Evaluation of community services.

Implementation and expansion of community-based psychiatric services was followed by a wide range of positive and negative effects. Differences seem due to scale and speed of implementation, to proper coordination with closing down mental hospitals, but also to differences in goals and expectations as well as methods applied to reach them. An analysis of empirical evaluation studies reveals a series of conceptual and methodological difficulties. Operational research has been limited so far by the scarcity of controlled studies and especially of multicenter coordinated research. The same is true for evaluation using external criteria, for instance evaluation of utilization data, of unintentional side-effects etc. The preventive effects of community psychiatry are practically not evaluated on the levels of primary and secondary prevention. On the other hand, important studies have been made on the transfer of care from mental hospitals to alternative care, especially in nursing and boarding homes; its results reveal an important deficit of adequate care for those who have been deinstitutionalized but without profiting from the community mental health movement. The conclusions concern the reorientation of goals for community psychiatry, the priorities of care in times of limited resources, and the specifications for evaluative research in the future.