Community mental health team management in severe mental illness: a systematic review.

BACKGROUND Community mental health teams are now generally recommended for the management of severe mental illness but a comparative evaluation of their effectiveness is lacking. AIMS To assess the benefits of community mental health team management in severe mental illness. METHOD A systematic review was conducted of community mental health team management compared with other standard approaches. RESULTS Community mental health team management is associated with fewer deaths by suicide and in suspicious circumstances (odds ratio=0.32, 95% Cl 0.09-1.12), less dissatisfaction with care (odds ratio=0.34, 95% Cl 0.2-0.59) and fewer drop-outs (odds ratio=0.61, 95% Cl 0.45-0.83). Duration of in-patient psychiatric treatment is shorter with community team management and costs of care are less, but there are no gains in clinical symptomatology or social functioning. CONCLUSIONS Community mental health team management is superior to standard care in promoting greater acceptance of treatment, and may also reduce hospital admission and avoid deaths by suicide. This model of care is effective and deserves encouragement.