0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Clinical and Cost-Effectiveness of Acute and Subacute Residential Mental Health Services: A Systematic Review
Kerry A. Thomas, B.Sc.(Psych.), B.Soc.Sc.(Psych.); Debra Rickwood, Ph.D., B.A.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200427
View Author and Article Information

The authors are with the Faculty of Health, University of Canberra, University Dr., Bruce, Australian Capital Territory 2601 (e-mail: kerry.thomas@canberra.edu.au).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  In recognition of a service gap between hospital inpatient and community-based care, a range of mental health services have been developed to provide treatment and support for people with mental illness outside the inpatient setting. Acute and subacute residential services provide care for individuals experiencing episodes of acute mental illness and provide transitional services to assist people in their reintegration into the community. This article provides a systematic review of studies evaluating the effectiveness of these alternative services.

Methods  A systematic review of the literature was conducted by searching MEDLINE, PsycINFO, CINAHL, and Cochrane with no years specified to identify studies that have evaluated the clinical effectiveness, user satisfaction, or cost-effectiveness of acute or subacute residential treatments. Outcome data were extracted from quantitative studies, and themes relevant to service satisfaction were extracted from qualitative studies.

Results  A total of 26 studies were identified that evaluated the effectiveness of acute or subacute residential services. Most studies of acute residential units demonstrated clinical improvements equal to those of inpatient units and similar readmission rates, as well as cost benefits. User satisfaction was generally higher for clients of acute residential units. Only three studies examined subacute units, a number not sufficient to evaluate the effectiveness of these services.

Conclusions  Acute residential mental health services offer treatment outcomes equivalent to those of inpatient units, with users reporting high satisfaction. Acute residential services offer a cost-effective alternative to inpatient services. Further research is needed to determine client groups that will benefit most from these alternative services.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
Table 1Evaluative studies of the effectiveness of acute residential mental health services
Table Footer Note

a C-S, cross-sectional study; PP-RCT, patient preference–randomized controlled trial; RCT, randomized controlled trial; R-M, repeated-measures study;

Table Footer Note

b BASIS32, Behavior and Symptoms Identification Scale; BDI, Beck Depression Inventory; BPRS, Brief Psychiatric Rating Scale; CAN, Camberwell Assessment of Need; CSQ, Client Satisfaction Questionnaire 8; EQ–5D, EuroQol (health related quality of life); GAF, Global Assessment of Functioning; GAS, Global Assessment Scale; HoNOS, Health of the Nations Outcome Scale; HRSD, Hamilton Rating Scale for Depression; HSC-40, Hopkins Symptom Checklist; LQLP, Lancashire Quality of Life Profile; PANSS, Positive and Negative Syndrome Scale; PCS, Perceptions of Care Scale; Q-LES-Q, Quality of Life Enjoyment and Satisfaction Questionnaire; QoLI, Quality of Life Interview; QoLS, Quality of Life Scale; RSES, Rosenberg Self-Esteem Scale; SAS, Social Adjustment Scale; SCID, Structured Clinical Interview for DSM-III-R; SF36, Medical Outcomes Short-Form 36; SSS-RF, Service Satisfaction Scale–Residential Form; TAG, Threshold Assessment Grid; UCDI, Uniform Client Data Inventory; VSSS, Verona Service Satisfaction Scale; WAS, Ward Atmosphere Scale.

Anchor for Jump
Table 2Evaluative studies of the effectiveness of subacute residential mental health services
Table Footer Note

a RCT, randomized controlled trial; R-M, repeated-measures study

Table Footer Note

b ADIS-IV, Anxiety Disorders Interview Schedule for DSM-IV; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; BPRS, Brief Psychiatric Rating Scale; CAN-SAS, Camberwell Assessment of Need Short Appraisal Schedule; GAF, Global Assessment of Functioning

+

References

Hawthorne  WB;  Green  EE;  Gilmer  T  et al:  A randomized trial of short-term acute residential treatment for veterans.  Psychiatric Services 56:1379–1386, 2005
[CrossRef] | [PubMed]
 
Sheridan  EP;  Zuskar  DM;  Walsh  SF  et al:  Identifying variables predictive of success: the next step in alternatives to psychiatric hospitalization research.  Journal of Community Psychology 17:356–368, 1989
[CrossRef]
 
Lloyd-Evans  B;  Johnson  S;  Morant  N  et al:  Alternatives to standard acute in-patient care in England: differences in content of care and staff-patient contact.  British Journal of Psychiatry 197(suppl 53):s46–s51, 2010
[CrossRef]
 
Hawthorne  WB;  Green  EE;  Folsom  D  et al:  A randomized study comparing the treatment environment in alternative and hospital-based acute psychiatric care.  Psychiatric Services 60:1239–1244, 2009
[CrossRef] | [PubMed]
 
