Community mental health teams for people with severe mental illnesses and disordered personality

Malone D, Marriott S, Newton-Howes G, Simmonds S, Tyrer P

Published Online:

March 17, 2010

Since the 1950s there has been a trend to close institutions of care for people who are mentally unwell. In addition, government policy has sought to reduce the number of hospital beds available in favour of care being provided in the community to enable people to live more independent lives. The aim of Community Mental Health Teams (CMHTs) is to bring a specialist care package to people in the community. We reviewed the available evidence on CMHTs compared with standard non-team community care. We found only three trials which indicated some benefit in terms of acceptability of treatment, but overall the evidence for CMHTs is inadequate and further trials are needed to determine its effectiveness.

Abstract (click to read)

Background:

Closure of asylums and institutions for the mentally ill, coupled with government policies focusing on reducing the number of hospital beds for people with severe mental illness in favour of providing care in a variety of non-hospital settings, underpins the rationale behind care in the community. A major thrust towards community care has been the development of community mental health teams (CMHT).

Objectives:

To evaluate the effects of community mental health team (CMHT) treatment for anyone with serious mental illness compared with standard non-team management.

Search strategy:

We searched The Cochrane Schizophrenia Group Trials Register (March 2006). We manually searched the Journal of Personality Disorders, and contacted colleagues at ENMESH, ISSPD and in forensic psychiatry.

Selection criteria:

We included all randomised controlled trials of CMHT management versus non-team standard care.

Data collection and analysis:

We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a fixed effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a fixed effects model.

Main results:

CMHT management did not reveal any statistically significant difference in death by suicide and in suspicious circumstances (n=587, 3 RCTs, RR 0.49 CI 0.1 to 2.2) although overall, fewer deaths occurred in the CMHT group. We found no significant differences in the number of people leaving the studies early (n=253, 2 RCTs, RR 1.10 CI 0.7 to 1.8). Significantly fewer people in the CMHT group were not satisfied with services compared with those receiving standard care (n=87, RR 0.37 CI 0.2 to 0.8, NNT 4 CI 3 to 11). Also, hospital admission rates were significantly lower in the CMHT group (n=587, 3 RCTs, RR 0.81 CI 0.7 to 1.0, NNT 17 CI 10 to 104) compared with standard care. Admittance to accident and emergency services, contact with primary care, and contact with social services did not reveal any statistical difference between comparison groups.

Authors' conclusions:

Community mental health team management is not inferior to non-team standard care in any important respects and is superior in promoting greater acceptance of treatment. It may also be superior in reducing hospital admission and avoiding death by suicide. The evidence for CMHT based care is insubstantial considering the massive impact the drive toward community care has on patients, carers, clinicians and the community at large.

This record should be cited as:

Malone D, Marriott S, Newton-Howes G, Simmonds S, Tyrer P. Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD000270. DOI: 10.1002/14651858.CD000270.pub2

Assessed as up to date:

May 21, 2007

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Schizophrenia Group

Health topics:

Effective practice/health systems > Reviews of interventions to improve specific types of practice > General management of a problem

Mental health > Schizophrenia & psychosis > Care package/setting of care

Mental health > Effective practice/health systems

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Community mental health teams for people with severe mental illnesses and disordered personality

More like this

Copyright © 2011 - The Cochrane Collaboration