Provisions for acute specialist care

Specialist care of acute psychiatric disorder requires community teams, supported by out-patient, day patient, and in-patient provisions.

Home-based care - Home-based care also aims to assess and treat patients in their homes. However, the psychiatric team is less well staffed than an ACT team, and depends more on collaboration with the primary care teams responsible for the patients. This approach is appropriate for patients with less severe disorders than some of those treated with ACT or admitted to day hospitals. Also, the approach requires well-developed primary care teams, and probably for this reason has been evaluated only in the UK . Two randomized controlled trials found that admission to hospital was reduced, with no worsening of clinical or social outcome and no evidence of lack of safety. Costs were less than those of the comparison group. Caution is needed when applying to routine practice the findings of clinical trials in which highly motivated staff work for a limited period

Also, all the studies confirmed the need for some beds for the treatment of the acute stage of illness; intensive home care can reduce- the number of beds needed, but a basic requirement remains.

Out-patient clinics - Although it is often helpful for a psychiatrist to treat patients with acute psychiatric disorders in general practice work in a central clinic has two important advantages: first, professional staff spends less time travelling and more delivering treatment; second, a senior person is available immediately when less experienced staff need advice. The disadvantages of out-patient clinics are that patients and relatives may have to make long journeys and may be less likely to attend regularly.

Day hospitals

In-patient units

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