51
|
Impact of changes in community psychiatric service provision on mental health presentations to the emergency department. Ir J Med Sci 2020; 190:1195-1200. [PMID: 33222076 PMCID: PMC7680212 DOI: 10.1007/s11845-020-02442-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022]
Abstract
Background The reconfiguration of many Irish stand-alone psychiatric units has led to many patients in acute mental health need now being assessed in emergency departments (EDs). This has implications for ED resources and raises questions about appropriate assessment location for this group. Aims This report aims to examine the impact of removal of a direct community access point for patients in acute mental health need on ED presentations in a Dublin hospital. Methods We examined data on ED referrals to psychiatry over 5 years: 12 months before the service change, and four subsequent 12-month periods. We compared numbers referred, mode of referral, average ED length of stay, proportion with no physical issue requiring psychiatric assessment only, and numbers who did not wait for psychiatry assessment. Results In the year directly after the service change, referrals to psychiatry from ED increased by 200%, remaining at this level for the subsequent 3 years. Of these, 32.5% were referred by a GP—more than a threefold increase in numbers from the previous year, with both numbers remaining similarly elevated over subsequent years. In the year after the service change, 52.1% of total ED to psychiatry presented solely for mental health reasons—nearly a fourfold increase in cases from the previous year, and remained high. Conclusions Removing a direct community access point for this group resulted in a substantial increase in ED presentations, many of which did not have physical needs. This study has implications for future policy to address the needs of this group, especially in light of the pandemic.
Collapse
|
52
|
Stulz N, Kawohl W, Jäger M, Mötteli S, Schnyder U, Hepp U. From research to practice: Implementing an experimental home treatment model into routine mental health care. Eur Psychiatry 2020; 63:e94. [PMID: 33168129 PMCID: PMC7681154 DOI: 10.1192/j.eurpsy.2020.91] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background 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. Methods 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. Results 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. Conclusions 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.
Collapse
Affiliation(s)
- N Stulz
- Integrated Psychiatric Services Winterthur-Zurcher Unterland, P.O. Box 144, CH-8408Winterthur, Switzerland
| | - W Kawohl
- Psychiatric Services Aargau, P.O. Box 432, CH-5201Brugg, Switzerland.,KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland
| | - M Jäger
- KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland.,Psychiatrie Baselland, Bienentalstrasse 7, CH-4410Liestal, Switzerland
| | - S Mötteli
- KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland
| | - U Schnyder
- University of Zurich, CH-8001Zurich, Switzerland
| | - U Hepp
- Integrated Psychiatric Services Winterthur-Zurcher Unterland, P.O. Box 144, CH-8408Winterthur, Switzerland
| |
Collapse
|
53
|
Fusar-Poli P, De Micheli A, Patel R, Signorini L, Miah S, Spencer T, McGuire P. Real-World Clinical Outcomes Two Years After Transition to Psychosis in Individuals at Clinical High Risk: Electronic Health Record Cohort Study. Schizophr Bull 2020; 46:1114-1125. [PMID: 32303767 PMCID: PMC7505186 DOI: 10.1093/schbul/sbaa040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The objective of this study is to describe the 2-year real-world clinical outcomes after transition to psychosis in patients at clinical high-risk. The study used the clinical electronic health record cohort study including all patients receiving a first index primary diagnosis of nonorganic International Classification of Diseases (ICD)-10 psychotic disorder within the early psychosis pathway in the South London and Maudsley (SLaM) National Health Service (NHS) Trust from 2001 to 2017. Outcomes encompassed: cumulative probability (at 3, 6, 12, and 24 months) of receiving a first (1) treatment with antipsychotic, (2) informal admission, (3) compulsory admission, and (4) treatment with clozapine and (5) numbers of days spent in hospital (at 12 and 24 months) in patients transitioning to psychosis from clinical high-risk services (Outreach and Support in south London; OASIS) compared to other first-episode groups. Analyses included logistic and 0-inflated negative binomial regressions. In the study, 1561 patients were included; those who had initially been managed by OASIS and had subsequently transitioned to a first episode of psychosis (n = 130) were more likely to receive antipsychotic medication (at 3, 6, and 24 months; all P < .023), to be admitted informally (at all timepoints, all P < .004) and on a compulsory basis (at all timepoints, all P < .013), and to have spent more time in hospital (all timepoints, all P < .007) than first-episode patients who were already psychotic when seen by the OASIS service (n = 310), or presented to early intervention services (n = 1121). The likelihood of receiving clozapine was similar across all groups (at 12/24 months, all P < .101). Transition to psychosis from a clinical high-risk state is associated with severe real-world clinical outcomes. Prevention of transition to psychosis should remain a core target of future research. The study protocol was registered on www.researchregistry.com; researchregistry5039).
Collapse
Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrea De Micheli
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Rashmi Patel
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lorenzo Signorini
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Syed Miah
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Thomas Spencer
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Philip McGuire
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
54
|
Gaebel W, Kerst A, Janssen B, Becker T, Musalek M, Rössler W, Ruggeri M, Thornicroft G, Zielasek J, Stricker J. EPA guidance on the quality of mental health services: A systematic meta-review and update of recommendations focusing on care coordination. Eur Psychiatry 2020; 63:e75. [PMID: 32703326 PMCID: PMC7443789 DOI: 10.1192/j.eurpsy.2020.75] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has received increased attention and has been put into practice. Thus, we focused on care coordination in this update of a previous European Psychiatric Association (EPA) guidance on the quality of mental health services. METHODS We conducted a systematic meta-review of systematic reviews, meta-analyses, and evidence-based clinical guidelines focusing on care coordination for persons with mental illness in three literature databases. RESULTS We identified 23 relevant documents covering the following topics: case management, integrated care, home treatment, crisis intervention services, transition from inpatient to outpatient care and vice versa, integrating general and mental healthcare, technology in care coordination and self-management, quality indicators, and economic evaluation. Based on the available evidence, we developed 15 recommendations for care coordination in European mental healthcare. CONCLUSIONS Although evidence is limited, some concepts of care coordination seem to improve the effectiveness and efficiency of mental health services and outcomes on patient level. Further evidence is needed to better understand the advantages and disadvantages of different care coordination models.
Collapse
Affiliation(s)
- W Gaebel
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.,WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - A Kerst
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.,WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - B Janssen
- LVR-Klinik Langenfeld, Langenfeld, Germany
| | - T Becker
- Department of Psychiatry II, University of Ulm, Bezirkskrankenhaus Günzburg, Germany
| | - M Musalek
- Anton Proksch Institute, Vienna, Austria
| | - W Rössler
- Department of Psychiatry and Psychotherapy, Charité, Universitätsmedizin Berlin, Berlin, Germany.,Psychiatric University Hospital, University of Zurich, Zurich, Switzerland.,Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of Sao Paulo; Sao Paulo, Brazil
| | - M Ruggeri
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - G Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology &Neuroscience, King's College, London, United Kingdom
| | - J Zielasek
- LVR-Institute for Healthcare Research, Cologne, Germany
| | - J Stricker
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.,WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| |
Collapse
|
55
|
van Weeghel J. Fidelity Scale: From Black Box to Holy Grail. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:927-931. [PMID: 32500430 PMCID: PMC7547993 DOI: 10.1007/s10488-020-01057-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Fidelity scales are indispensable in the pursuit of evidence-based mental healthcare. Without fidelity checks, treatment remains a mysterious black box. The aim of this article is to comment on the studies in this special section, and to discuss some general issues with regard to fidelity assessment. Despite all of their supposed benefits, resistance to fidelity scales persists among mental health practitioners. One way to overcome this resistance is to conduct fidelity assessments in the context of a well-guided learning community. The predictive validity of fidelity scales is considered the single most valuable attribute of these instruments. Research on predictive validity requires large sample sizes, which is difficult to achieve. It should nevertheless not prevent us from rigorously searching for this Holy Grail of fidelity assessment. In addition, fidelity assessment should be placed in a broader perspective. The quality of care for people with severe mental illness cannot be assessed conclusively according to the extent to which separate interventions have been applied with good fidelity. These individuals need access to high-quality treatment and support systems within the community, which can enable them to live their lives as valued citizens. In conclusion, fidelity assessment, both at the level of interventions and systems, contributes to a highly desirable transparency in practice variations within the field of mental healthcare.
Collapse
Affiliation(s)
- Jaap van Weeghel
- Tranzo Scientific Center for Care and Welfare, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands. .,Parnassia Psychiatric Institute, The Hague, The Netherlands. .,Phrenos Center of Expertise, Da Costakade 45, 3521 VS, Utrecht, The Netherlands.
| |
Collapse
|
56
|
Robertson J, Fitts MS, Petrucci J, McKay D, Hubble G, Clough AR. Cairns Mental Health Co-Responder Project: Essential elements and challenges to programme implementation. Int J Ment Health Nurs 2020; 29:450-459. [PMID: 31840401 DOI: 10.1111/inm.12679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 11/27/2022]
Abstract
In Australia and internationally, co-responder models are becoming an increasingly common intervention to respond to police callouts where there is an assumed mental health-related component or crisis. This type of model involves a collaborative approach where trained police officers team with mental health clinicians to provide specialized responses in order to improve outcomes for persons with mental illness. However, there is limited understanding as to major elements required for implementation of the model. This study aims to identify the essential elements and challenges in implementation of the Mental Health Co-Responder Project in Cairns, Australia, where the team consists of a mental health nurse with demonstrated competencies in crisis intervention and a specially trained police officer. In 2016, 39 participants completed semi-structured interviews regarding knowledge and experience of the Cairns co-responder model. The participants represented first responders and community-based service providers who work with and support persons living with mental illness. Using a thematic analysis approach, key elements identified as essential to successful project implementation were as follows: co-responder team characteristics, senior and project executive level support, collaborative project governance, and co-location of the team within a mental health setting. The main perceived challenges to project implementation included the following: initial concerns regarding client confidentiality, lack of an evaluation plan, and adequate project resourcing. Governance through a vigorous joint agency operation committee and adequate resourcing is imperative to the sustainability of this model.
