Inpatient treatment and care arrangements to replace or avoid it - Searching for an evidence-based balance

In several countries, it seems to be policy to strive for a mental health system dominated by variants of community care replacing hospital care and culminating in closure of hospitals. Scientific evidence shows that no form of community care for the seriously mentally ill can do without the hospital, but also indicates compellingly that hospital care can be replaced or avoided by community alternatives, although only partially so. The randomized controlled trials that have produced such evidence are reviewed. Emphasis is placed on the convergence of findings across trials, their generalisability and the degree to which community alternatives succeeded in avoiding or replacing inpatient treatment. The results of the review are confronted with the justified demand for an evidence-based mental health system.