Question: In adults with mental health conditions in secure services who are being discharged into the community, how effective are extensive follow up systems/services, compared to no or minimal follow up systems/services, in reducing re-admittance to inpatient care?

Answer:

Plain language summary

There is limited high quality evidence that demonstrates that follow up services are effective in reducing re-admittance to inpatient care. More rigorous research is needed in this area.

Clinical and research implications

One moderate quality and two low quality randomised controlled trials (RCTs) showed no evidence that continued involuntary outpatient commitment, a model of integrated care, or a cognitive behavioural therapy program reduced  re-admittance to inpatient care or prison. Overall, there was a lack of high quality evidence, particularly with regards to follow-up services in the UK as the evidence was from RCTs conducted in the USA and Switzerland.

One RCT recommended that the use of outpatient commitment is not a substitute for intensive treatment as to be effective it needs a substantial commitment of treatment resources (Swartz et al. (1999). The number of re-admissions was not the primary outcome in any of the RCTs and the follow-up periods may have been too short to detect differences in admission rates so further research using follow-up over several years is required. Further research into the needs of women with mental health conditions in prison is also needed.

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