Collapse
Affiliation(s)
- Jan Robertson
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Michelle S Fitts
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia
| | | | - Donni McKay
- Forensic Services Group, Operations Support Command, Queensland Police Service, Cairns, Queensland, Australia
| | - Gary Hubble
- Mental Health and Well-being, Centacare FNQ, Cairns, Queensland, Australia
| | - Alan R Clough
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| |
Collapse
|
57
|
Stulz N, Wyder L, Maeck L, Hilpert M, Lerzer H, Zander E, Kawohl W, Grosse Holtforth M, Schnyder U, Hepp U. Home treatment for acute mental healthcare: randomised controlled trial. Br J Psychiatry 2020; 216:323-330. [PMID: 30864532 DOI: 10.1192/bjp.2019.31] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Home treatment has been proposed as an alternative to acute in-patient care for mentally ill patients. However, there is only moderate evidence in support of home treatment. AIMS To test whether and to what degree home treatment services would enable a reduction (substitution) of hospital use. METHOD A total of 707 consecutively admitted adult patients with a broad spectrum of mental disorders (ICD-10: F2-F6, F8-F9, Z) experiencing crises that necessitated immediate admission to hospital, were randomly allocated to either a service model including a home treatment alternative to hospital care (experimental group) or a conventional service model that lacked a home treatment alternative to in-patient care (control group) (trial registration at ClinicalTrials.gov: NCT02322437). RESULTS The mean number of hospital days per patient within 24 months after the index crisis necessitating hospital admission (primary outcome) was reduced by 30.4% (mean 41.3 v. 59.3, P<0.001) when a home treatment team was available (intention-to-treat analysis). Regarding secondary outcomes, average overall treatment duration (hospital days + home treatment days) per patient (mean 50.4 v. 59.3, P = 0.969) and mean number of hospital admissions per patient (mean 1.86 v. 1.93, P = 0.885) did not differ statistically significantly between the experimental and control groups within 24 months after the index crisis. There were no significant between-group differences regarding clinical and social outcomes (Health of the Nation Outcome Scales: mean 9.9 v. 9.7, P = 0.652) or patient satisfaction with care (Perception of Care questionnaire: mean 0.78 v. 0.80, P = 0.242). CONCLUSIONS Home treatment services can reduce hospital use among severely ill patients in acute crises and seem to result in comparable clinical/social outcomes and patient satisfaction as standard in-patient care.
Collapse
Affiliation(s)
- Niklaus Stulz
- Head of Research, Integrated Psychiatric Services Winterthur - Zurcher Unterland; Senior Researcher (Former Head of Research), Psychiatric Services Aargau; and Research Associate, Department of Psychology, University of Berne, Switzerland
| | - Lea Wyder
- Research Associate, Psychiatric Services Aargau; and Former PhD Student, Department of Psychology, University of Berne, Switzerland
| | - Lienhard Maeck
- Senior Physician, Psychiatric Services Aargau, Switzerland
| | - Matthias Hilpert
- Deputy Head of Department, Psychiatric Services Aargau, Switzerland
| | - Helmut Lerzer
- Deputy Head of Nursing Services, Psychiatric Services Aargau, Switzerland
| | - Eduard Zander
- Senior Physician, Psychiatric Services Aargau, Switzerland
| | - Wolfram Kawohl
- Head of Department, Psychiatric Services Aargau, Switzerland
| | - Martin Grosse Holtforth
- Associate Professor, Department of Psychology, University of Berne; and Head Researcher, Division of Psychosomatic Medicine, Department of Neurology, Inselspital, University Hospital Berne, Switzerland
| | | | - Urs Hepp
- Medical Director, Integrated Psychiatric Services Winterthur - Zurcher Unterland, Switzerland
| |
Collapse
|
58
|
Lloyd-Evans B, Osborn D, Marston L, Lamb D, Ambler G, Hunter R, Mason O, Sullivan S, Henderson C, Onyett S, Johnston E, Morant N, Nolan F, Kelly K, Christoforou M, Fullarton K, Forsyth R, Davidson M, Piotrowski J, Mundy E, Bond G, Johnson S. The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial. Br J Psychiatry 2020; 216:314-322. [PMID: 30761976 PMCID: PMC7511901 DOI: 10.1192/bjp.2019.21] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/18/2018] [Accepted: 01/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care. AIMS To evaluate a 1-year programme to improve CRTs' model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233). METHOD Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated. RESULTS All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI -1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes. CONCLUSIONS The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT model fidelity and reducing acute in-patient admissions.
Collapse
Affiliation(s)
| | - David Osborn
- Professor of Psychiatric Epidemiology, Division of Psychiatry, University College London; and St Pancras Hospital, Camden and Islington NHS Foundation Trust, UK
| | - Louise Marston
- Principal Research Associate, Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus); and Priment Clinical Trials Unit, UK
| | - Danielle Lamb
- Research Associate, Division of Psychiatry, University College London, UK
| | - Gareth Ambler
- Associate Professor in Medical Statistics, Department of Statistical Science, UCL, UK
| | - Rachael Hunter
- Senior Research Associate, Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus); and Priment Clinical Trials Unit, UK
| | - Oliver Mason
- Reader in Clinical Psychology, School of Psychology, University of Surrey, UK
| | - Sarah Sullivan
- Research Fellow, Epidemiology and Health Services Research, CLAHRC West, UK
| | - Claire Henderson
- Clinical Senior Lecturer, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | | | - Elaine Johnston
- Principal Research Associate, Division of Psychiatry, University College London, UK
| | - Nicola Morant
- Associate Professor, Division of Psychiatry, University College London, UK
| | - Fiona Nolan
- Professor of Nursing, School of Health and Human Sciences, University of Essex, UK
| | - Kathleen Kelly
- Consultant Psychiatrist, Barnes Unit, John Radcliffe Hospital, Oxford Health NHS Foundation Trust, UK
| | | | - Kate Fullarton
- Research Assistant, Division of Psychiatry, University College London, UK
| | - Rebecca Forsyth
- Research Assistant, Division of Psychiatry, University College London, UK
| | - Mike Davidson
- Research Assistant, Division of Psychiatry, University College London, UK
| | - Jonathan Piotrowski
- Research Assistant, Avon and Wiltshire Mental Health Partnership NHS Trust, Research & Development Office, UK
| | - Edward Mundy
- Research Assistant, Division of Psychiatry, University College London, UK
| | - Gary Bond
- Professor of Psychiatry, Westat, Rivermill Commercial Center, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, University College London; and St Pancras Hospital, Camden and Islington NHS Foundation Trust, UK
| |
Collapse
|
59
|
Giménez-Díez D, Maldonado Alía R, Rodríguez Jiménez S, Granel N, Torrent Solà L, Bernabeu-Tamayo MD. Treating mental health crises at home: Patient satisfaction with home nursing care. J Psychiatr Ment Health Nurs 2020; 27:246-257. [PMID: 31663224 DOI: 10.1111/jpm.12573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 09/30/2019] [Accepted: 10/28/2019] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Most studies have focused on whether hospital admissions have been reduced by the introduction of crisis services, rather than focusing on how these services are employed. Research has also shown that home assistance decreases costs and increases the level of patient satisfaction, thereby being more efficient in terms of the cost/effectiveness ratio than is traditional hospital care. Patient satisfaction with nursing care has long been identified as a key element of quality of care; however, satisfaction with nursing care among patients and families receiving crisis resolution at home has not been studied yet. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: There is limited research on patient satisfaction with CRHTTs. This study provides new insights and data including that on relationships between patient satisfaction and the teams' attention to person-centred mental health care. The difference between this study and other studies on patient satisfaction with crisis resolution home treatment teams is that this study focused on patients' and families' satisfaction with the nursing care provided by crisis resolution home treatment teams rather than with the general service provided. This study is the first of its kind with such a focus. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This research has both academic and clinical implications. Patients' and their families' satisfaction with nursing care is an integral aspect for evaluating mental health services, and this is especially important regarding services provided by crisis resolution home treatment teams because such teams are currently being introduced in countries such as Spain. Closely examining patients and families' satisfaction with nursing care can also foster improvements in current practices. Nurses in crisis teams might need to focus on equalizing power relations, which the data gathered in this study suggests is most important to patient satisfaction. ABSTRACT: Introduction Crisis resolution home treatment teams (CRHTT) provide short-term, intensive home treatment to people experiencing mental health crises. Patient satisfaction has long been identified as a key element of quality of care; however, satisfaction with nursing care as part of this service has not been studied yet. Aim To assess patients' and their families' satisfaction with the nursing care provided through a home care program offered by a hospital in Catalonia which administers person-centred care. Method A mixed methods research design was conducted. A cross-sectional study including quantitative survey data and qualitative interview data with a phenomenological focus was conducted. Results Twenty interviews were conducted. Patients and relatives reported high satisfaction that seems to be related to the person-centred nature of the care. Discussion The findings provide new insights, including how home treatment tends to equalize power relations between nurses and patients/the patient's family members, and how nurses increase sensitivity when focusing on service users' needs and priorities, leading to high patient and family satisfaction. Implications for practice This research has both academic and clinical implications. It highlights what mental health patients and their families value most about home care and interactions with nurses, and also drives improvements in current practices.
Collapse
Affiliation(s)
- David Giménez-Díez
- CPB Serveis de Salut Mental, Barcelona, Spain.,GRIVIS Research Group, Nursing Department, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | | | | | - Nina Granel
- GRIVIS Research Group, Nursing Department, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Lídia Torrent Solà
- Consorci Corporació Sanitària Parc Taulí, Centre de Salut Mental, Barcelona, Spain
| | | |
Collapse
|
60
|
Lamb D, Lloyd-Evans B, Fullarton K, Kelly K, Goater N, Mason O, Gray R, Osborn D, Nolan F, Pilling S, Sullivan SA, Henderson C, Milton A, Burgess E, Churchard A, Davidson M, Frerichs J, Hindle D, Paterson B, Brown E, Piotrowski J, Wheeler C, Johnson S. Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology. Int J Ment Health Nurs 2020; 29:187-201. [PMID: 31566846 DOI: 10.1111/inm.12658] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2019] [Indexed: 11/27/2022]
Abstract
Crisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. Previous UK research, based on self-report surveys, suggests that a loosely specified model has resulted in wide variations in CRTs' service delivery, organization and outcomes. A fidelity scale (developed through evidence review and stakeholder consensus) provided a means of objectively measuring adherence to a model of good practice for CRTs, via one-day fidelity reviews of UK crisis teams. Reviews included interviews with service users, carers, staff and managers, and examination of data, policies, protocols and anonymized case notes. Of the 75 teams reviewed, 49 (65%) were assessed as being moderate fidelity and the rest as low fidelity, with no team achieving high fidelity. The median score was 122 (range: 73-151; inter-quartile range: 111-132). Teams achieved higher scores on items about structure and organization, for example ease of referral, medication and safety systems, but scored poorly on items about the content of care and interventions. Despite a national mandate to implement the CRT model, there are wide variations in implementation in the UK and no teams in our sample achieved overall high fidelity. This suggests that a mandatory national policy is not in itself sufficient to achieve good quality implementation of a service model. The CRT Fidelity Scale provides a feasible and acceptable means to objectively assess model fidelity in CRTs. There is a need for development and testing of interventions to enhance model fidelity and facilitate improvements to these services.
