Alternatives to inpatient mental health care for children and young people

Evidence Summaries

Level of Evidence = D
There is insufficient evidence from controlled trials on the alternatives to inpatient mental health care for children and young people.

A Cochrane review 1 included 7 studies with a total of 799 subjects. The studies evaluated four distinct models of care: multi-systemic therapy (MST) at home, specialist outpatient service, intensive home treatment and intensive home-based crisis intervention ('Homebuilders' model for crisis intervention). Young people receiving home-based MST experienced some improved functioning in terms of externalising symptoms and they spent fewer days out of school and out-of-home placement. At short term follow up the control group had a greater improvement in terms of adaptability and cohesion; this was not sustained at four months follow up. There were small, significant patient improvements reported in both groups in the trial evaluating the intensive home-based crisis intervention using the 'Homebuilders' model. No differences at follow up were reported in the two trials evaluating intensive home treatment, or in the trials evaluating specialist outpatient services.

Comment: The evidence is downgraded by by study quality (inadequate or unclear allocation concealment) and by by indirectness (differences in studied interventions).

References

1. Shepperd S, Doll H, Gowers S, James A, Fazel M, Fitzpatrick R, Pollock J. Alternatives to inpatient mental health care for children and young people. Cochrane Database Syst Rev 2009 Apr 15;(2):CD006410.  [PMID:19370634]


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