Peer support

What is peer support?

Peer support involves providing support or services to people with mental health problems by other people who have experienced mental health problems. Peer support may promote confidence and hope through sharing experiences and modelling recovery and coping strategies. The potential for recipients of peer support to provide reciprocal support may also be empowering and of therapeutic value.

What is the evidence for peer support?

With unidirectional peer support, moderate to low quality evidence suggests a small effect of improved recovery and hope at the end of treatment and at follow-up, and improved depression and anxiety, quality of life, and empowerment at follow-up only. No differences were reported between unidirectional peer support and standard care in psychotic symptoms, hospitalisation or satisfaction with services. With bidirectional mutual support, moderate to low quality evidence suggests a medium-sized effect of improved depression and anxiety, and a large effect of improved quality of life and empowerment at the end of treatment. No differences were reported between bidirectional peer support and standard care in recovery or hospitalisation rates. Moderate to low quality evidence suggests a medium-sized effect of less satisfaction with services with peer delivered services compared to standard delivery.

 

June 2016

User-held records

What are user-held records?

User-held information is where the patient holds information about their care. Providing people with information about their care increases feelings of involvement in treatment, and should increase satisfaction and participation with services, ensure early treatment and prevent hospital admission. Some research suggests that while many people decline the offer of a user-held record, the majority of those who carry their records report this to be useful.

What is the evidence for user-held records?

Moderate quality evidence suggests no benefit of user-held records over standard care for a reduction in hospital re-admissions.

 

June 2016

Inpatient and outpatient care

What is inpatient and outpatient care?

Treatment that is provided to patients in a home environment, community or outpatient mental health facility are more commonly provided for patients in chronic or stable phases of the disorder. Treatments are integrated as part of a comprehensive program in conjunction with ongoing medication. Patients in a more acute phase of illness are usually treated through psychiatric inpatient hospital services.

 

What is the evidence for inpatient care and outpatient care?

Moderate to low quality evidence suggests improved overall symptoms and social adjustment with home-based crisis intervention by 20 months, reduced unsociable behaviour, agitation, and disorientation by 4-6 months, and reduced family burden and disruption by 3 months (but not 6 months). Patients and their relatives also report greater satisfaction with treatment with home-based crisis intervention compared to hospitalisation.

Moderate to low quality evidence suggests community care involving assertive community treatment, intensive case management, or educational support, may provide some benefit over standard care or case management for treatment adherence. Community care plus family interventions may reduce the rate of transition to psychosis in the short term (< 1 year), but not the longer term (> 1 year) in people at an ultra-high risk of psychosis. There is some benefit of community based mental health programs in low and middle income countries for improving symptoms, and reducing relapse rates and disability.

Moderate quality evidence suggests day hospitals may have short-term benefit for global functioning and employment rates compared to outpatient care. Moderate to low quality evidence suggests there is longer duration of treatment in day hospitals compared to inpatient care.

Moderate to low quality evidence suggests inpatients who abscond from hospital are often young men in the first three weeks following admission. Absconding may occur in up to 34% of admissions, and up to 80% of absconders return within 24 hours. A large proportion of absconders indicate intent to leave, and most commonly abscond directly from the ward. There is insufficient evidence regarding interventions for preventing absconding.

Moderate quality evidence suggests some benefit of cognitive behavioural therapy provided in hospital settings for reducing symptom severity in patients with acute recent-onset psychosis. Moderate to low quality evidence suggests pre- and post-discharge transitional programs may reduce psychiatric hospital readmissions by 1 – 2 years after discharge, particularly transitioning programs that involve a psychoeducation component and that provide transition managers who start their relationship with the patient pre-discharge and follow through until the patient is settled in the community. Moderate to high quality evidence suggests patients with hospital stays between 1 week and 1 month are more likely to be unemployed by 1 to 2 years after hospitalisation than patients with hospital stays over 2 months.

 

April 2016

Supported housing

What is supported housing? 

Support housing services may include group homes, hostels, therapeutic communities, or supported independent tenancies, and incorporate availability of outreach care workers who visit or who are located on-site. These programs are designed to support people with severe mental disorders such as schizophrenia living in the community, who are not living with family or in residential care, in order to increase independence, quality of life, and achieve greater social and community functioning.

What is the evidence for supported housing programs?

Low quality evidence is unclear as to the benefit of supported housing for improving outcomes for people with schizophrenia and substance misuse.

 

June 2016

Home-based care

What is home-based care?

For people with schizophrenia, there are many options for receiving treatment. For patients in chronic or stable phases of the illness, some interventions and treatments can be provided in a home environment. These types of interventions are integrated as part of a comprehensive treatment program in conjunction with ongoing medication.

What is the evidence for home-based care?

High quality evidence suggests home-based crisis intervention increases rates of study retention in the medium term (6-12 months) and reduces family disruption, particularly in the short term compared to standard care. Moderate quality evidence suggests home-based crisis intervention may reduce rates of unsociable behaviour, agitation and disorientation, and may be associated with greater patient and relative satisfaction, and lower family burden compared to standard care.

 

June 2016

Day centres and day hospitals

What are day centres?

Day treatment programs and day hospitals are medically focused community-based units, often described as an intermediary between inpatient and outpatient hospital care. This type of program provides a more engaged, integrated treatment service than traditional outpatient units and incorporate diagnostic, medical/psychiatric, psychosocial, and prevocational treatment services.

What is the evidence for day centre programs?

Moderate to low quality evidence suggests there may be a longer duration of treatment in day hospitals compared to inpatient care. There appears to be no benefit of day hospitals over outpatient care for reducing hospital readmissions.

 

May 2016

Community care

What is community care?

Community care refers to community-based interventions that involve medication, psychosocial treatments, monitoring of clinical progress, and housing and supportive services. These programs encourage patients to establish meaningful relationships, occupations and activities, while also establishing routines at home. Community treatment may also involve involuntary outpatient commitment (compulsory community treatment) to ensure patients receive their necessary treatment.

What is the evidence for community care?

Moderate to high quality evidence suggests no differences between compulsory and voluntary community care in the number of hospital readmissions. Lower quality evidence also suggests no differences in the number of bed days, symptom severity or functioning. However, community care may  provide some benefit over standard care for improving treatment adherence, and may provide benefit in low and middle income countries for improving symptoms and disability, and for reducing relapse rates.

Barriers to feasibility of community care in low and middle  income countries include low education, lack of caregivers, resource constraints, and other logistical issues. Barriers to acceptability include fear of stigma and  lack of appreciation of intervention benefits. Facilitators of acceptability include satisfaction with, and appropriateness of, interventions, increased participation rates, and health worker characteristics (e.g. knowledge, trustworthiness, fluency in local  dialects, listening skills).

 

May 2016