Collapse
Affiliation(s)
| | - Brynmor Lloyd-Evans
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | | | - Kathleen Kelly
- Northamptonshire Healthcare NHS Foundation Trust, London, UK
| | | | - Oliver Mason
- North East London NHS Foundation Trust, London, UK
| | | | - David Osborn
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Fiona Nolan
- Camden and Islington NHS Foundation Trust, London, UK
| | - Steve Pilling
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sonia Johnson
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| |
Collapse
|
61
|
Fleury MJ, Grenier G, Farand L, Ferland F. Use of Emergency Rooms for Mental Health Reasons in Quebec: Barriers and Facilitators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:18-33. [PMID: 30074113 DOI: 10.1007/s10488-018-0889-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Lambert Farand
- Department of Health Administration, Policy and Evaluation School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Laval University, Quebec City, QC, Canada
| |
Collapse
|
62
|
Schwarz J, Galbusera L, Bechdolf A, Birker T, Deister A, Duve A, Heiser P, Hojes K, Indefrey S, Johne J, Rehr B, Rout S, Scherk H, Schulz-Du Bois A, Wilms B, Zedlick D, Zeipert M, Heinze M, von Peter S. Changes in German Mental Health Care by Implementing a Global Treatment Budget-A Mixed-Method Process Evaluation Study. Front Psychiatry 2020; 11:426. [PMID: 32523551 PMCID: PMC7261866 DOI: 10.3389/fpsyt.2020.00426] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Internationally, there is a broad spectrum of outreach and integrative care models, whereas in Germany acute psychiatric treatment is still mostly provided in inpatient settings. To overcome this, a new legal framework (§64b Social Code V) has been introduced, promoting "Flexible and Integrative Treatment" Models (FIT64b), based on a "Global Treatment Budget" (GTB) financing approach. 23 hospitals have implemented the framework according to local needs and concepts. Prior research has already identified specific components of FIT64b. Based on this, our paper aims to examine the implementation process and underpinning change mechanisms of GTB-based FIT64b models from a staff, service user and caregiver perspective. METHOD 31 focus groups and 15 semi-structured interviews were conducted with hospital staff (n = 138), service users (n = 63), and caregivers (n = 35) in 10 psychiatric hospitals implementing FIT64b. Using qualitative analysis, we identified 5 core themes describing the implementation process, which were theoretically modeled into a logical diagram. The core mechanisms of change were thus identified across themes. Additional structural and semi-quantitative performance data was collected from all study departments. RESULTS The qualitative analysis showed that the shift from a daily- and performance-based payment to a lump-sum GTB and the shift of resources from in- to outpatient settings were of crucial importance for the process of change. Saved budget shares could be reinvested to integrate in-, out-, and day-patient units and to set up outreach home care. Clinicians reported feeling relieved by the increase of treatment options. They also emphasized a stronger relationship with and a better understanding of service users and a simplification of bureaucracy. Finally, service users and caregivers experienced higher need-adaptedness of treatment, a feeling of deeper understanding and safety, and the possibility to maintain everyday life during treatment. Finally, two FIT64b implementation prototypes were classified according to the semi-quantitative performance data. CONCLUSION Based on the results, we developed 3 core mechanisms of change of FIT64b models: (1) Need-adaptedness and flexibility; (2) Continuity of care; (3) Maintaining everyday life. Our findings outline and emphasize the potential a GTB approach may have for improving psychiatric hospital services.
Collapse
Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Laura Galbusera
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, Vivantes Krankenhaus am Urban and Vivantes Klinikum im Friedrichshain, Charite University Medicine Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,ORYGEN, National Center of Excellence of Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Thomas Birker
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Westklinikum Heide, Heide, Germany
| | - Arno Deister
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Psychosoziales Zentrum Itzehoe, Itzehoe, Germany
| | - Annette Duve
- Department of Child and Adolescent Psychiatry, Vitos Klinikum Riedstadt, Riedstadt, Germany
| | - Philip Heiser
- Department of Child and Adolescent Psychiatry, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - Kerit Hojes
- Department of Psychiatry and Psychotherapy, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - Sonja Indefrey
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany.,Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Jakob Johne
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany.,Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Burkhard Rehr
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany.,Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Sandeep Rout
- Department of Psychiatry and Psychotherapy, Vivantes Krankenhaus Neukölln, Charité University Medicine Berlin, Berlin, Germany
| | - Harald Scherk
- Department of Psychiatry and Psychotherapy, Vitos Klinikum Riedstadt, Riedstadt, Germany
| | - Anna Schulz-Du Bois
- Department of Psychiatry and Psychotherapy, Imland Krankenhaus Rendsburg, Rendsburg, Germany
| | - Bettina Wilms
- Department of Psychiatry and Psychotherapy, Basedow Klinikum Saalekreis, Querfurt, Germany
| | - Dyrk Zedlick
- Department of Psychiatry and Psychotherapy, Rudolf Virchow Krankenhaus Glauchau, Glauchau, Germany
| | - Manfred Zeipert
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany.,Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Imland Krankenhaus Rendsburg, Rendsburg, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| |
Collapse
|
63
|
Muskens JB, Herpers PCM, Hilderink C, van Deurzen PAM, Buitelaar JK, Staal WG. Intensive home treatment for adolescents in psychiatric crisis. BMC Psychiatry 2019; 19:412. [PMID: 31856770 PMCID: PMC6924140 DOI: 10.1186/s12888-019-2407-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents with acute psychiatric disorders are typically treated with long-term clinical admission. However, long term admission may be associated with a variety of negative outcomes. This pilot study presents a new model of care, that is, the combined application of intensive home treatment and the possibility of short term stay at a psychiatric high & intensive care. METHODS In total 112 referred adolescents with mixed diagnoses participated in this longitudinal observational design. Clinical outcome was measured by the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) which measures the severity of multiple mental health problems. The HoNOSCA was clinician-rated at intake, after two months and after four months at discharge. Change in HoNOSCA total score was analysed with paired t-tests. Outcome moderators were gender, age, primary diagnosis, clinical admission, home treatment-time, medication and additional therapies. Follow up data were completed for 62 patients after two months and for 53 after four months. RESULTS Participants aged between 11 and 18 years (M = 14.8 years, SD = 0.3; 52% female). Mean HoNOSCA total score at intake was 18.8 (SD = 5.2), after two months 13.0 (SD = 5.0); after four months resulting in a score of 9.3 (SD = 5.2). None of the moderators tested showed a significant effect on HoNOSCA scores. However, a control group could not be used because of the severe psychopathology and high risk for suicidality and the lack of an effective treatment intervention for a comparable study group. CONCLUSION With a symptom decrease of over 50% within four months as measured by the HoNOSCA, including less risk for hospitalization, this new model appears promising and of clinical relevance. Nevertheless, further research regarding stability of treatment outcome is warranted and evaluation of long-term effects of this model in follow-up studies is needed.
Collapse
Affiliation(s)
- Jet B. Muskens
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Pierre C. M. Herpers
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Caroline Hilderink
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
| | - Patricia A. M. van Deurzen
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
| | - Jan K. Buitelaar
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
| | - Wouter G. Staal
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
- Faculty of Social Sciences, Leiden Institute for Brain and Cognition, Postzone C2-5, P.O.Box 9600, 2300 RC Leiden, The Netherlands
| |
Collapse
|
64
|
Abstract
PURPOSE OF REVIEW The aim of this review is to evaluate recent literature on the use of telepsychiatry in mental crises or emergency situations. RECENT FINDINGS Results from recent studies which evaluated the implementation of a telepsychiatric consultation model in emergency departments point at a reduction of length of stay and a drop in admissions, increased cost-effectiveness, and improved satisfaction of patients and staff. There was almost no empirical evidence on videoconferencing in crisis intervention within the context of crisis resolution teams or online therapies. No study reporting on telepsychiatry videoconferencing in the context of disasters was found. There is still very little but increasing empirical evidence supporting the implementation of telepsychiatry in emergencies. Other mental crisis-related implementation settings remain to be researched. The implications and future research potential are discussed.
Collapse
|
65
|
Abstract
OBJECTIVES To determine the distribution, functioning and perceived impact of home-based treatment (HBT) teams for acute mental disorders on the island of Ireland. METHODS A 28-item questionnaire exploring the structure, staffing and operation of HBT teams was emailed to all clinical directors of mental health services in Ireland (n=26) and Northern Ireland (NI) (n=5). Quantitative data was analysed using the Survey Monkey package, while free-text responses to open questions were analysed for thematic content. RESULTS In total, 11 of 16 (68%) mental health services in Ireland and four of five (80%) in NI confirmed the presence of HBT teams. For 80% of respondents the primary function of HBT was as an alternative to inpatient admission. All NI respondents reported provision of a 24/7 HBT service. A 7 day a week service was reported by 82% of Republic of Ireland respondents. In total, 70% of respondents reported a gate-keeping role for their teams. Staffing levels and multidisciplinary representation varied widely. Most respondents perceived HBT as improving patient/carer experience and cost-effectiveness. CONCLUSIONS Our findings suggest that the implementation of the HBT model in Ireland has not fulfilled the aspirations set out in mental health policy in both Irish jurisdictions. Many areas have no HBT services while wide variations in staffing levels and functioning persist. However, mental health services with established HBT teams appear convinced of their positive impact. An All-Ireland forum on HBT may help to define the model in an Irish context and standardise its future resourcing, operation and evaluation.
Collapse
|
66
|
Abstract
OBJECTIVE Home-based crisis team (HBCT) in North Cork was established in 2013 to provide short term, intensive home treatment to people who are experiencing acute mental health problems, with the aim of averting hospital admission wherever possible or supporting patients discharged from hospital. METHODS A retrospective descriptive study design was adopted to describe the activities of the North Cork HBCT over a 1 year period. Data were analysed using R version 3.4.0 for Windows. RESULTS A total of 388 patients were referred to the HBCT in 2015, of which 328 required assessments. General practitioners (GPs) made 56% of all referrals. The most common referral reason was low mood (40%). Stepped-up care to the psychiatric inpatient unit was required for 12.4% of patients, 62% were discharged to the outpatient clinic for routine follow-up. CONCLUSION Many common psychiatric presentations can be managed at home with the support of the HBCT although hospital admission is required for significant numbers.
