Tyrer P, Coid J, Simmonds S, Joseph P, Marriott S
Paterson Centre, 20 South Wharf Road, Paddington, London, UK, W2 1PD.
Cochrane Database Syst Rev. 2000(2):CD000270. doi: 10.1002/14651858.CD000270.
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).
To evaluate the effects of community mental health team (CMHT) treatment for anyone with serious mental illness.
Electronic searches of Biological Abstracts (1982-1997), the Cochrane Library (1998, Issue 2), EMBASE (1980-1997), MEDLINE (1966-1997), PsycLIT (1974-1997) and SCISEARCH (1997) were undertaken. The Journal of Personality Disorders was hand searched, and contact was made with colleagues at ENMESH, ISSPD and in forensic psychiatry.
All randomised or quasi-randomised controlled trials of CMHT management versus non-team standard care.
The selection of trials, assessment of quality and data extraction was undertaken independently and in parallel by two reviewers. Where possible the data were entered into RevMan and an intention-to-treat analysis undertaken. Tests of heterogeneity were undertaken.
CMHT management may be associated with fewer deaths by suicide and in suspicious circumstances (OR 0.32 CI 0.09-1.12). It causes less people to be dissatisfied with their care (OR 0.34 CI 0.2-0.59) and to leave the studies early (OR 0.61 CI 0.45-0.83). No clear difference was found in admission rates, overall clinical outcomes and duration of in-patient hospital treatment, although this was partly a consequence of poorly presented data.
REVIEWER'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.
精神病院和机构的关闭，以及政府政策侧重于减少为重症精神病患者提供的医院病床数量，转而支持在各种非医院环境中提供护理，这构成了社区护理背后的基本原理。社区护理的一个主要推动力是社区精神卫生团队（CMHT）的发展。
评估社区精神卫生团队（CMHT）治疗对任何重症精神病患者的效果。
对《生物学文摘》（1982 - 1997年）、《考科蓝图书馆》（1998年第2期）、《荷兰医学文摘数据库》（1980 - 1997年）、《医学索引》（1966 - 1997年）、《心理学文摘》（1974 - 1997年）和《科学引文索引》（1997年）进行了电子检索。对《人格障碍杂志》进行了手工检索，并与欧洲精神分裂症研究网络（ENMESH）、国际人格障碍研究学会（ISSPD）以及法医精神病学领域的同事进行了联系。
所有关于社区精神卫生团队管理与非团队标准护理对比的随机或半随机对照试验。
两名评审员独立且并行地进行试验选择、质量评估和数据提取。尽可能将数据录入RevMan软件并进行意向性分析。进行了异质性检验。
社区精神卫生团队管理可能与自杀及可疑情况下的死亡人数减少相关（比值比0.32，可信区间0.09 - 1.12）。它使较少的人对护理不满意（比值比0.34，可信区间0.2 - 0.59），并减少提前退出研究的人数（比值比0.61，可信区间0.45 - 0.83）。在住院率、总体临床结局和住院治疗时长方面未发现明显差异，不过这部分是数据呈现不佳的结果。
社区精神卫生团队管理在任何重要方面都不逊色于非团队标准护理，且在促进对治疗的更高接受度方面更具优势。在减少住院和避免自杀死亡方面可能也更具优势。
