Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) Acute day hospital versus admission; (2) Vocational rehabilitation; (3) Day hospital versus outpatient care

Marshall M, Crowther R, Almaraz-Serrano A, Creed F, Sledge W, Kluiter H, Roberts C, Hill E, Wiersma D, Bond GR, Huxley P, Tyrer P
Record ID 32001000958
Authors' objectives:

The aim of this review was to assess the effectiveness and feasibility of day care for people with acute psychiatric disorders.

Authors' recomendations: (1) Acute day hospital versus admission for acute psychiatric disorders Acute day hospitals are an attractive option in situations where demand for inpatient care is high and facilities exist that are suitable for conversion. They are a less attractive option when demand for inpatient care is low and where effective alternatives already exist. The interpretation of day hospital research would be enhanced if future trials made use of the common set of outcome measures used in this review. It is important to examine how acute day hospital care can be most effectively integrated into a modern community-based psychiatric service. (2) Vocational rehabilitation for people with severe mental disorders The main finding was that Supported Employment (SEm) was more effective than Prevocational training (PVT) for patients suffering from a severe mental disorder who wanted to work. There was no evidence that PVT was more effective than standard community care or hospital care. The implication of these findings is that people suffering from mental disorders who want to work should be offered the option of SEm. Commissioning agencies would be justified in encouraging vocational rehabilitation (VR) providers to develop more SEm schemes. From a research perspective, the cost-effectiveness of SEm should be examined in larger multicentre trials, both within and outside the USA. There is a case for countries outside the USA to survey their existing VR services to determine the extent to which the most effective interventions are being offered. (3) Day hospital versus outpatient care for patients with psychiatric disorders There was some limited evidence to support the use of day treatment programme for patients with anxiety or depression who have not responded to standard outpatient treatment. Future research should address the feasibility of day treatment programmes and how far they are cost-effective against other alternatives, such as outpatient cognitive behavioural therapy. There was no evidence to support the use of day hospitals as day care centres.
Authors' methods: Systematic review
Project Status: Completed
URL for project:
Year Published: 2001
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Patient Care
  • Rehabilitation, Vocational
  • Psychotic Disorders
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name:
Contact Email:
Copyright: 2001 Queen's Printer and Controller of HMSO
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.