Young people with severe mental illness benefit from community treatment
New research from the Institute for Psychiatry, Psychology & Neuroscience (IoPPN) and South London and Maudsley NHS Foundation Trust shows that community treatment for adolescent psychiatric patients can reduce self-harm and prevent institutionalisation.
The researchers found that intensive community care for adolescents with severe mental health disorders not only brought down the usage of inpatient beds but reduced the likelihood of multiple episodes of self-harm among young people by 82 per cent and helped them return to school.
The randomised controlled trial included 106 patients aged between 12 and 18, from the boroughs of Southwark, Lambeth, Croydon, Lewisham and Kent, who were admitted to inpatient units at the Trust, or private inpatient units when units at the Trust were full. Results of the trial are published in The Lancet Psychiatry.
Patients were randomly allocated to receive either usual in-patient care followed by a return to standard outpatient care, or to be discharged early with intensive community support provided by the Supported Discharge Service (SDS), a team offering intensive therapeutic support and access to home treatment, day care and intensive case management.
Home treatment is an integral part of community support from the SDS teams, which includes mental state monitoring, administering medication, monitoring of side effects and individualised psychotherapies. SDS aims to engage family members in all aspects of care and also supports young people in their school or vocation and positive recreational activities.
Lead author Dr Dennis Ougrin from the IoPPN, and consultant child and adolescent psychiatrist at the Trust, said: ‘In the first UK trial of its kind intensive community care provided to adolescents with severe mental health disorders reduced inpatient bed usage but had no effect on functional status and symptoms of most mental health disorders compared with usual care.’
‘Adolescents who received intensive community care had reduced self-harm and improved reintegration into school.’
Co-author, Emeritus Professor Eric Taylor from IoPPN and honorary consultant at the Trust said: ‘The implication is that this method of treatment is an affordable and safe way of helping children with severe illnesses to live in their natural communities for longer.’
Urgent psychiatric admission for adolescents can lead to serious distress, and the highest risk of suicide and self-harm are encountered following discharge from an inpatient setting. The results of the study revealed the likelihood of patients in the SDS group having multiple self-harm episodes was 82 per cent lower than the odds of patients who received usual inpatient care.
Patients in the SDS group were also found to have spent significantly fewer days out of school than the control group and were more likely to reintegrate into an educational setting.
The findings from the study also suggest a trend towards reduced bed usage at six-month follow up.
The trial revealed using intensive community services was associated with clinical improvements similar to inpatient care, in line with studies in other countries. Further studies are required to investigate the effectiveness and cost-effectiveness of SDS against usual treatment beyond a six-month follow up.
Paper reference
‘Supported discharge service versus Inpatient care Evaluation (SITE): a randomised controlled trial comparing effectiveness and cost-effectiveness of an intensive community service versus treatment as usual for adolescents with psychiatric emergencies’ Dennis Ougrin et al, The Lancet Psychiatry, DOI 10.1186/ISRCTN82129964
Contact
For further media information please contact Robin Bisson, Senior Press Officer, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, robin.bisson@kcl.ac.uk / +44 20 7848 5377 / +44 7718 697176.