RESEARCH WEEKLY: Community and Inpatient Care as Complements

Often hospital and community-based care options are considered alternatives for each other, with advocates suggesting that an increase of one must be associated with a decrease with the other.

However, new international evidence suggests that this dichotomy between hospital and community care does not in fact exist. Published in the new year by Isabel Perara, PhD, data shows that countries that have high levels of community care also tend to have higher numbers of psychiatric hospital beds. 

“Only by reducing hospital care and expanding community care, it is presumed, can societies optimize the treatment, empowerment, and ultimately, quality of life of people with mental disorders,” writes Dr. Perera. “If the desired expansion of community psychiatry rests on the reduction of hospital care, then societies with ample outpatient care should have very little inpatient care.”

However, Dr. Perera’s results calls these assumptions into question. As we know, hospital care is an essential component of the treatment continuum for people with serious mental illness. And in fact, outpatient and inpatient care are complements to one another.

Analyzing mental health system data from the World Health Organization across 15 developed countries, including the United States, Canada, and Australia, among others, Dr. Perara found that there is a positive correlation between the supply of psychiatric beds and community care facilities per population in a given country. This means that countries that have high-levels of psychiatric beds also tend to have high numbers of community care facilities. As well, countries that have low-levels of psychiatric beds also tend to provide the least amount of outpatient care. Interestingly, Dr. Perera found that countries that tend to have more inpatient beds were more likely to have them in specialty psychiatric hospitals, not in psychiatric wards in general hospitals.

“Achieving a top policy priority—a robust community care system—requires the destigmatization of the mental hospital,” concludes Dr. Perera. Rather than assuming there are trade-offs between inpatient and outpatient care, resources should be allocated to services throughout the continuum, she argues. Both outpatient and inpatient care serve important functions in the treatment continuum for people with mental illness.

Reminder: The Treatment Advocacy Center has submitted a public comment on the National Institute of Mental Health’s (NIMH) draft five-year strategic plan and urges you to do the same . The deadline to submit public comments has been extended to January 15, 2020. Share your story of how the decisions of NIMH affect you and your loved ones. These stories are vital to help NIMH understand why their proposed priorities are misplaced.

Elizabeth Sinclair Hancq
Director of Research
Treatment Advocacy Center

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Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.  

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