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Alternative Settings: Unintended Consequences
Dieneke A. A. Hubbeling, M.Sc., M.R.C.Psych.; David Chang, M.B.B.S., M.R.C.Psych.
Psychiatric Services 2013; doi: 10.1176/appi.ps.641202
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The authors are affiliated with Wandsworth Crisis and Home Treatment Team, South West London, and with St. George’s Trust, London, United Kingdom.

Copyright © 2013 by the American Psychiatric Association


To the Editor: The November issue includes a timely review by Thomas and Rickwood (1) of residential alternatives to psychiatric hospitalization for patients who need acute care. Their main conclusion was that care provided in these settings can improve symptoms at least as well as care provided in psychiatric hospitals and that the alternative settings appear to be cost-effective. At a time when saving money is becoming increasingly important, it is essential to look closely at these findings. The authors noted the enormous variation among these services. They also remarked that the studies they reviewed did not provide much detail about the patients and the actual treatment and support provided. A recent review of nonresidential alternatives to psychiatric hospitalization also mentioned the omission of such details (2), and we agree with the authors that these aspects should be investigated further.

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Thomas  KA;  Rickwood  D:  Clinical and cost-effectiveness of acute and subacute residential mental health services: a systematic review.  Psychiatric Services 64:1140–1149, 2013
Hubbeling  D;  Bertram  R:  Crisis resolution teams in the UK and elsewhere.  Journal of Mental Health 21:285–295, 2012
[CrossRef] | [PubMed]
Tyrer  P;  Gordon  F;  Nourmand  S  et al:  Controlled comparison of two crisis resolution and home treatment teams.  Psychiatrist 34:50–54, 2010
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