Twenty-four hour care for schizophrenia

Area of Science:

• Psychiatry
• Mental Health Services Research
• Rehabilitation

Background:

• Modern psychiatric care struggles to discharge some patients directly into the community.
• Twenty-four hour residential rehabilitation, a 'ward-in-a-house' model, has emerged alongside psychiatric hospital closures.

Purpose of the Study:

• To compare the effectiveness of 24-hour residential rehabilitation with standard hospital-based care.

Main Methods:

• A systematic review of randomized or quasi-randomized trials was conducted using the Cochrane Schizophrenia Group Trials Register.
• One study with 22 participants, evaluating a UK hostel ward for 'new long stay patients', was included.
• Data quality, selection, and extraction were performed, excluding studies with over 50% loss to follow-up.

Main Results:

• The single included study had methodological limitations but suggested hostel residents developed superior domestic skills and community engagement.
• One outcome, 'unable to manage in the placement', showed a non-significant increased risk in the hostel group (RR 7.0 CI 0.4 to 121.4).
• Economic data suggested the 24-hour care model might be less costly than standard hospital care.

Conclusions:

• The limited evidence suggests 24-hour residential rehabilitation may be cost-effective and beneficial for severe mental illness.
• Further rigorous trials are needed to confirm these preliminary findings, as current evidence is sparse.
• The review highlights the importance of early evaluation of innovative mental health service models before they are superseded.