The authors examined the effectiveness of compulsory community treatment for people with severe mental illness through a systematic review of all relevant randomised controlled clinical trials. Only two relevant trials were found and these provided little evidence of efficacy on any outcomes such as health service use, social functioning, mental state, quality of life or satisfaction with care. No data were available for cost and unclear presentation of data made it impossible to assess the effect on mental state and most aspects of satisfaction with care. In terms of numbers needed to treat, it would take 85 outpatient commitment orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest.
The authors examined the effectiveness of compulsory community treatment for people with severe mental illness through a systematic review of all relevant randomised controlled clinical trials. Only two relevant trials were found and these provided little evidence of efficacy on any outcomes such as health service use, social functioning, mental state, quality of life or satisfaction with care. No data were available for cost and unclear presentation of data made it impossible to assess the effect on mental state and most aspects of satisfaction with care. In terms of numbers needed to treat, it would take 85 outpatient commitment orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest.
Extended abstract:
Author
KISLEY S.; CAMPBELL L.A.; PRESTON N.; Title
Compulsory community and involuntary outpatient treatment for people with severe mental disorders: review Publisher
Cochrane Collaboration, 2005
Summary
The authors examined the effectiveness of compulsory community treatment for people with severe mental illness through a systematic review of all relevant randomised controlled clinical trials. Only two relevant trials were found and these provided little evidence of efficacy on any outcomes such as health service use, social functioning, mental state, quality of life or satisfaction with care. No data were available for cost and unclear presentation of data made it impossible to assess the effect on mental state and most aspects of satisfaction with care. In terms of numbers needed to treat, it would take 85 outpatient commitment orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest. Context
There is controversy as to whether compulsory community treatment for people with severe mental illnesses reduces health service use, or improves clinical outcome and social functioning. Given the widespread use of such powers it is important to assess the effects of this type of legislation.
Contents
The report begins with an abstract summarising the background and objectives, describing the search strategy, selection criteria and data collection and analysis, and giving the main results and authors' conclusions. This is followed by a synopsis and description of the background, objectives, criteria for considering studies for the review, search strategy and methods. The studies are described and methodological quality discussed. This is followed by the results, discussion and authors conclusions, references, and tables of characteristics of included and excluded studies and additional tables and graphs.
Conclusion
Based on current evidence, community treatment orders may not be an effective alternative to standard care. It appears that compulsory community treatment results in no significant difference in service use, social functioning or quality of life compared with standard care. There is currently no evidence of cost effectiveness. People receiving compulsory community treatment were, however, less likely to be victims of violent or non-violent crime. It is, nevertheless, difficult to conceive of another group in society that would be subject to measures that curtail the freedom of 85 people to avoid one hospital admission or 238 to prevent one arrest. Further, good quality randomised controlled studies are urgently required to consolidate findings and establish whether it is the intensity of treatment in compulsory community treatment or its compulsory nature that affects outcome. Evaluation of a wide range of outcomes should be included if this type of legislation is introduced.
77 references
Subject terms:
involuntary clients, literature reviews, medical treatment, mental health problems, randomised controlled trials, community care, compulsory treatment;
Social Work in Health Care, 25(3), 1997, pp.25-36.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Reviews the contemporary literature on early psychiatric social work. Then discusses the mental hygiene movement and early psychiatric social work practice. Concludes with a consideration of the changes in psychiatric social work which accompanied World War I.
Reviews the contemporary literature on early psychiatric social work. Then discusses the mental hygiene movement and early psychiatric social work practice. Concludes with a consideration of the changes in psychiatric social work which accompanied World War I.
Subject terms:
literature reviews, mental health problems, psychiatric social work, social work, social work history, social work methods, community care;
Health and Social Care in the Community, 30(4), 2022, pp.1286-1306.
Publisher:
Wiley
Despite apparent need, many older people with cognitive impairment and/or mental health needs do not fully engage with social care. This can manifest in different ways, including passive or aggressive attempts to avoid or repel care workers. However, little is known about how to support such individuals in their own homes and deliver effective care. Against this background, the researchers undertook a scoping review with a view to developing a preliminary theory of change suggesting how care might be modified to engage this client group. The most recent search was conducted on 21/04/21. Papers were included if they (i) focused on older people (65+) living at home with social care needs and (ii) described difficulties/problems with the provision/receipt of social care associated with individuals’ mental health needs. Twenty-six citations were identified through electronic database searches and reference screening, and the results were charted according to key theory of change concepts (long-term outcomes, preconditions, interventions, rationale and assumptions). All the included papers were related to people with dementia. Four subgroups of papers were identified. The first highlights those external conditions that make it more likely an intervention will be successful; the second describes specific interventions to engage older people who by virtue of their mental health needs have not engaged with social care; the third explores what services can be done to increase service uptake by older people with mental health needs and their caregivers more generally; and the fourth details theoretical approaches to explaining the behaviour of people with dementia. Each provides information that could be used to inform care delivery and the development of interventions to improve engagement with health and social care for these individuals. The study concludes that different framing of engagement difficulties, such as that offered through positioning theory, may assist in future service design.
