Journal Article

Alternative approaches to standard inpatient mental health care: development of a typology of service models

Mitchell, Lizzie, Vasikaran, Jerusaa, Griffiths, Jessica L., Lusted-Challen, Molly, Pryjmachuk, Steven, Nyikavaranda, Patrick, Saunders, Katherine R. K., Rains, Luke Sheridan, Cooper, Ruth E., Lomani, Jo, Persaud, Karen, Olive, Rachel Rowan, Johnson, Sonia, Barnett, Phoebe, Pillutla, Ramya, Lloyd-Evans, Brynmor, Baldwin, Helen, Jarvis, Ruby, Simpson, Alan, Newbigging, Karen, Brennan, Geoff, Lynch, Chris, Foye, Una

2025

Overview

Background Inpatient mental health care is an integral part of the continuum of mental health care in many countries, though it can be associated with challenges, such as reliance on coercive practices, negative patient experiences, and limited therapeutic options. Given these issues, there is a growing interest in exploring alternative approaches for individuals experiencing a mental health crisis. This research aimed to identify models which offer an alternative to standard inpatient mental health care across all age groups, both nationally and internationally, and to develop a typology for these alternative models. Methods A dual literature search and expert consultation research methodology was adopted to identify relevant models. Three typologies of models were developed according to age group and acuity, including: alternatives to standard acute inpatient services for adults; alternatives to longer-stay inpatient services for adults, including rehabilitation and forensic inpatient services; and alternatives to standard inpatient services for children and young people. Results We identified an array of service models in each typology, some in community settings, some hospital-based and some working across settings. Models varied greatly in characteristics, extent of implementation and supporting evidence. Conclusions Through this mapping exercise, we have developed three novel typologies of alternatives to standard inpatient care. A range of community-based, hospital-based and cross-setting approaches were identified. The identification of services providing inpatient care in a substantially different way to the standard suggests that some improvements could be provided within existing structures. Potential inequities in access to alternatives were identified for certain groups, such as people who are compulsorily detained, younger children, and young people transitioning between children’s and adults' services. These typologies can inform future description, evaluation and comparison of different service models. This research also yields some key considerations for the design, development and implementation of alternative mental health service models and service arrays.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acuity / Acute care / Age groups / Care and treatment / Children / Clinical Psychology / Community care / Crisis care / Health Administration / Health care / Health services / Human rights / Inpatient care / Inpatient mental health care / Inpatient mental health care alternatives / Medicine / Medicine & Public Health / Mental health / Mental health care / Methods / Psychiatric hospital patients / Psychiatric services / Psychiatry / Rehabilitation / Typology / Typology development / Working groups