Which of Community-Based Services are Effective for People with Psychiatric Disorders? A Review of Evidence

The study aimed at reviewing evidence of effectiveness and cost-effectiveness of community-based services for psychiatric disorders. Cochrane and PubMed bibliographic databases and reference lists of relevant studies were investigated. Systematic reviews and controlled randomized clinical trials were analyzed. The inclusion criteria were having effectiveness and cost-effectiveness scales for community-based services models. These scales were compared for services delivered to patients with mild severe and mild psychiatric disorders. Provided services were assertive community treatment، case management، home visit، crisis intervention services، prompting، patient and family education and supported employment. The effectiveness and cost-effectiveness of assertive community treatment and family education had the strongest evidence and were effective on hospital admission rate، duration of hospital stay and maintaining contact with treatment system. The evidence for other services were insufficient or contradictory. For the mild psychiatric disorders، the service models included screening of disorders and feedback alone، continuous medical education، using practice guidelines، telephone-based intervention/care، referral system and consultation- liaison service، internet-based prevention and treatment programs، school-based prevention program and collaborative care. The most effective and cost-effective models were collaborative and internet-based care programs. Some of the positive outcomes of interventions were symptom reduction، patient’s satisfaction and decrease in economic burden of disease on family. The evidence for the models of delivering services to patients with mild psychiatric disorders mainly support collaborative models for delivering services and for more severe disorders support active follow-up and family education. These models are effective and feasible to clinical outcomes with a desirable cost - effectiveness.