Collapse
|
67
|
Muehsam JP. Association between clinical observations and a mobile crisis team's level of care recommendations. Community Ment Health J 2019; 55:394-400. [PMID: 29948626 DOI: 10.1007/s10597-018-0296-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 06/07/2018] [Indexed: 10/14/2022]
Abstract
Mobile mental health crisis programs are a widely used and valuable community resource. Literature analyzing the service, however, is sparse and descriptive in nature. This study uses multinomial logistic regression to analyze clinical data from a mobile crisis program in Pennsylvania over 12 months. 793 individuals recommended to various levels of care were analyzed. Clinical and demographic presentations were used as predictor variables and level of care recommendation as outcome variable. Several clinical presentations were found to increase the likelihood of various levels of care recommendations. These findings are discussed in light of current suicide intervention and data-driven practice.
Collapse
Affiliation(s)
- John P Muehsam
- Widener University, Chester, PA, USA. .,, 111 Elwyn Road, Phoenix Hall, Elwyn, PA, 19063, USA.
| |
Collapse
|
68
|
Lombardo C, Santos M, Van Bortel T, Croos R, Arensman E, Kar Ray M. Decision-making in crisis resolution and home treatment teams: The AWARE framework. BJPsych Bull 2019; 43:61-66. [PMID: 30451131 PMCID: PMC6472319 DOI: 10.1192/bjb.2018.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and methodThe aim of the study is to improve patient safety by identifying factors influencing gatekeeping decisions by crisis resolution and home treatment teams. A theoretical sampling method was used to recruit clinicians. Semi-structured interviews to elicit various aspects of clinical decision-making were carried out. The transcripts were thematically analysed using a grounded theory approach. RESULTS: Patient needs (safety and treatment) was the primary driver behind decisions. The research also revealed that information gathered was processed using heuristics. We identified five key themes (anxiety, weighting, agenda, resource and experience), which were constructed into an acronym 'AWARE'.Clinical implicationsAWARE provides a framework to make explicit drivers for decision-making that are often implicit. Incorporating these drivers into reflective practice will help staff be more mindful of undue influences and result in improved clinical decisions.Declaration of interestNone.
Collapse
Affiliation(s)
- Chiara Lombardo
- Institute for Health and Human Development, University of East London,UK
| | - Mónica Santos
- Adult Mental Health Services,Cambridgeshire and Peterborough NHS Foundation Trust,UK
| | - Tine Van Bortel
- Institute for Health and Human Development, University of East London,UK
| | - Robert Croos
- Adult Mental Health Services,Cambridgeshire and Peterborough NHS Foundation Trust,UK
| | - Ella Arensman
- School of Public Health, National Suicide Research Foundation,University College Cork, National University of Ireland,Ireland
| | - Manaan Kar Ray
- Adult Mental Health Services,Cambridgeshire and Peterborough NHS Foundation Trust,UK
| |
Collapse
|
69
|
Lloyd-Evans B, Christoforou M, Osborn D, Ambler G, Marston L, Lamb D, Mason O, Morant N, Sullivan S, Henderson C, Hunter R, Pilling S, Nolan F, Gray R, Weaver T, Kelly K, Goater N, Milton A, Johnston E, Fullarton K, Lean M, Paterson B, Piotrowski J, Davidson M, Forsyth R, Mosse L, Leverton M, O’Hanlon P, Mundy E, Mundy T, Brown E, Fahmy S, Burgess E, Churchard A, Wheeler C, Istead H, Hindle D, Johnson S. Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background
Crisis resolution teams (CRTs) seek to avert hospital admissions by providing intensive home treatment for people experiencing a mental health crisis. The CRT model has not been highly specified. CRT care is often experienced as ending abruptly and relapse rates following CRT discharge are high.
Aims
The aims of CORE (Crisis resolution team Optimisation and RElapse prevention) workstream 1 were to specify a model of best practice for CRTs, develop a measure to assess adherence to this model and evaluate service improvement resources to help CRTs implement the model with high fidelity. The aim of CORE workstream 2 was to evaluate a peer-provided self-management programme aimed at reducing relapse following CRT support.
Methods
Workstream 1 was based on a systematic review, national CRT manager survey and stakeholder qualitative interviews to develop a CRT fidelity scale through a concept mapping process with stakeholders (n = 68). This was piloted in CRTs nationwide (n = 75). A CRT service improvement programme (SIP) was then developed and evaluated in a cluster randomised trial: 15 CRTs received the SIP over 1 year; 10 teams acted as controls. The primary outcome was service user satisfaction. Secondary outcomes included CRT model fidelity, catchment area inpatient admission rates and staff well-being. Workstream 2 was a peer-provided self-management programme that was developed through an iterative process of systematic literature reviewing, stakeholder consultation and preliminary testing. This intervention was evaluated in a randomised controlled trial: 221 participants recruited from CRTs received the intervention and 220 did not. The primary outcome was re-admission to acute care at 1 year of follow-up. Secondary outcomes included time to re-admission and number of days in acute care over 1 year of follow-up and symptoms and personal recovery measured at 4 and 18 months’ follow-up.
Results
Workstream 1 – a 39-item CRT fidelity scale demonstrated acceptability, face validity and promising inter-rater reliability. CRT implementation in England was highly variable. The SIP trial did not produce a positive result for patient satisfaction [median Client Satisfaction Questionnaire score of 28 in both groups at follow-up; coefficient 0.97, 95% confidence interval (CI) –1.02 to 2.97]. The programme achieved modest increases in model fidelity. Intervention teams achieved lower inpatient admission rates and less inpatient bed use. Qualitative evaluation suggested that the programme was generally well received. Workstream 2 – the trial yielded a statistically significant result for the primary outcome, in which rates of re-admission to acute care over 1 year of follow-up were lower in the intervention group than in the control group (odds ratio 0.66, 95% CI 0.43 to 0.99; p = 0.044). Time to re-admission was lower and satisfaction with care was greater in the intervention group at 4 months’ follow-up. There were no other significant differences between groups in the secondary outcomes.
Limitations
Limitations in workstream 1 included uncertainty regarding the representativeness of the sample for the primary outcome and lack of blinding for assessment. In workstream 2, the limitations included the complexity of the intervention, preventing clarity about which were effective elements.
Conclusions
The CRT SIP did not achieve all its aims but showed potential promise as a means to increase CRT model fidelity and reduce inpatient service use. The peer-provided self-management intervention is an effective means to reduce relapse rates for people leaving CRT care.
Study registration
The randomised controlled trials were registered as Current Controlled Trials ISRCTN47185233 and ISRCTN01027104. The systematic reviews were registered as PROSPERO CRD42013006415 and CRD42017043048.
Funding
The National Institute for Health Research Programme Grants for Applied Research programme.
Collapse
Affiliation(s)
| | | | - David Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Danielle Lamb
- Division of Psychiatry, University College London, London, UK
| | - Oliver Mason
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Sarah Sullivan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Claire Henderson
- Health Service and Population Research, King’s College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Stephen Pilling
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Fiona Nolan
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Richard Gray
- Department of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Tim Weaver
- Mental Health Social Work and Interprofessional Learning, Middlesex University London, London, UK
| | | | | | - Alyssa Milton
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Elaine Johnston
- Division of Psychiatry, University College London, London, UK
| | - Kate Fullarton
- Division of Psychiatry, University College London, London, UK
| | - Melanie Lean
- Division of Psychiatry, University College London, London, UK
| | - Beth Paterson
- Division of Psychiatry, University College London, London, UK
| | | | | | - Rebecca Forsyth
- Division of Psychiatry, University College London, London, UK
| | - Liberty Mosse
- Division of Psychiatry, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | - Puffin O’Hanlon
- Division of Psychiatry, University College London, London, UK
| | - Edward Mundy
- Division of Psychiatry, University College London, London, UK
| | - Tom Mundy
- Division of Psychiatry, University College London, London, UK
| | - Ellie Brown
- Psychiatric Health Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Sarah Fahmy
- Division of Psychiatry, University College London, London, UK
| | - Emma Burgess
- Division of Psychiatry, University College London, London, UK
| | | | - Claire Wheeler
- Division of Psychiatry, University College London, London, UK
| | - Hannah Istead
- Division of Psychiatry, University College London, London, UK
| | - David Hindle
- Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| |
Collapse
|
70
|
Abstract
Home treatment has been proposed as an alternative to acute psychiatric inpatient treatment. Health insurance systems in Germany and in Switzerland hinder the nationwide implementation of home treatment teams into mental health systems, although the German S3 guidelines for psychosocial treatments of severe mental illnesses recommend provision of acute care at home. Evidence for home treatment is positive, yet there are only few up-to-date studies from Europe and differential indication criteria are lacking. The aim of home treatment is to reduce inpatient bed-days by nonadmission or early discharge. Home treatment teams are mobile, interdisciplinary, and provide 24 h services. The average treatment length in home treatment should not exceed the duration of the inpatient treatment. The home treatment team usually takes the responsibility for the gatekeeping for inpatient treatment. Future research should focus on precise definitions of the structures and interventions of home treatment teams. Home treatment for severely mental ill patients should be distinguished from assertive community treatment and case management, which offer continuing rather than acute crises care.
Collapse
|
71
|
Alba Palé L, León Caballero J, Córcoles Martínez D, González Fresnedo AM, Bellsolà Gonzalez M, Martín López LM, Pérez Solà V. Psychiatric Home Hospitalization Unit of the Hospital del Mar. A crisis resolution and home treatment team in Barcelona. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 12:207-212. [PMID: 30670368 DOI: 10.1016/j.rpsm.2018.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/08/2018] [Accepted: 09/11/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although home hospitalization has begun to develop widely in recent years there is a notable lack of studies. The following study includes data from the Psychiatric Home Hospitalization Unit of the Hospital del Mar (HADMar). This program has been running for 2years and takes place in a socio-demographically depressed area in Barcelona. It receives patients from community and hospital services. Monitoring is limited in time and at discharge patient are referred to the ambulatory unit. MATERIAL AND METHODS All patients visited from 2015 to the present time were selected. A total of 135 patients were included in the sample. A qualitative descriptive study was carried out in order to define the socio-demographic characteristics. The severity of symptoms, suicidal risk and changes in the functionality were considered as clinical outcomes. RESULTS The mean age of patients was 44.6 years and there were no gender differences. A total of 26 patients had a history of suicidal attempts and 11.1% lived alone; 51.1% were diagnosed with a psychotic disorder. The mean GEP score for the severity of the psychiatric symptoms was 2.39 and the mean risk of suicide was 0.49. There is an increase in the EEAG score from admission to discharge, which means an improvement in the functionality of patients. CONCLUSIONS The results obtained in our study are consistent with previous results. Home crisis intervention teams have proved to be an alternative to traditional hospitalization. However, more studies are needed to support these results.
