Many countries place emphasis on providing mental health services in the least restrictive setting, recognizing that some children will need to be admitted to hospital. As a result there are a range of mental health services to manage young people with serious mental health problems in community or outpatient settings who are at risk of being admitted to hospital.
This review found seven studies which evaluated whether these other services helped children and young people with mental health problems. This review did not find any studies about intensive day treatment (where children attend treatment programmes during the day for a short period of time), intensive case management (health care professionals coordinate services and support for the children), therapeutic foster care (children live with specially trained foster parents) or residential care with inpatient care (children live in a residence, but not a hospital, which provides mental health care services).
The studies evaluated four different types of services. In Multisystemic therapy (MST) at home, therapists provide therapy to the child and the family together in their home. Some behaviours in the children, improved with MST. They also spent fewer days out of school and in hospital. Intensive home treatment provides children with therapy in their home to solve problems with the way they interact with other people in the home and to improve their psychological symptoms. Children who received this type of service did not improve any more than children who did not. Intensive home based crisis intervention (Homebuilders model for crisis intervention), focuses on the child and family to learn skills in relationship building, reframing problems, anger management, communication, and cognitive behavioural therapy. Children with this service had small improvements. Specialist outpatient services are provided by a range of health care professionals in clinics. Children who received this service did not improve any more than children who did not.
The quality of some of the studies was not high and most did not have enough people to evaluate the true effect of the services. The evidence we now have provides very little guidance for the development of these types of services.