Equipos comunitarios de salud mental (ECSM) para personas con enfermedades mentales graves y trastornos de personalidad

Antecedentes: El cierre de asilos e instituciones para pacientes con enfermedades mentales, acompañado de las políticas gubernamentales que se centran en la reducción del número de camas hospitalarias para los pacientes con enfermedades mentales graves y que están a favor de la prestación de asistencia en una variedad de ámbitos extrahospitalarios, respalda el fundamento para la atención comunitaria. Un paso importante hacia la atención comunitaria ha sido el desarrollo de equipos comunitarios de salud mental (ECSM). Objetivos: Evaluar la efectividad de los Equipos Comunitarios de Salud Mental (ECSM) en el tratamiento de cualquier tipo de enfermedad mental grave en comparación con el tratamiento estándar de estas enfermedades sin estos equipos. (AU)

Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality.

BACKGROUND: Closure of asylums and institutions for the mentally ill, coupled with government policies focusing on reducing the number of hospital beds for people with severe mental illness in favour of providing care in a variety of non-hospital settings, underpins the rationale behind care in the community. A major thrust towards community care has been the development of community mental health teams (CMHT). OBJECTIVES: To evaluate the effects of community mental health team (CMHT) treatment for anyone with serious mental illness compared with standard non-team management. SEARCH STRATEGY: We searched The Cochrane Schizophrenia Group Trials Register (March 2006). We manually searched the Journal of Personality Disorders, and contacted colleagues at ENMESH, ISSPD and in forensic psychiatry. SELECTION CRITERIA: We included all randomised controlled trials of CMHT management versus non-team standard care. DATA COLLECTION AND ANALYSIS: We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a fixed effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a fixed effects model. MAIN RESULTS: CMHT management did not reveal any statistically significant difference in death by suicide and in suspicious circumstances (n=587, 3 RCTs, RR 0.49 CI 0.1 to 2.2) although overall, fewer deaths occurred in the CMHT group. We found no significant differences in the number of people leaving the studies early (n=253, 2 RCTs, RR 1.10 CI 0.7 to 1.8). Significantly fewer people in the CMHT group were not satisfied with services compared with those receiving standard care (n=87, RR 0.37 CI 0.2 to 0.8, NNT 4 CI 3 to 11). Also, hospital admission rates were significantly lower in the CMHT group (n=587, 3 RCTs, RR 0.81 CI 0.7 to 1.0, NNT 17 CI 10 to 104) compared with standard care. Admittance to accident and emergency services, contact with primary care, and contact with social services did not reveal any statistical difference between comparison groups. AUTHORS' CONCLUSIONS: Community mental health team management is not inferior to non-team standard care in any important respects and is superior in promoting greater acceptance of treatment. It may also be superior in reducing hospital admission and avoiding death by suicide. The evidence for CMHT based care is insubstantial considering the massive impact the drive toward community care has on patients, carers, clinicians and the community at large.