Collapse
Affiliation(s)
- Leila Alba Palé
- Unidad de hospitalización domiciliaria de CASM Benito Menni, Germanes Hospitalaries, Sant Boi de Llobregat, Barcelona, España.
| | - Jordi León Caballero
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, España; Departamento de Psiquiatría y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, España
| | | | | | | | | | - Víctor Pérez Solà
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, España; Medical Research Institute (IMIM), Hospital del Mar , Barcelona; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), España
| |
Collapse
|
72
|
Schöttle D, Ruppelt F, Schimmelmann BG, Karow A, Bussopulos A, Gallinat J, Wiedemann K, Luedecke D, Rohenkohl AC, Huber CG, Bock T, Lambert M. Reduction of Involuntary Admissions in Patients With Severe Psychotic Disorders Treated in the ACCESS Integrated Care Model Including Therapeutic Assertive Community Treatment. Front Psychiatry 2019; 10:736. [PMID: 31708810 PMCID: PMC6822062 DOI: 10.3389/fpsyt.2019.00736] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/13/2019] [Indexed: 01/12/2023] Open
Abstract
Objective: The ACCESS treatment model offers assertive community treatment (ACT) embedded in an integrated care program to patients with severe psychotic disorders. Compared to standard care, it proved to be more effective in terms of service disengagement and other outcomes in patients with psychotic disorders over 12, 24, and 48 months. Many patients with severe mental disorders experience involuntary admissions which can be potentially traumatic. In this study, we assessed the effect of ACT on reducing involuntary admissions over an observation period of 4 years. Method: One hundred seventy-one patients treated in ACCESS were included in this study. The primary outcome was rate of involuntary admissions during 48 months. Secondary outcomes were differences between those with and without involuntary admissions in the 2 years prior to ACCESS regarding change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication non-adherence, and service-disengagement. Results: Of 171 patients, 58 patients (33.9%) were involuntarily admitted to hospital in the past 2 years before entry. During the 4 years of treatment, 16 patients (9.4%) were involuntarily admitted to hospital which was a significantly lower rate compared to the 2 years before inclusion in ACCESS (p < .001). Comparing the two groups, larger improvements in severity of illness (p = .004) and functional status (p = .043) were detected in the group with no history of involuntary admissions. At 4-year follow-up, of the remaining patients, 69.2% (n = 81) were full adherent (p < .001), compared to 18.9% (n = 31) at baseline with no differences between the two groups over the study period (p = .25). Over 4 years, only 13 patients (13.2%) were service-disengaged due to non-practical reasons. Conclusions: In this long-term study, we were able to demonstrate a reduction in involuntary admissions in four treatment years compared to the 2 years prior to admission to the ACCESS model in patients with severe and mostly multiphase schizophrenia spectrum disorders and affective disorders with psychotic features. This may help prevent patients from suffering from a potentially traumatic experience during treatment in the psychiatric system. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT01888627.
Collapse
Affiliation(s)
- Daniel Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Bussopulos
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken Basel (UPK), University of Basel, Basel, Switzerland
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Christine Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian G Huber
- Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken Basel (UPK), University of Basel, Basel, Switzerland
| | - Thomas Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
73
|
Vallarino M, Rapisarda F, Scott J, Vecchi T, Barbato A, D'Avanzo B. Experiences of Mental Healthcare Reported by Individuals Diagnosed with Bipolar Disorder: An Italian Qualitative Study. Community Ment Health J 2019; 55:129-136. [PMID: 30074118 DOI: 10.1007/s10597-018-0311-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 07/28/2018] [Indexed: 01/06/2023]
Abstract
This qualitative study explores experiences of mental health care by nine Italian users with a diagnosis of bipolar disorder. The findings from semi-structured interviews carried by professional researchers highlighted the following themes: mixed feelings about the diagnosis; lack of access to psychological interventions despite preferences of users; positive view of peer support, job as a safe haven, traumatic experiences of compulsory hospital admissions; need for crisis interventions as alternative to hospital admission. Most users' views look in accordance with evidence-based recommendations seldom implemented in practice. Future research directions, implications of users' expectations and experiences for service planning and quality improvement, are presented and discussed in the light of the qualitative available literature.
Collapse
Affiliation(s)
- Martine Vallarino
- Department of Brain and Behavioral Sciences, University of Pavia, Piazza Botta 6, 27100, Pavia, Italy.
| | - Filippo Rapisarda
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Tomaso Vecchi
- Department of Brain and Behavioral Sciences, University of Pavia, Piazza Botta 6, 27100, Pavia, Italy
- Brain Connectivity Center, National Neurological Institute C. Mondino, Pavia, Italy
| | - Angelo Barbato
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Barbara D'Avanzo
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| |
Collapse
|
74
|
Silva B, Golay P, Morandi S. Factors associated with involuntary hospitalisation for psychiatric patients in Switzerland: a retrospective study. BMC Psychiatry 2018; 18:401. [PMID: 30594163 PMCID: PMC6311042 DOI: 10.1186/s12888-018-1966-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the scarce evidence for patients' benefits of coercion and its well-documented negative effects, the use of compulsion is still very common around Europe, with important variations among different countries. These variations have been partially explained by the different legal frameworks, but also by several individual-related, system-related and area-related characteristics, identified as predictors of the use of coercive measures. This study aimed to compare the socio-demographic and clinical profile as well as the referral and hospitalisation process of people voluntarily and involuntarily hospitalized in order to identify which factors could be associated with the use of coercion. METHODS All psychiatric admissions occurred between the 1st January 2015 and the 31st December 2015 were included in this retrospective study (n = 5027). The whole sample was split into two subgroups accordingly to the hospitalisation legal status at admission (voluntary vs involuntary) and differences between the two groups were examined. In order to identify the factors associated with coercion, all the variables reaching a p < .01 level of significance when comparing the two groups were included as independent variables into a multivariate logistic regression model. RESULTS Globally, 62% of the admissions were voluntary and 38% were involuntary. Compared to the voluntary group, involuntary patients were significantly older, more frequently widowed and living in one specific district, and had a main diagnosis of schizophrenia (F20-F29) or organic mental disorders (F00-F09). People affected by organic mental disorders (F00-F09), with higher levels of psychotic symptoms, aggression and problems with medication adherence, were more likely to be involuntarily admitted. Moreover, living in District 1, being referred by a general practitioner, a general hospital or a psychiatric hospital and being involuntarily admitted during the previous 12 months, was associated with a higher risk of coercion. CONCLUSIONS This study identified several individual-related, as well as system-related factors associated with the use of coercion. These results allowed us to trace a clearer profile of high-risk patients and to provide several inputs that could help local authorities, professionals and researchers to develop better-targeted alternative interventions reducing the use of coercion.
Collapse
Affiliation(s)
- Benedetta Silva
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland.
| | - Philippe Golay
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Stéphane Morandi
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| |
Collapse
|
75
|
Gillès de Pélichy E, Ebbing K, Matos Queiros A, Hanon C, von Gunten A, Sellah Z, Verloo H. Demographics, Clinical Characteristics, and Therapeutic Approaches among Older Adults Referred to Mobile Psychiatric Crisis Intervention Teams: A Retrospective Study. Dement Geriatr Cogn Dis Extra 2018; 8:402-413. [PMID: 30483306 PMCID: PMC6243965 DOI: 10.1159/000493525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022] Open
Abstract
Background / Aims The advent of mobile old age psychiatry intervention teams supports policies maintaining older adults in their habitual living environments, even those who are very old and suffering from acute cognitive and psychiatric impairments. Analyzing sociodemographic data, clinical and health characteristics, reasons for crisis-oriented psychiatric consultations, and other therapeutic suggestions for supporting home- or nursing home-dwelling older adult patients suffering from an onset of a psychiatric crisis. Methods Reviews of the medical records and discharge letters of home- or nursing home-dwelling older adults who had undergone a consultation with the Lausanne region's Mobile Old Age Psychiatry Teams (MOAPTs), between May 2016 and December 2017. Results Of 570 older adult patients referred for consultation with MOAPTs, 333 had medical records and discharge letters eligible for retrospective analysis (59%). The majority of these older adult patients were women aged over 80 years suffering from dementia, mood disorders with and without a risk of suicide, and delirium. Challenging behaviors related to different stages of cognitive impairment were the most important clinical reason for crisis consultations. Nonpharmacological and pharmacological treatments were delivered concurrently in 68% of crisis consultations. Conclusion Appropriate responses by dual nurse-psychiatrist teams using crisis-oriented nonpharmacological and pharmacological interventions decreased hospitalization.
