5th Edition of Addiction World Conference 2026

Abstract

Background: Acute psychiatric crises are commonly managed through inpatient psychiatric admission. However, community-based alternatives, including intensive home treatment, crisis resolution teams, and crisis houses, have been developed to provide acute psychiatric care while reducing hospitalization. This systematic review and meta-analysis evaluated whether these models provide effective and safe alternatives to inpatient care.
Methods: We searched PubMed, Embase, and PsycINFO through May 2026 for randomized and non-randomized controlled studies comparing intensive home treatment or other acute community-based alternatives with standard inpatient psychiatric care in adults experiencing acute psychiatric crises. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Outcomes included inpatient readmission, acute readmission, inpatient bed-days, clinical outcomes, adverse events, patient satisfaction, and treatment costs. The review was registered with PROSPERO (CRD420261396554).
 Results: Sixteen studies (11 randomized and 5 non-randomized) including 3,904 participants were included. Community-based alternatives significantly reduced inpatient readmission (RR=0.65, 95% CI 0.50–0.84; p=0.001) and inpatient bed-days (RoM=0.54, 95% CI 0.38–0.75; p<0.001). No significant difference was found for combined acute readmissions (RR=0.89, 95% CI 0.75–1.05; p=0.15). Patient satisfaction was higher with community-based care (Hedges' g=0.27, 95% CI 0.04–0.50; p=0.03). Clinical outcomes and adverse events were comparable between groups. Community-based models were also associated with lower costs.
Conclusion: Intensive home treatment and other acute community-based alternatives represent effective and safe alternatives to inpatient psychiatric hospitalization for appropriately selected adults experiencing acute psychiatric crises. These services reduce hospital utilization while maintaining comparable clinical outcomes and improving patient satisfaction.