Psychiatric hospital versus community treatment: the results of a randomised trial

One hundred and twenty patients presenting for admission were randomly allocated into two groups. Controls received standard hospital care and after-care. Projects were not admitted if this could be avoided; instead they and their relatives were provided with comprehensive community treatment and a 24-hour crisis service. Patients with a primary diagnosis of alcohol or drug dependence, organic brain disorder or mental retardation were excluded. During the 12 months study period, 96% of controls were admitted, 51% more than once. Of the projects, 60% were not admitted at all and only 8% were admitted more than once. Controls spent an average of 53.5 days in psychiatric hospitals; projects spent an average of 8.4 days. Community treatment did not increase the burden upon the community, was considered to be significantly more satisfactory and helpful by patients and their relatives, achieved a clinically superior outcome, and cost less than standard care and after-care.

[Clinical trial under trial. 'Trial and error']

Randomized controlled clinical trials are being exposed to severe criticism in recent years. It is questioned if the use of placebos in such trials is ethically justified. This and other ethical problems will be discussed in this paper. Ethical problems include, besides the use of placebos, obtainment of informed consent and the belief in 'treatment indifference'. Beforehand a historical overview is presented and the design of the randomized controlled clinical trial is explained. Some other types of clinical trials will also be touched upon.