Residential alternatives to hospital

Inpatient mental-health services are unpopular with patients. They often fail to address individuals' needs or provide a safe or therapeutic environment. However, home treatment is not always appropriate, either because of the levels of risk to patients and others involved, or because people's domestic circumstances are part of the problem not part of the solution. Researchers at University College London and the Institute of Psychiatry looked at research into residential alternatives to psychiatric hospitals. One was Soteria houses, developed by Loren Mosher in California in the 1970s. In these houses primary staff are not clinically-trained but work long shifts designed to help them attune to, and engage with, residents. Staff and service users share responsibility for household tasks and there is minimal reliance on antipsychotic medication. Other studies looked at crisis houses and schemes where service users are placed with individual families. In these schemes the host family support one or two acutely-ill people with training and assistance from local crisis services. Individuals are involved in a normal family environment with participation in meals and other domestic tasks and activities, a model which has been used on a small scale in Powys, Wales. The review found that there was no evidence to suggest these schemes were harmful and some preliminary evidence to suggest that they were cheaper than hospital and that service users were more satisfied. The researchers concluded that 'residential crisis services may provide a feasible and acceptable alternative to hospital admission for some people with acute mental illness.'

Lloyd-Evans, Brynmor ... [et al] - Residential alternatives to acute psychiatric hospital admission: systematic review British Journal of Psychiatry August 2009, 195(2), 109-117