Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality

Background Closure of asylums and institutions for the mentally ill, coupled with government policies focusing on reducing the number of hospital beds for people with severe mental illness in favour of providing care in a variety of non- hospital settings, underpins the rationale behind care in the community. A major thrust towards community care has been the development of community mental health teams ( CMHT). Objectives To evaluate the effects of community mental health team ( CMHT) treatment for anyone with serious mental illness compared with standard non- team management. Search strategy We searched The Cochrane Schizophrenia Group Trials Register ( March 2006). We manually searched the Journal of Personality Disorders, and contacted colleagues at ENMESH, ISSPD and in forensic psychiatry. Selection criteria We included all randomised controlled trials of CMHT management versus non- team standard care. Data collection and analysis We extracted data independently. For dichotomous data we calculated relative risks ( RR) and their 95% confidence intervals ( CI) on an intention- to- treat basis, based on a fixed effects model. We calculated numbers needed to treat/ harm ( NNT/ NNH) where appropriate. For continuous data, we calculated weighted mean differences ( WMD) again based on a fixed effects model. Main results CMHT management did not reveal any statistically significant difference in death by suicide and in suspicious circumstances ( n= 587, 3 RCTs, RR 0.49 CI 0.1 to 2.2) although overall, fewer deaths occurred in the CMHT group. We found no significant differences in the number of people leaving the studies early ( n= 253, 2 RCTs, RR 1.10 CI 0.7 to 1.8). Significantly fewer people in the CMHT group were not satisfied with services compared with those receiving standard care ( n= 87, RR 0.37 CI 0.2 to 0.8, NNT 4 CI 3 to 11). Also, hospital admission rates were significantly lower in the CMHT group ( n= 587, 3 RCTs, RR 0.81 CI 0.7 to 1.0, NNT 17 CI 10 to 104) compared with standard care. Admittance to accident and emergency services, contact with primary care, and contact with social services did not reveal any statistical difference between comparison groups. Author's conclusions Community mental health team management is not inferior to non- team standard care in any important respects and is superior in promoting greater acceptance of treatment. It may also be superior in reducing hospital admission and avoiding death by suicide. The evidence for CMHT based care is insubstantial considering the massive impact the drive toward community care has on patients, carers, clinicians and the community at large.