Frequency and predictors of adverse events. PRiSM Psychosis Study. 3

Community care has been criticised as a hazardous policy associated with high rates of adverse events. There is little research evidence as to the truth of this claim.

Best available evidence from public records, interviews, case notes, key workers and general practitioners was assembled to establish: (a) which of the 514 subjects initially identified as having psychotic illnesses had died during an average follow-up of 4.9 years; (b) care currently received by all 286 subjects originally selected for interview; and (c) rates of major adverse events and of admission for these 286 individuals.

Twenty-eight natural and II unnatural deaths had occurred. Among subjects still living at the end of the follow-up, 84% were in contact with specialist mental health services and 11% only with primary care services. Rates of serious violence, imprisonment and homelessness were relatively low. Forty-one per cent had been admitted at least once during a mean follow-up of 3.2 years and 20% at least once under the Mental Health Act. After adjustment, there were no significant differences between standard and intensive care sectors.

Rates of adverse events and 'slipping through the net' are relatively low among individuals receiving community-based services, whether intensive or standard care.