Collapse
Affiliation(s)
- Estelle Gillès de Pélichy
- Service of Old Age Psychiatry (SUPAA), Lausanne University Hospital, Prilly / Prangins, Switzerland
- Administration of Health and Social Welfare, Service of Public Health, Lausanne, Switzerland
- *Estelle Gillès de Pélichy, MD, FRC-Psych, Department of Psychiatry, Lausanne University Hospital, CH-1197 Prangins (Switzerland), E-Mail , Karsten Ebbing, MD, FRC-Psych, Department of Psychiatry, Lausanne University Hospital, CH-1011 Lausanne (Switzerland), E-Mail
| | - Karsten Ebbing
- Service of Old Age Psychiatry (SUPAA), Lausanne University Hospital, Prilly / Prangins, Switzerland
| | - Alcina Matos Queiros
- Administration of Health and Social Welfare, Service of Public Health, Lausanne, Switzerland
| | - Cécile Hanon
- Regional Resource Center of Old Age Psychiatry, Mobile Team for Old Age Psychiatric Subjects – EMPSA 92 South, Paris University Hospitals-West, Corentin-Celton Hospital, Issy-Les-Moulineaux, France
| | - Armin von Gunten
- Service of Old Age Psychiatry (SUPAA), Lausanne University Hospital, Prilly / Prangins, Switzerland
| | - Zaia Sellah
- Service of Old Age Psychiatry (SUPAA), Lausanne University Hospital, Prilly / Prangins, Switzerland
| | - Henk Verloo
- Service of Old Age Psychiatry (SUPAA), Lausanne University Hospital, Prilly / Prangins, Switzerland
- University of Applied Sciences Western Switzerland, Nursing Sciences, Sion, Switzerland
| |
Collapse
|
76
|
Daggenvoorde TH, Gijsman HJ, Goossens PJJ. Emergency care in case of acute psychotic and/or manic symptoms: Lived experiences of patients and their families with the first interventions of a mobile crisis team. A phenomenological study. Perspect Psychiatr Care 2018; 54:462-468. [PMID: 28960363 DOI: 10.1111/ppc.12247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/16/2017] [Accepted: 09/10/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To explore the lived experiences of patients with a psychotic or bipolar disorder and their families with emergency care during the first contact with a mobile crisis team. METHODS Open individual interviews were held with ten patients and ten family members. Content data-analysis was conducted. FINDINGS Communication and cooperation was difficult in several cases. Personal crisis plans were not always used. Stigma was felt, especially when police-assistance was needed. A calm, understanding attitude was appreciated. PRACTICE IMPLICATIONS Focus explicitly on communication with the patient, despite the acute condition, enhances the chance of cooperation. Taking time for contact is important.
Collapse
Affiliation(s)
- Thea H Daggenvoorde
- Dimence Group, Mental Health Care Centre, Deventer, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Harm J Gijsman
- Pro Persona Mental Health, Program for Psychose & Severe Mental Illness, Wolfheze, The Netherlands
| | - Peter J J Goossens
- Dimence Group, Mental Health Care Centre, Deventer, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,GGZ-VS, Institute for Education of Clinical Nurse Specialist in Mental Health, Utrecht, The Netherlands.,Department of Public Health, Faculty of Medicine and Health Sciences, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| |
Collapse
|
77
|
Johnson S, Lamb D, Marston L, Osborn D, Mason O, Henderson C, Ambler G, Milton A, Davidson M, Christoforou M, Sullivan S, Hunter R, Hindle D, Paterson B, Leverton M, Piotrowski J, Forsyth R, Mosse L, Goater N, Kelly K, Lean M, Pilling S, Morant N, Lloyd-Evans B. Peer-supported self-management for people discharged from a mental health crisis team: a randomised controlled trial. Lancet 2018; 392:409-418. [PMID: 30102174 PMCID: PMC6083437 DOI: 10.1016/s0140-6736(18)31470-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND High resource expenditure on acute care is a challenge for mental health services aiming to focus on supporting recovery, and relapse after an acute crisis episode is common. Some evidence supports self-management interventions to prevent such relapses, but their effect on readmissions to acute care following a crisis is untested. We tested whether a self-management intervention facilitated by peer support workers could reduce rates of readmission to acute care for people discharged from crisis resolution teams, which provide intensive home treatment following a crisis. METHODS We did a randomised controlled superiority trial recruiting participants from six crisis resolution teams in England. Eligible participants had been on crisis resolution team caseloads for at least a week, and had capacity to give informed consent. Participants were randomly assigned to intervention and control groups by an unmasked data manager. Those collecting and analysing data were masked to allocation, but participants were not. Participants in the intervention group were offered up to ten sessions with a peer support worker who supported them in completing a personal recovery workbook, including formulation of personal recovery goals and crisis plans. The control group received the personal recovery workbook by post. The primary outcome was readmission to acute care within 1 year. This trial is registered with ISRCTN, number 01027104. FINDINGS 221 participants were assigned to the intervention group versus 220 to the control group; primary outcome data were obtained for 218 versus 216. 64 (29%) of 218 participants in the intervention versus 83 (38%) of 216 in the control group were readmitted to acute care within 1 year (odds ratio 0·66, 95% CI 0·43-0·99; p=0·0438). 71 serious adverse events were identified in the trial (29 in the treatment group; 42 in the control group). INTERPRETATION Our findings suggest that peer-delivered self-management reduces readmission to acute care, although admission rates were lower than anticipated and confidence intervals were relatively wide. The complexity of the study intervention limits interpretability, but assessment is warranted of whether implementing this intervention in routine settings reduces acute care readmission. FUNDING National Institute for Health Research.
Collapse
Affiliation(s)
- Sonia Johnson
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | - Danielle Lamb
- Division of Psychiatry, University College London, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - David Osborn
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Oliver Mason
- Division of Psychology and Language Sciences, University College London, London, UK; School of Psychology, University of Surrey, Guildford, UK
| | - Claire Henderson
- Health Service and Population Research, King's College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Alyssa Milton
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | | | - Sarah Sullivan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - David Hindle
- Division of Psychiatry, University College London, London, UK
| | - Beth Paterson
- Division of Psychiatry, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | | | - Rebecca Forsyth
- Division of Psychiatry, University College London, London, UK
| | - Liberty Mosse
- Division of Psychiatry, University College London, London, UK
| | | | | | - Mel Lean
- Division of Psychiatry, University College London, London, UK
| | - Stephen Pilling
- Division of Psychology and Language Sciences, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | | |
Collapse
|
78
|
Lloyd-Evans B, Lamb D, Barnby J, Eskinazi M, Turner A, Johnson S. Mental health crisis resolution teams and crisis care systems in England: a national survey. BJPsych Bull 2018; 42:146-151. [PMID: 29792390 PMCID: PMC6436049 DOI: 10.1192/bjb.2018.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/15/2018] [Accepted: 02/23/2018] [Indexed: 11/23/2022] Open
Abstract
Aims and methodA national survey investigated the implementation of mental health crisis resolution teams (CRTs) in England. CRTs were mapped and team managers completed an online survey. RESULTS Ninety-five per cent of mapped CRTs (n = 233) completed the survey. Few CRTs adhered fully to national policy guidelines. CRT implementation and local acute care system contexts varied substantially. Access to CRTs for working-age adults appears to have improved, compared with a similar survey in 2012, despite no evidence of higher staffing levels. Specialist CRTs for children and for older adults with dementia have been implemented in some areas but are uncommon.Clinical implicationsA national mandate and policy guidelines have been insufficient to implement CRTs fully as planned. Programmes to support adherence to the CRT model and CRT service improvement are required. Clearer policy guidance is needed on requirements for crisis care for young people and older adults.Declaration of interestNone.
Collapse
|
79
|
The coping process of Japanese parents who experience violence from adult children with schizophrenia. Arch Psychiatr Nurs 2018; 32:549-554. [PMID: 30029746 DOI: 10.1016/j.apnu.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 03/06/2018] [Indexed: 11/21/2022]
Abstract
With the acceleration of deinstitutionalization might increase families' chances of suffering violence by patients. This study clarified parents' coping processes with violence experienced from patients with schizophrenia. The grounded theory approach was used, and 26 parents were interviewed. We identified a four-stage coping process: (1) hope for treatment, (2) living with violence, (3) trying to solve violence, and (4) last solution for violence. This coping process had two illness-related characteristics: (1) a process of coping with two main stressful events (the illness and violence), and (2) the need for long-term appraisal of violence because of its unclear causes.
Collapse
|
80
|
Coates D. Service Models for Urgent and Emergency Psychiatric Care: An Overview. J Psychosoc Nurs Ment Health Serv 2018; 56:23-30. [DOI: 10.3928/02793695-20180212-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/10/2018] [Indexed: 11/20/2022]
|
81
|
Lay B, Kawohl W, Rössler W. Outcomes of a psycho-education and monitoring programme to prevent compulsory admission to psychiatric inpatient care: a randomised controlled trial. Psychol Med 2018; 48:849-860. [PMID: 28805175 DOI: 10.1017/s0033291717002239] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is a need for interventions that effectively reduce compulsory admission to psychiatry. We conducted a randomised controlled trial to investigate whether an innovative intervention programme prevents compulsory re-admission in people with serious mental illness. METHODS The programme addresses primarily patients' self-management skills. It consists of individualised psychoeducation focusing on behaviours prior to and during illness-related crises, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. A total of 238 inpatients with compulsory admission(s) in the past were randomised to the intervention group or to treatment as usual (TAU). RESULTS Fewer participants who completed the 24-month programme were compulsorily readmitted to psychiatry (28%), compared with those receiving TAU (43%). Likewise, the number of compulsory readmissions per patient was significantly lower (0.6 v. 1.0) and involuntary episodes were shorter (15 v. 31 days), compared with TAU. A negative binomial regression model showed a significant intervention effect (RR 0.6; 95% confidence interval 0.3-0.9); further factors linked to the risk of compulsory readmission were the number of compulsory admissions in the patient's history (RR 2.8), the diagnosis of a personality disorder (RR 2.8), or a psychotic disorder (RR 1.9). Dropouts (37% intervention group; 22% TAU) were characterised by a high number of compulsory admissions prior to the trial, younger age and foreign nationality. CONCLUSIONS This study suggests that this intervention is a feasible and valuable option to prevent compulsory re-hospitalisation in a high-risk group of people with severe mental health problems, social disabilities, and a history of hospitalisations.
