CoChat
Sign Up
Cited by 101Psychiatric care and mental health servicesEmergency and Acute Care StudiesMental Health Treatment and Access

Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial

Open access
Ougrin, Dennis, Corrigall, Richard, Poole, Jason, Zundel, Toby, Sarhane, Mandy, Slater, Victoria, Stahl, Daniel, Reavey, Paula +9 more·2018·The Lancet Psychiatry
DOI 10.1016/s2215-0366(18)30129-9PMC PMC5994473
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Intensive community treatment to reduce dependency on adolescent psychiatric inpatient care is recommended in guidelines but has not been assessed in a randomised controlled trial in the UK. We designed a supported discharge service (SDS) provided by an intensive community treatment team and compared outcomes with usual care. METHODS: Eligible patients for this randomised controlled trial were younger than 18 years and had been admitted for psychiatric inpatient care in the South London and Maudsley NHS Foundation Trust. Patients were assigned 1:1 to either the SDS or to usual care by use of a computer-generated pseudorandom code with random permuted blocks of varying sizes. The primary outcome was number of inpatient bed-days, change in Strengths and Difficulties Questionnaire (SDQ) scores, and change in Children's Global Assessment Scale (CGAS) scores at 6 months, assessed by intention to treat. Cost-effectiveness was explored with acceptability curves based on CGAS scores and quality-adjusted life-years (QALYs) calculated from the three-level EuroQol measure of health-related quality of life (EQ-5D-3L), taking a health and social care perspective. This study is registered with the ISRCTN Registry, number ISRCTN82129964. FINDINGS: Hospital use at 6 months was significantly lower in the SDS group than in the usual care group (unadjusted median 34 IQR 17-63 vs 50 days, 19-125, p=0·04). The ratio of mean total inpatient days for usual care to SDS was 1·67 (95% CI 1·02-2·81, p=0·04), which decreased to 1·65 (0·99-2·77, p=0·057) when adjusted for differences in hospital use before randomisation. Scores for SDQ and CGAS did not differ between groups. The cost-effectiveness acceptability curve based on QALYs showed that the probability of SDS being cost-effective compared with usual care was around 60% with a willingness-to-pay threshold of £20 000-30 000 per QALY, and that based on CGAS showed at least 58% probability of SDS being cost-effective compared with usual care irrespective of willingness to pay. We recorded no adverse events attributable to SDS or usual care. INTERPRETATION: SDS provided by an intensive community treatment team reduced bed usage at 6 months' follow-up but had no effect on functional status and symptoms of mental health disorders compared with usual care. The possibility of preventing admissions, particularly through features such as reduced self-harm and improved reintegration into school, with intensive community treatment should be investigated in future studies. FUNDING: South London and Maudsley NHS Trust.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/s2215-0366(18)30129-9

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Intensive community treatment can reduce need for hospital admission among adolescents.

    “Intensive community treatment can reduce need for hospital admission among adolescents [42]”

    From Social media, internet use and suicide attempts in adolescents (2019) · cites this paper as [42]

    The Results (page unavailable) report fewer occupied hospital bed-days for adolescents receiving intensive community supported discharge than for those receiving usual care. But the Abstract’s Interpretation (page unavailable) says whether this treatment can prevent admissions should be investigated in future studies. Reduced hospital use is supported; a reduced need for admission is not established. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 1

  1. [18]NICE Guide to the methods of technology appraisal 2013 2013 National Institute of Health and Care Excellence London 27905712

Cited by

Sorted by citations

Related

Authors
Ougrin, D., Corrigall, R., Poole, J., Zundel, T., Sarhane, M., Slater, V., Stahl, D., Reavey, P., Byford, S., Heslin, M., Ivens, J., Crommelin, M., Abdulla, Z., Hayes, D., Middleton, K., Nnadi, B., & Taylor, E.
Affiliations
  • King's College London (GB)
  • South London and Maudsley NHS Foundation Trust (GB)
  • London South Bank University (GB)
Corresponding author
Ougrin, Dennis
ORCID
Venue
The Lancet Psychiatry
Publisher
Elsevier BV
Published
2018-06
Volume
5
Issue
6
Pages
477-485
ISSN
2215-0366 (ISSN-L)
DOI
10.1016/s2215-0366(18)30129-9
PMC
PMC5994473
OpenAlex
W2799609585
Cited by
101
References
31
Citations by year
2026: 7 · 2025: 11 · 2024: 15 · 2023: 9 · 2022: 3 · 2021: 21 · 2020: 17 · 2019: 11 · 2018: 7
FWCI
16.45
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Psychiatry (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Research Open (London South Bank University) (acceptedVersion, cc-by-nc-nd)
  • Research Open (London South Bank University) (acceptedVersion)
  • Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
Funders
  • South London and Maudsley NHS Foundation Trust
  • NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
  • National Institute for Health and Care Research
  • King's College London
  • National Institutes of Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
psychiatric inpatient care, community mental health services, hospital readmission, cost-effectiveness, quality-adjusted life years, hospital bed days, adolescents
MeSH terms
Adolescent, Mental Disorders, Child, Community Mental Health Services, Cost-Benefit Analysis, Emergency Services, Psychiatric, Female, Humans, Male, Neuropsychological Tests, Patient Discharge, Quality of Life

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review