Fenton  WS;  Mosher  LR:  Crisis residential care for patients with serious mental illness; in  Psychosis: Psychological Approaches and Their Effectiveness . Edited by Martindale  B;  Bateman  A;  Margison  F.  London,  Gaskell–Royal College of Psychiatrists, 2000
 
Fenton  WS;  Mosher  LR;  Herrell  JM  et al:  Randomized trial of general hospital and residential alternative care for patients with severe and persistent mental illness.  American Journal of Psychiatry 155:516–522, 1998
[PubMed]
 
Greenfield  TK;  Stoneking  BC;  Humphreys  K  et al:  A randomized trial of a mental health consumer–managed alternative to civil commitment for acute psychiatric crisis.  American Journal of Community Psychology 42:135–144, 2008
[CrossRef] | [PubMed]
 
Howard  L;  Flach  C;  Leese  M  et al:  Effectiveness and cost-effectiveness of admissions to women's crisis houses compared with traditional psychiatric wards: pilot patient-preference randomised controlled trial.  British Journal of Psychiatry 197(suppl 53):s32–s40, 2010
[CrossRef]
 
Slade  M;  Byford  S;  Barrett  B  et al:  Alternatives to standard acute in-patient care in England: short-term clinical outcomes and cost-effectiveness.  British Journal of Psychiatry 197(suppl 53):s14–s19, 2010
[CrossRef]
 
Adams  CL;  El-Mallakh  RS:  Patient outcome after treatment in a community-based crisis stabilization unit.  Journal of Behavioral Health Services and Research 36:396–399, 2009
[CrossRef] | [PubMed]
 
Hawthorne  WB;  Green  EE;  Lohr  JB  et al:  Comparison of outcomes of acute care in short-term residential treatment and psychiatric hospital settings.  Psychiatric Services 50:401–406, 1999
[PubMed]
 
Byford  S;  Sharac  J;  Lloyd-Evans  B  et al:  Alternatives to standard acute in-patient care in England: readmissions, service use and cost after discharge.  British Journal of Psychiatry 197(suppl 53):s20–s25, 2010
[CrossRef]
 
Fenton  WS;  Hoch  JS;  Herrell  JM  et al:  Cost and cost-effectiveness of hospital vs residential crisis care for patients who have serious mental illness.  Archives of General Psychiatry 59:357–364, 2002
[CrossRef] | [PubMed]
 
Sledge  WH;  Tebes  J;  Wolff  N  et al:  Day hospital/crisis respite care versus inpatient care: part II. service utilization and costs.  American Journal of Psychiatry 153:1074–1083, 1996
[PubMed]
 
Haycox  A;  Unsworth  L;  Allen  K  et al:  North Staffordshire Community Beds Study: longitudinal evaluation of psychiatric in-patient units attached to community mental health centres: 2. impact upon costs and resource use.  British Journal of Psychiatry 175:79–86, 1999
[CrossRef] | [PubMed]
 
Ryan  T;  Nambiar-Greenwood  G;  Haigh  C  et al:  A service evaluation of a community-based mental health crisis house in inner city Liverpool.  Mental Health Review Journal 16:56–63, 2011
 
Borge  FM;  Hoffart  A;  Sexton  H  et al:  Residential cognitive therapy versus residential interpersonal therapy for social phobia: a randomized clinical trial.  Journal of Anxiety Disorders 22:991–1010, 2008
[CrossRef] | [PubMed]
 
Meiser-Stedman  C;  Howard  L;  Cutting  P:  Evaluating the effectiveness of a women's crisis house: a prospective observational study.  Psychiatric Bulletin 30:324–326, 2006
[CrossRef]
 
Bedell  J;  Ward  JC:  An intensive community-based treatment alternative to state hospitalization.  Hospital and Community Psychiatry 40:533–535, 1989
[PubMed]
 
A National Approach to Mental Health: From Crisis to Community—First Report. Canberra, Commonwealth of Australia Department of Health and Ageing, 2006. Available at www.aph.gov.au
 
Ward Watch: Mind’s Campaign to Improve Hospital Conditions for Mental Health Patients. London, Mind, 2004. Available at www.mind.org.uk/assets/0000/0353/ward_watch_report.pdf
 
Rose D: Users’ Voices: The Perspectives of Mental Health Service Users on Community and Hospital Care. London, Sainsbury Centre for Mental Health, 2001. Available at www.centreformentalhealth.org.uk/pdfs/Users_voices.pdf
 
Tanzman  B:  An overview of surveys of mental health consumers’ preferences for housing and support services.  Hospital and Community Psychiatry 44:450–455, 1993
[PubMed]
 
Anthony  WA:  A recovery-oriented service system: setting some system level standards.  Psychiatric Rehabilitation Journal 24:159–168, 2000
[CrossRef]
 
Anthony  WA:  Recovery from mental illness: the guiding vision of the mental health service system in the 1990s.  Psychosocial Rehabilitation Journal 16:11–23, 1993
[CrossRef]
 