Collapse
Affiliation(s)
- B Lay
- Department of Psychiatry,Psychotherapy and Psychosomatics,University Hospital of Psychiatry Zurich,Switzerland
| | - W Kawohl
- Department of Psychiatry,Psychotherapy and Psychosomatics,University Hospital of Psychiatry Zurich,Switzerland
| | - W Rössler
- Department of Psychiatry,Psychotherapy and Psychosomatics,University Hospital of Psychiatry Zurich,Switzerland
| |
Collapse
|
82
|
Cornelis J, Barakat A, Dekker J, Schut T, Berk S, Nusselder H, Ruhl N, Zoeteman J, Van R, Beekman A, Blankers M. Intensive home treatment for patients in acute psychiatric crisis situations: a multicentre randomized controlled trial. BMC Psychiatry 2018; 18:55. [PMID: 29486741 PMCID: PMC6389203 DOI: 10.1186/s12888-018-1632-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 02/12/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hospitalization is a common method to intensify care for patients experiencing a psychiatric crisis. A short-term, specialised, out-patient crisis intervention by a Crisis Resolution Team (CRT) in the Netherlands, called Intensive Home Treatment (IHT), is a viable intervention which may help reduce hospital admission days. However, research on the (cost-)effectiveness of alternatives to hospitalisation such as IHT are scarce. In the study presented in this protocol, IHT will be compared to care-as-usual (CAU) in a randomized controlled trial (RCT). CAU comprises low-intensity outpatient care and hospitalisation if necessary. In this RCT it is hypothesized that IHT will reduce inpatient days by 33% compared to CAU while safety and clinical outcomes will be non-inferior. Secondary hypotheses are that treatment satisfaction of patients and their relatives are expected to be higher in the IHT condition compared to CAU. METHODS A 2-centre, 2-arm Zelen double consent RCT will be employed. Participants will be recruited in the Amsterdam area, the Netherlands. Clinical assessments will be carried out at baseline and at 6, 26 and 52 weeks post treatment allocation. The primary outcome measure is the number of admission days. Secondary outcomes include psychological well-being, safety and patients' and their relatives' treatment satisfaction. Alongside this RCT an economic evaluation will be carried out to assess the cost-effectiveness and cost-utility of IHT compared to CAU. DISCUSSION RCTs on the effectiveness of crisis treatment in psychiatry are scarce and including patients in studies performed in acute psychiatric crisis care is a challenge due to the ethical and practical hurdles. The Zelen design may offer a feasible opportunity to carry out such an RCT. If our study finds that IHT is a safe and cost-effective alternative for CAU it may help support a further decrease of in-patient bed days and may foster the widespread implementation of IHT by mental health care organisations internationally. TRIAL REGISTRATION The trial is registered in the Netherlands Trial Register as # NTR-6151 . Registered 23 November 2016.
Collapse
Affiliation(s)
- Jurgen Cornelis
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033, NN, Amsterdam, The Netherlands. .,Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands.
| | - Ansam Barakat
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Jack Dekker
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands ,0000 0004 1754 9227grid.12380.38Department Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Tessy Schut
- Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Sandra Berk
- 0000 0004 0546 0540grid.420193.dDepartment of Emergency Psychiatry, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Hans Nusselder
- Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Nikander Ruhl
- 0000 0004 0546 0540grid.420193.dDepartment of Emergency Psychiatry, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Jeroen Zoeteman
- Department of Emergency Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Rien Van
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Aartjan Beekman
- 0000 0004 0435 165Xgrid.16872.3aGGZ inGeest and Department of Psychiatry, Amsterdam Public Health research institute, VU University Medical Center, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands ,0000000084992262grid.7177.6Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands ,0000 0001 0835 8259grid.416017.5Trimbos Institute – The Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands
| |
Collapse
|
83
|
Lloyd-Evans B, Paterson B, Onyett S, Brown E, Istead H, Gray R, Henderson C, Johnson S. National implementation of a mental health service model: A survey of Crisis Resolution Teams in England. Int J Ment Health Nurs 2018; 27:214-226. [PMID: 28075067 DOI: 10.1111/inm.12311] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2016] [Indexed: 12/01/2022]
Abstract
In response to pressures on mental health inpatient beds and a perceived 'crisis in acute care', Crisis Resolution Teams (CRTs), acute home treatment services, were implemented nationally in England following the NHS Plan in the year 2000: an unprecedentedly prescriptive policy mandate for three new types of functional community mental health team. We examined the effects of this mandate on implementation of the CRT service model. Two hundred and eighteen CRTs were mapped in England, including services in all 65 mental health administrative regions. Eighty-eight percent (n = 192) of CRT managers in England participated in an online survey. CRT service organization and delivery was highly variable. Nurses were the only professional group employed in all CRT staff teams. Almost no teams adhered fully to government implementation guidance. CRT managers identified several aspects of CRT service delivery as desirable but not routinely provided. A national policy mandate and government guidance and standards have proved insufficient to ensure CRT implementation as planned. Development and testing of resources to support implementation and monitoring of a complex mental health intervention is required.
Collapse
Affiliation(s)
| | - Bethan Paterson
- Division of Psychiatry, University College London, London, UK
| | - Steve Onyett
- Onyett Entero Ltd/Department of Psychology, University of Exeter Washington Singer Building, Exeter, UK
| | - Ellie Brown
- Glenside Campus, University of the West of England, Bristol, UK
| | - Hannah Istead
- Division of Psychiatry, University College London, London, UK
| | - Richard Gray
- Glenside Campus, University of the West of England, Bristol, UK
| | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| |
Collapse
|
84
|
Wullschleger A, Berg J, Bermpohl F, Montag C. Can "Model Projects of Need-Adapted Care" Reduce Involuntary Hospital Treatment and the Use of Coercive Measures? Front Psychiatry 2018; 9:168. [PMID: 29765339 PMCID: PMC5939233 DOI: 10.3389/fpsyt.2018.00168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 04/12/2018] [Indexed: 11/13/2022] Open
Abstract
Intensive outpatient models of need-adapted psychiatric care have been shown to reduce the length of hospital stays and to improve retention in care for people with severe mental illnesses. In contrast, evidence regarding the impact of such models on involuntary hospital treatment and other coercive measures in inpatient settings is still sparse, although these represent important indicators of the patients' wellbeing. In Germany, intensive models of care still have not been routinely implemented, and their effectiveness within the German psychiatric system is only studied in a few pioneering regions. An innovative model of flexible, assertive, need-adapted care established in Berlin, Germany, in 2014, treating unselected 14% of the catchment area's patients, was evaluated on the basis of routine clinical data. Records of n = 302 patients diagnosed with severe mental disorders, who had been hospitalized at least once during a 4-year-observational period, were analyzed in a retrospective individual mirror-image design, comparing the 2 years before and after inclusion in the model project regarding the time spent in hospital, the number and duration of involuntary hospital treatments and the use of direct coercive interventions like restraint or isolation. After inclusion to the project, patients spent significantly less time in hospital. Among patients treated on acute wards and patients with a diagnosis of psychosis, the number of patients subjected to provisional detention due to acute endangerment of self or others decreased significantly, as did the time spent under involuntary hospital treatment. The number of patients subjected to mechanical restraint, but not to isolation, on the ward decreased significantly, while the total number of coercive interventions remained unchanged. Findings suggest some potential of intensive models of need-adapted care to reduce coercive interventions in psychiatry. However, results must be substantiated by evidence from randomized-controlled trials and longer observation periods.
Collapse
Affiliation(s)
- Alexandre Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jürgen Berg
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
85
|
von Peter S, Ignatyev Y, Johne J, Indefrey S, Kankaya OA, Rehr B, Zeipert M, Bechdolf A, Birkner T, Deister A, Duve A, Rout S, Scherk H, Schulz-Dubois A, Wilms B, Zedlick D, Grollich P, Braun B, Timm J, Heinze M. Evaluation of Flexible and Integrative Psychiatric Treatment Models in Germany-A Mixed-Method Patient and Staff-Oriented Exploratory Study. Front Psychiatry 2018; 9:785. [PMID: 30723433 PMCID: PMC6349706 DOI: 10.3389/fpsyt.2018.00785] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
Contrary to the practice in some countries, access to flexible and integrated forms of psychiatric care (FIT models) is limited in Germany. Several legislations have been introduced to improve this situation, notably the recent §64b (flexible and integrative treatment model; FIT64b) of the German Social Code, which allows for a capitation-based accounting of fees for services. The aim of this study was to explore the effects of FIT64b implementation on various stakeholders (patients, informal caregivers and staff) in 12 psychiatric hospital departments across Germany. Structural as well as quantitative and qualitative data are included, with integration of different methodological approaches. In all departments, the implementation of the new accounting system resulted into a relatively stable set of structural and processual changes where rigid forms of mainly inpatient care shifted to more flexible and integrated types of outpatient and outreach treatments. These changes were more likely to be perceived by patients and staff, and likewise received better evaluations, in those departments showing higher level or longer duration of implementation. Patients' evaluations, furthermore, were largely influenced by the advent of continuous forms of care, better accessibility, and by their degree of autonomy in steering of their services.
Collapse
Affiliation(s)
- Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Yuriy Ignatyev
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Jakob Johne
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Sonja Indefrey
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Onur Alp Kankaya
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Burkhard Rehr
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Manfred Zeipert
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany.,Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, Vivantes Krankenhaus am Urban, Charité University Medicine Berlin, University of Cologne, Berlin, Germany
| | - Thomas Birkner
- Department for Psychiatry, Psychotherapy and Psychosomatic Medicine, Westklinikum Heide, Heide, Germany
| | - Arno Deister
- Psychosoziales Zentrum Itzehoe, Itzehoe, Germany
| | - Annette Duve
- Department of Child and Adolescent Psychiatry, Vitos Klinikum Riedstadt, Riedstadt, Germany
| | - Sandeep Rout
- Department of Psychiatry and Psychotherapy, Vivantes Krankenhaus Neukölln, Charité University Medicine Berlin, Berlin, Germany
| | - Harald Scherk
- Department of Psychiatry and Psychotherapy, Vitos Klinikum Riedstadt, Riedstadt, Germany
| | - Anna Schulz-Dubois
- Department of Psychiatry and Psychotherapy, Imland Krankenhaus Rendsburg, Rendsburg, Germany
| | - Bettina Wilms
- Department of Psychiatry and Psychotherapy, Basedow Klinikum Saalekreis, Querfurt, Germany
| | - Dyrk Zedlick
- Department of Psychiatry and Psychotherapy, Rudolf Virchow Krankenhaus Glauchau, Glauchau, Germany
| | - Peter Grollich
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Bernard Braun
- SOCIUM Research Center, University of Bremen, Bremen, Germany
| | - Jürgen Timm
- Biometry Section, Competence Center for Clinical Trials, University of Bremen, Bremen, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| |
Collapse
|
86
|
Niimura J, Nakanishi M, Yamasaki S, Nishida A. Regional supply of outreach service and length of stay in psychiatric hospital among patients with schizophrenia: National case mix data analysis in Japan. Psychiatry Res 2017; 258:295-298. [PMID: 28865718 DOI: 10.1016/j.psychres.2017.08.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 11/25/2022]
Abstract
Several clinical trials have demonstrated that linkage to an outreach service can prevent prolonged length of stay of patients at psychiatric hospitals. However, there has been no investigation of the association between length of stay in psychiatric hospital and regional supply of outreach services using national case mix data. The aim of this study was to clarify the relationship between length of stay in psychiatric hospital and regional supply of outreach services. We used data from the National Patient Survey in Japan, a nationally representative cross-sectional survey of inpatient care conducted every three years from 1996 to 2014. Data from 42,268 patients with schizophrenia who had been admitted to psychiatric hospitals were analyzed. After controlling for patient and regional characteristics, patients in regions with fewer number of visits for psychiatric nursing care at home had significantly longer length of stay in psychiatric hospitals. This finding implies that enhancement of the regional supply of outreach services would prevent prolonged length of stay in psychiatric hospitals.
