Community alternatives to acute inpatient care for severe psychiatric patients

Community psychiatry has mainly relied upon intermediate long term care services while there is a large gap between patient's needs and availability of acute care services. Taking this into consideration, the main aim of this paper is to review the evidence supporting the efficacy and feasibility of implementing the new models of care developed to fulfil the gap in the provision of community and hospital care for acute and severely ill patients. Finally the paper will propose a "care balanced approach" to integrate the key elements of the new alternatives of acute community and hospital care in the mental health system.

A review of the current literature was used to identify the key components of acute care for psychiatric illness. For this purpose Medline (1966-2010), EMBASE (1980-2010), and PsycINFO (1985-2010) databases were reviewed using key terms relating to assertive outreach, home treatment/crisis resolution, psychiatric acute day care, deinstitutionalization, Mental Health Service Models.

Three main types of acute care have been identified: Acute Continuous Day Care (ACDC) -day hospitals -, Assertive Outreach Care (AOC) -Assertive Community and Assertive Outreach teams-, and Home Acute Care (HAC) -Crisis resolution, Home treatment teams-. The feasibility of these alternatives is supported by available evidence. Although these acute care alternatives may be complementary and could be combined for achieving a greater positive impact on the clinical and social recovery of the patients, there are usually implemented independently.

An integrative acute care subsystem combining these three strategies in a balanced care system should be formally incorporated to the advanced community model in mental health care.