Harding  CM;  Brooks  GW;  Ashikaga  T  et al:  The Vermont longitudinal study of persons with severe mental illness: II. long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia.  American Journal of Psychiatry 144:727–735, 1987
[PubMed]
 
Harding  CM;  Zahniser  JH:  Empirical correction of seven myths about schizophrenia with implications for treatment.  Acta Psychiatrica Scandinavica. Supplementum 384:140–146, 1994
[CrossRef] | [PubMed]
 
Davidson  L:  Recovery, self management and the expert patient: changing the culture of mental health from a UK perspective.  Journal of Mental Health 14:25–35, 2005
[CrossRef]
 
Moher  D;  Liberati  A;  Tetzlaff  J  et al:  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.  Annals of Internal Medicine 151:264–269, 2009
[CrossRef] | [PubMed]
 
Cohen  J:  Statistical Power Analysis for the Behavioral Sciences .  New York,  Academic, 1969
 
Sledge  WH;  Tebes  J;  Rakfeldt  J  et al:  Day hospital/crisis respite care versus inpatient care: part I. clinical outcomes.  American Journal of Psychiatry 153:1065–1073, 1996
[PubMed]
 
Boardman  AP;  Hodgson  RE;  Lewis  M  et al:  North Staffordshire Community Beds Study: longitudinal evaluation of psychiatric in-patient units attached to community mental health centres: I. methods, outcome and patient satisfaction.  British Journal of Psychiatry 175:70–78, 1999
[CrossRef] | [PubMed]
 
Dott  SG;  Walling  DP;  Bishop  SL  et al:  The efficacy of short-term treatment for improving quality of life: a pilot study.  Journal of Nervous and Mental Disease 184:507–509, 1996
[CrossRef] | [PubMed]
 
Bittle  RG:  Acute care treatment services (ACTS): a model program for providing acute psychiatric services in a homelike environment in an institutional setting.  Behavioral Residential Treatment 1:275–288, 1986
 
Osborn  DPJ;  Lloyd-Evans  B;  Johnson  S  et al:  Residential alternatives to acute in-patient care in England: satisfaction, ward atmosphere and service user experiences.  British Journal of Psychiatry 197(suppl 53):s41–s45, 2010
[CrossRef]
 
Gilburt  H;  Slade  M;  Rose  D  et al:  Service users' experiences of residential alternatives to standard acute wards: qualitative study of similarities and differences.  British Journal of Psychiatry 197(suppl 53):s26–s31, 2010
[CrossRef]
 
Johnson  S;  Bingham  C;  Billings  J  et al:  Women's experiences of admission to a crisis house and to acute hospital wards: a qualitative study.  Journal of Mental Health 13:247–262, 2004
[CrossRef]
 
Andresen  R;  Oades  L;  Caputi  P:  The experience of recovery from schizophrenia: towards an empirically validated stage model.  Australian and New Zealand Journal of Psychiatry 37:586–594, 2003
[CrossRef] | [PubMed]
 
Slade  M;  Amering  M;  Oades  L:  Recovery: an international perspective.  Epidemiologia e Psichiatria Sociale 17:128–137, 2008
[CrossRef] | [PubMed]
 
Farkas  M;  Gagne  C;  Anthony  W  et al:  Implementing recovery oriented evidence based programs: identifying the critical dimensions.  Community Mental Health Journal 41:141–158, 2005
[CrossRef] | [PubMed]
 
Whitley  R;  Harris  M;  Drake  RE:  Safety and security in small-scale recovery housing for people with severe mental illness: an inner-city case study.  Psychiatric Services 59:165–169, 2008
[CrossRef] | [PubMed]
 
Flannery  RB  Jr;  Fisher  W;  Walker  A  et al:  Assaults on staff by psychiatric patients in community residences.  Psychiatric Services 51:111–113, 2000
[PubMed]
 
Beck  A;  Croudace  TJ;  Singh  S  et al:  The Nottingham Acute Bed Study: alternatives to acute psychiatric care.  British Journal of Psychiatry 170:247–252, 1997
[CrossRef] | [PubMed]
 
Shepherd  G;  Beadsmoore  A;  Moore  C  et al:  Relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units, and alternative residential options: a cross sectional survey, one day census data, and staff interviews.  British Medical Journal 314:262–266, 1997
[CrossRef] | [PubMed]
 
O’Hara  A:  Housing for people with mental illness: update of a report to the President’s New Freedom Commission.  Psychiatric Services 58:907–913, 2007
[CrossRef] | [PubMed]
 
O’Connell  M;  Rosenheck  R;  Kasprow  W  et al:  An examination of fulfilled housing preferences and quality of life among homeless persons with mental illness and/or substance use disorders.  Journal of Behavioral Health Services and Research 33:354–365, 2006
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 1

Related Content
Articles
Books
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 32.  >
Textbook of Psychotherapeutic Treatments > Chapter 18.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 33.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 22.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 32.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles