what is achievable given the level of resources and social ecology. For example, they may need to consider offering either crisis intervention or rehabilitation services and to rely on innovations, such as telehealth or strategic alliances with other service providers to fill the gap.