(Edited publisher abstract)
Despite apparent need, many older people with cognitive impairment and/or mental health needs do not fully engage with social care. This can manifest in different ways, including passive or aggressive attempts to avoid or repel care workers. However, little is known about how to support such individuals in their own homes and deliver effective care. Against this background, the researchers undertook a scoping review with a view to developing a preliminary theory of change suggesting how care might be modified to engage this client group. The most recent search was conducted on 21/04/21. Papers were included if they (i) focused on older people (65+) living at home with social care needs and (ii) described difficulties/problems with the provision/receipt of social care associated with individuals’ mental health needs. Twenty-six citations were identified through electronic database searches and reference screening, and the results were charted according to key theory of change concepts (long-term outcomes, preconditions, interventions, rationale and assumptions). All the included papers were related to people with dementia. Four subgroups of papers were identified. The first highlights those external conditions that make it more likely an intervention will be successful; the second describes specific interventions to engage older people who by virtue of their mental health needs have not engaged with social care; the third explores what services can be done to increase service uptake by older people with mental health needs and their caregivers more generally; and the fourth details theoretical approaches to explaining the behaviour of people with dementia. Each provides information that could be used to inform care delivery and the development of interventions to improve engagement with health and social care for these individuals. The study concludes that different framing of engagement difficulties, such as that offered through positioning theory, may assist in future service design.
(Edited publisher abstract)
Subject terms:
service uptake, older people, cognitive impairment, community care, health needs, home care, intervention, literature reviews, mental health problems, service provision;
Health and Social Care in the Community, 30(1), 2022, pp.27-57.
Publisher:
Wiley
Background: Mental health concerns in older adults are common, with increasing age-related risks to physical health, mobility and social isolation. Community-based approaches are a key focus of public health strategy in the UK, and may reduce the impact of these risks, protecting mental health and promoting wellbeing. The researchers conducted a review of UK community-based interventions to understand the types of intervention studied and mental health/wellbeing impacts reported. Method: the researchers conducted a scoping review of the literature, systematically searching six electronic databases (2000–2020) to identify academic studies of any non-clinical community intervention to improve mental health or wellbeing outcomes for older adults. Data were extracted, grouped by population targeted, intervention type, and outcomes reported, and synthesised according to a framework categorising community actions targeting older adults. Results: In total, 1,131 full-text articles were assessed for eligibility and 54 included in the final synthesis. Example interventions included: link workers; telephone helplines; befriending; digital support services; group social activities. These were grouped into: connector services, gateway services/approaches, direct interventions and systems approaches. These interventions aimed to address key risk factors: loneliness, social isolation, being a caregiver and living with long-term health conditions. Outcome measurement varied greatly, confounding strong evidence in favour of particular intervention types. Conclusion: The literature is wide-ranging in focus and methodology. Greater specificity and consistency in outcome measurement are required to evidence effectiveness – no single category of intervention yet stands out as ‘promising’. More robust evidence on the active components of interventions to promote older adult's mental health is required.
(Edited publisher abstract)
Background: Mental health concerns in older adults are common, with increasing age-related risks to physical health, mobility and social isolation. Community-based approaches are a key focus of public health strategy in the UK, and may reduce the impact of these risks, protecting mental health and promoting wellbeing. The researchers conducted a review of UK community-based interventions to understand the types of intervention studied and mental health/wellbeing impacts reported. Method: the researchers conducted a scoping review of the literature, systematically searching six electronic databases (2000–2020) to identify academic studies of any non-clinical community intervention to improve mental health or wellbeing outcomes for older adults. Data were extracted, grouped by population targeted, intervention type, and outcomes reported, and synthesised according to a framework categorising community actions targeting older adults. Results: In total, 1,131 full-text articles were assessed for eligibility and 54 included in the final synthesis. Example interventions included: link workers; telephone helplines; befriending; digital support services; group social activities. These were grouped into: connector services, gateway services/approaches, direct interventions and systems approaches. These interventions aimed to address key risk factors: loneliness, social isolation, being a caregiver and living with long-term health conditions. Outcome measurement varied greatly, confounding strong evidence in favour of particular intervention types. Conclusion: The literature is wide-ranging in focus and methodology. Greater specificity and consistency in outcome measurement are required to evidence effectiveness – no single category of intervention yet stands out as ‘promising’. More robust evidence on the active components of interventions to promote older adult's mental health is required.
(Edited publisher abstract)
Subject terms:
older people, systematic reviews, literature reviews, community care, intervention, prevention, mental health problems, mental health education, outcomes, wellbeing, mental health;
Journal of Mental Health, 28(2), 2019, pp.189-197.
