In line with previous findings, in a recent randomized controlled trial (RCT), we found that home treatment (HT) for acute mental health care can reduce (substitute) hospital use among severely ill patients in crises. This study examined whether the findings of the RCT generalize to HT services provided under routine care conditions.

We compared patients who received HT during the RCT study phase with patients who received the same HT service after it had become part of routine mental health services in the same catchment area. Sociodemographic and clinical characteristics as well as service use (HT and hospital bed days) were compared between the RCT and the subsequent routine care study period.

Compared to patients who received HT during the RCT, routine care HT patients were more often living with others, less often admitted compulsorily, more often diagnosed with anxiety and stress-related disorders (ICD-10 F4) and less often diagnosed with schizophrenia spectrum disorders (F2). When compared to patients who were exclusively treated on hospital wards, involvement of the HT team in patients’ care was associated with a clear-cut reduction of hospital bed days both during the RCT and under routine care conditions. However, unlike during the RCT study period, involvement of HT was associated with longer overall treatment episodes (inpatient + HT days) under routine care conditions.

HT seems to reduce the use of hospital bed days even under routine care conditions but is at risk of producing longer overall acute treatment episodes.

Cyclone Nargis struck on 02 May 2008 and was the worst disaster due to natural hazards in the recorded history of Myanmar. It left > 146,000 people dead and thousands more homeless. More than 200 hospitals and 400 clinics were destroyed by the cyclone. Singapore was the first non-bordering country to send a medical team to help Myanmar with the disaster relief efforts and carried out operations using mobile teams.

Demographic and medical data from the medical records were collected and analyzed.

A total of 4,489 patients were seen in nine days at hospitals, eight camps/villages, an orphanage, and an elderly care facility. Of the patients, 65% were female. More than a quarter of the patients were <12 years of age and 16.5% were >60 years old. The pediatrie patients suffered mainly from respiratory (26%) and gastrointestinal infections (28%), whereas the adults had a significant number of mus-culoskeletal complaints (21%), non-specific diagnoses (19%), and chronic medical conditions (11%). Only (6%) of the conditions required surgical interventions. A significant number of complaints were related to post traumatic stress disorder (10%).

Mobile clinics were useful for treating patients who did not have access to medical care. The post disaster epidemics that were expected were not experienced. Given the patient load, it was useful to have a pediatrician, primary healthcare physician, and emergency physician to cope with the cyclone-related medical conditions.