Epidemiology and Psychiatric Sciences

Original Articles

Implementing successful residential alternatives to acute in-patient psychiatric services: lessons from a multi-centre study of alternatives in England

N. Moranta1a2 c1, B. Lloyd-Evansa2, H. Gilburta3, M. Sladea3, D. Osborna2 and S. Johnsona2

a1 Department of Social and Developmental Psychology, University of Cambridge, Cambridge, UK

a2 Research Department of Mental Health Sciences, University College London, London, UK

a3 Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK


Background. Standard acute psychiatric care in the UK is costly but problematic. Alternatives to standard in-patient wards exist, but little is known about their effectiveness, implementation and sustainability. This paper explores successful features and limitations of five residential alternative services in England and factors that facilitate or impede their initial and sustained implementation and success.

Methods. Semi-structured interviews about the functioning of six alternative services were conducted with 36 mental health professionals with good working knowledge of, and various connections with these services. A group interview with study researchers was also conducted. Data were analysed using thematic analysis.

Results. One service did not show evidence of operating as an alternative and was excluded from further analysis. The remaining five alternatives are valued for providing a more holistic style of care than standard services that confers many perceived benefits. However, they are seen as less appropriate for compulsorily detained or highly disturbed patients, and as providing less comprehensive treatment packages than hospital settings. Factors identified as important to successful implementation and sustainability are: responding to known shortcomings in local acute care systems; balancing role clarity and adaptability; integration with other services; and awareness of the alternative among relevant local health-care providers.

Conclusions. Residential alternatives can play an important role in managing mental health crises. Their successful implementation and endurance depend on establishing and maintaining a valued position within local service systems. Findings contribute to bridging the gap between research evidence on the problems of standard acute care and delivering improved crisis management services.

(Received June 08 2011)

(Revised October 28 2011)

(Accepted November 03 2011)

(Online publication December 15 2011)


c1 Address for correspondence: Dr N. Morant, Department of Social and Developmental Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3QR, UK. (Email: nm432@cam.ac.uk)