Publisher:
Taylor and Francis
Place of publication:
London
Background: Despite significant need for mental health services targeting the requirements of inmates transitioning into the community there is little research about successful recovery-oriented or person-centred transition programs. Aims: This systematic narrative review brings together existing evidence to inform policymakers and practitioners about current practice in transition support, and barriers and facilitators of effective practice. Method: We carried out a systematic narrative review of recovery-oriented or person-centred mental health support programs supporting transition from incarceration to the community. Results were obtained from a systematic search of Medline, PubMed and Scopus databases. Results: We found 23 papers which met the paper inclusion criteria along with four other papers which were identified incidentally. Conclusions: Identified barriers to the implementation of effective transition support programs are: administrative problems leading to ineffective in-reach into correctional facilities or untimely support, lack of support for immediate needs meaning that inmates deprioritise their mental health needs, a lack of ongoing program resources and poor communication between correctional facilities and mental health services. Enablers for transition reflect the inverse of these barriers, alongside other successful strategies including medical home models, regionalised programs, programs which target connections with primary care, nurse-led patient-centred health programs and peer support initiatives.
(Edited publisher abstract)
Background: Despite significant need for mental health services targeting the requirements of inmates transitioning into the community there is little research about successful recovery-oriented or person-centred transition programs. Aims: This systematic narrative review brings together existing evidence to inform policymakers and practitioners about current practice in transition support, and barriers and facilitators of effective practice. Method: We carried out a systematic narrative review of recovery-oriented or person-centred mental health support programs supporting transition from incarceration to the community. Results were obtained from a systematic search of Medline, PubMed and Scopus databases. Results: We found 23 papers which met the paper inclusion criteria along with four other papers which were identified incidentally. Conclusions: Identified barriers to the implementation of effective transition support programs are: administrative problems leading to ineffective in-reach into correctional facilities or untimely support, lack of support for immediate needs meaning that inmates deprioritise their mental health needs, a lack of ongoing program resources and poor communication between correctional facilities and mental health services. Enablers for transition reflect the inverse of these barriers, alongside other successful strategies including medical home models, regionalised programs, programs which target connections with primary care, nurse-led patient-centred health programs and peer support initiatives.
(Edited publisher abstract)
Subject terms:
literature reviews, systematic reviews, mental health services, mental health care, mental health problems, service transitions, recovery, prisons, person-centred care, offenders, community care, rehabilitation;
This report provides a review of the literature on home based treatment for people with disabling mental illness, examining models of service, their effectiveness and outcomes for users and carers.There are two broad models: acute, community based alternatives to in patient care, and long term assertive outreach for those with the most severe and disabling mental illnesses. The key points pertinent to service development are also summarised.
This report provides a review of the literature on home based treatment for people with disabling mental illness, examining models of service, their effectiveness and outcomes for users and carers.There are two broad models: acute, community based alternatives to in patient care, and long term assertive outreach for those with the most severe and disabling mental illnesses. The key points pertinent to service development are also summarised.
Subject terms:
home care, literature reviews, mental health problems, models, outcomes, service development, severe mental health problems, social care provision, treatment, therapy and treatment, acute psychiatric care, assertive outreach, community care, crisis intervention;
Mental Health and Learning Disabilities Care, 3(9), May 2000, pp.299-303.
Publisher:
Pavilion
Government policy demands that the majority of people with mental illness are cared for in the community. Yet the implementation of this policy remains controversial and variable in outcome. Reviews the literature on recent developments in community mental health care, and the evidence for their relative effectiveness.
Government policy demands that the majority of people with mental illness are cared for in the community. Yet the implementation of this policy remains controversial and variable in outcome. Reviews the literature on recent developments in community mental health care, and the evidence for their relative effectiveness.
Subject terms:
literature reviews, mental health problems, mental health services, management, models, organisational structure, outcomes, policy, severe mental health problems, social care provision, community care, community mental health services, evidence-based practice, health care;
Journal of Mental Health, 8(5), October 1999, pp.431-440.
Publisher:
Taylor and Francis
Place of publication:
London
Public tolerance of, and non-discrimination towards, people with mental health problems are key factors on which success in achieving the goal of community mental health care depends. This paper tests Thomas Scheff's sociological theory of mental illness through a critical review of recent U.K literature on the subject. The review suggests that negative representations predominate in the media, while a significant minority of the U.K public seem to possess negative attitudes towards people with mental health problems and their care and social participation in the community.
Public tolerance of, and non-discrimination towards, people with mental health problems are key factors on which success in achieving the goal of community mental health care depends. This paper tests Thomas Scheff's sociological theory of mental illness through a critical review of recent U.K literature on the subject. The review suggests that negative representations predominate in the media, while a significant minority of the U.K public seem to possess negative attitudes towards people with mental health problems and their care and social participation in the community.
Subject terms:
literature reviews, mass media, mental health problems, public opinion, publicity, research methods, social policy, sociology, stereotyped attitudes, attitudes, community care, discrimination;