Lamb Clare E
North Wales Adolescent Service, North Wales NHS Trust, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK.
Curr Opin Psychiatry. 2009 Jul;22(4):345-50. doi: 10.1097/YCO.0b013e32832c9082.
To review the evidence on alternatives to inpatient mental healthcare for children and adolescents requiring intensive treatment for severe and complex mental health problems.
Systematic reviews of intensive case management in adult mental healthcare conclude that intensive treatment models such as assertive community treatment and crisis resolution teams improve patient satisfaction and reduce hospital use in some circumstances. The relatively few studies on children suggest that intensive community-based services can be as effective as inpatient care for certain groups. However, the mental health needs of the young people involved in the studies, their social and family circumstances and the context of local mental health provision varied greatly.
There is little high-quality research into the effectiveness of alternatives to inpatient care for young people requiring intensive treatment for complex, severe mental health problems. Studies support the use of alternatives to inpatient admission for particular groups of young people and suggest a need for a combination of complementary models of specialist intensive provision. There is insufficient evidence on which to base decisions on which model is best for which group of young people and randomized control studies are urgently needed.
回顾针对患有严重复杂心理健康问题且需要强化治疗的儿童和青少年，提供住院精神卫生保健替代方案的相关证据。
对成人精神卫生保健中强化个案管理的系统评价得出结论，在某些情况下，诸如积极社区治疗和危机解决团队等强化治疗模式可提高患者满意度并减少住院次数。针对儿童的研究相对较少，表明基于社区的强化服务对某些群体而言可与住院治疗同样有效。然而，参与研究的年轻人的心理健康需求、他们的社会和家庭状况以及当地精神卫生服务的背景差异很大。
对于患有复杂、严重心理健康问题且需要强化治疗的年轻人，住院治疗替代方案有效性的高质量研究很少。研究支持针对特定年轻人群体采用住院治疗替代方案，并表明需要结合多种互补的专科强化服务模式。目前尚无足够证据来决定哪种模式最适合哪类年轻人，因此迫切需要进行随机对照研究。