Collapse
Affiliation(s)
- Junko Niimura
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Miharu Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan.
| | - Syudo Yamasaki
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Atsushi Nishida
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| |
Collapse
|
87
|
Newbigging K, Mohan J, Rees J, Harlock J, Davis A. Contribution of the voluntary sector to mental health crisis care in England: protocol for a multimethod study. BMJ Open 2017; 7:e019238. [PMID: 29122807 PMCID: PMC5695387 DOI: 10.1136/bmjopen-2017-019238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Timely access to the right kind of support for people experiencing a mental health crisis can be problematic. The voluntary sector (VS) plays a key role in providing support and enabling access, but there is a knowledge gap concerning its contribution and interface with public services in mental health crisis care. This study aims to address this. METHODS AND ANALYSIS The study has three empirical elements: (1) a national survey of voluntary sector organisations (VSOs) in England and national stakeholder interviews to develop a typology of organisations and interventions provided by VSOs; (2) detailed mapping of VS services in two regions through interviews and extending the national survey; (3) four case studies, identified from the regional mapping, of VS mental health crisis services and their interface with National Health Service (NHS) and local authority services, at both a system and individual level. Data collection will involve interviews with commissioners; VSO and NHS or local authority providers; and focus groups with people who have experience of VSO crisis support, both service users and carers; and mapping the crisis trajectory of 10 service users in each study site through narrative interviews with service users and informal carers to understand the experience of VSO crisis care and its impact. ETHICS AND DISSEMINATION The University of Birmingham Humanities and Social Sciences Ethical Review Committee granted ethical approval (reference ERN_16-1183) for the national and regional elements of the study. Ethical review by the Health Research Authority will be required for the case study research once the sites have been identified from the first two elements of the study. A range of methods including a policy seminar, publication in academic journals and a tool kit for commissioners and practitioners will be produced to maximise the impact of the findings on policy and practice.
Collapse
Affiliation(s)
- Karen Newbigging
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - John Mohan
- Third Sector Research Centre, University of Birmingham, Birmingham, UK
| | - James Rees
- Open University Business School, Milton Keynes, UK
| | - Jenny Harlock
- Nuffield Department of Population Health, Oxford University, Oxford, UK
| | | |
Collapse
|
88
|
Morant N, Lloyd-Evans B, Lamb D, Fullarton K, Brown E, Paterson B, Istead H, Kelly K, Hindle D, Fahmy S, Henderson C, Mason O, Johnson S. Crisis resolution and home treatment: stakeholders' views on critical ingredients and implementation in England. BMC Psychiatry 2017; 17:254. [PMID: 28716022 PMCID: PMC5512942 DOI: 10.1186/s12888-017-1421-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis resolution teams (CRTs) can provide effective home-based treatment for acute mental health crises, although critical ingredients of the model have not been clearly identified, and implementation has been inconsistent. In order to inform development of a more highly specified CRT model that meets service users' needs, this study used qualitative methods to investigate stakeholders' experiences and views of CRTs, and what is important in good quality home-based crisis care. METHOD Semi-structured interviews and focus groups were conducted with service users (n = 41), carers (n = 20) and practitioners (CRT staff, managers and referrers; n = 147, 26 focus groups, 9 interviews) in 10 mental health catchment areas in England, and with international CRT developers (n = 11). Data were analysed using thematic analysis. RESULTS Three domains salient to views about optimal care were identified. 1. The organisation of CRT care: Providing a rapid initial responses, and frequent home visits from the same staff were seen as central to good care, particularly by service users and carers. Being accessible, reliable, and having some flexibility were also valued. Negative experiences of some referral pathways, and particularly lack of staff continuity were identified as problematic. 2. The content of CRT work: Emotional support was at the centre of service users' experiences. All stakeholder groups thought CRTs should involve the whole family, and offer a range of interventions. However, carers often feel excluded, and medication is often prioritised over other forms of support. 3. The role of CRTs within the care system: Gate-keeping admissions is seen as a key role for CRTs within the acute care system. Service users and carers report that recovery is quicker compared to in-patient care. Lack of knowledge and misunderstandings about CRTs among referrers are common. Overall, levels of stakeholder agreement about the critical ingredients of good crisis care were high, although aspects of this were not always seen as achievable. CONCLUSIONS Stakeholders' views about optimal CRT care suggest that staff continuity, carer involvement, and emotional and practical support should be prioritised in service improvements and more clearly specified CRT models.
Collapse
Affiliation(s)
- Nicola Morant
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | | | - Danielle Lamb
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Kate Fullarton
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | | | - Beth Paterson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Hannah Istead
- Anna Freud National Centre for Children and Families, 12 Maresfield Gardens, London, NW3 5SU UK
| | - Kathleen Kelly
- Oxford Health NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - David Hindle
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sarah Fahmy
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Claire Henderson
- Health Service and Population Research Department P029, King’s College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Oliver Mason
- School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH UK
| | - Sonia Johnson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| |
Collapse
|
89
|
Zanello A, Berthoud L, Bacchetta JP. Emotional crisis in a naturalistic context: characterizing outpatient profiles and treatment effectiveness. BMC Psychiatry 2017; 17:130. [PMID: 28388881 PMCID: PMC5384152 DOI: 10.1186/s12888-017-1293-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis happens daily yet its understanding is often limited, even in the field of psychiatry. Indeed, a challenge is to assess the potential for change of patients so as to offer appropriate therapeutic interventions and enhance treatment program efficacy. This naturalistic study aimed to identify the socio-demographical characteristics and clinical profiles at admission of patients referred to a specialized Crisis Intervention Center (CIC) and to examine the effectiveness of the intervention. METHOD The sample was composed of 352 adult outpatients recruited among the referrals to the CIC. Assessment completed at admission and at discharge examined psychiatric symptoms, defense mechanisms, recovery styles and global functioning. The crisis intervention consisted in a psychodynamically oriented multimodal approach associated with medication. RESULTS Regarding the clinical profiles at intake, patients were middle-aged (M = 38.56, SD = 10.91), with a higher proportion of women (62.22%). They were addressed to the CIC because they had attempted to commit suicide or had suicidal ideation or presented depressed mood related to interpersonal difficulties. No statistical differences were found between patients dropping out (n = 215) and those attending the crisis intervention (n = 137). Crisis intervention demonstrated a beneficial effect (p < 0.01) on almost all variables, with Effect Sizes (ES) ranging from small to large (0.12 < ES < 0.75; median = 0.49). However, the Reliable Change Index indicated that most of the issues fall into the undetermined category (range 41.46 to 96.35%; median = 66.20%). CONCLUSIONS This study establishes the profile of patients referred to the CIC and shows that more than half of the patients dropped out from the crisis intervention before completion. Our findings suggest that people presenting an emotional crisis benefit from crisis intervention. However, given methodological constraints, these results need to be considered with caution. Moreover, the clinical significance of the improvements is not confirmed. Thus, the effectiveness of crisis intervention in naturalistic context is not fully determined and should be more rigorously studied in future research.
Collapse
Affiliation(s)
- Adriano Zanello
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland. .,HUG Département de Santé Mentale et de Psychiatrie, Site Belle-Idée, Ch. du Petit-Bel-Air 2, CH-1225, Chêne-Bourg, Switzerland.
| | - Laurent Berthoud
- grid.9851.5Department of Psychiatry, University of Lausanne, Lausanne, Switzerland
| | - Jean-Pierre Bacchetta
- grid.150338.cDepartment of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| |
Collapse
|
90
|
Admission to acute mental health services after contact with crisis resolution and home treatment teams: an investigation in two large mental health-care providers. Lancet Psychiatry 2017; 4:49-56. [PMID: 27979719 DOI: 10.1016/s2215-0366(16)30416-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Crisis resolution and home treatment teams (CRTs) offer an alternative to hospital admission for patients undergoing mental health crises in the UK. Few studies have been done to examine predictors of relapse and readmission after contact with CRTs. METHODS We used the Clinical Record Interactive Search to identify all patients receiving care from CRTs in two National Health Service (NHS) mental health trusts in London: Camden and Islington NHS Foundation Trust and South London and Maudsley NHS Foundation Trust. We used Cox regression models to examine rates and predictors of admission to acute mental health services within 1 year of contact with CRTs. Sex, age, ethnicity, marital status, social deprivation, severity of psychopathology, duration of index CRT episode, first contact with services, and diagnosis were extracted and examined as predictors of admission. FINDINGS Between Jan 1, 2008, and Aug 31, 2014, 17 666 patients were treated by CRTs-8759 patients in the Camden and Islington trust and 8907 patients in the South London and Maudsley trust. 53·9 patients per 100 person-years (95% CI 52·1-55·8) in Camden and Islington and 51·3 patients per 100 person-years (95% CI 49·6-53·1) in South London and Maudsley were admitted to acute services within 1 year of seeing the CRT. In both cohorts, non-affective psychotic disorders (adjusted hazard ratio [HR] 1·25, 95% CI 1·09-1·44 in Camden and Islington; 1·27, 1·17-1·38 in South London and Maudsley) and age older than 65 years (1·18, 1·01-1·37 in Camden and Islington; 1·32, 1·12-1·56 in South London and Maudsley) were associated with increased risk of admission, whereas first contact with services (0·57, 0·52-0·62 in Camden and Islington; 0·69, 0·63-0·75 in South London and Maudsley), anxiety disorders (0·81, 0·69-0·96 in Camden and Islington; 0·77, 0·67-0·87 in South London and Maudsley), and longer index CRT episodes (adjusted HR per day 0·996, 0·994-0·998 in Camden and Islington; 0·989, 0·987-0·991 in South London and Maudsley) were associated with reduced risk of admission. INTERPRETATION Past use of mental health services and a diagnosis of non-affective psychosis, which are markers of severity of mental illness, and older age, which is a marker of chronicity, are all risk factors for future relapse after interactions with CRTs. These findings might help clinicians and policy makers to offer more targeted and cost-effective services to reduce relapse rates. FUNDING None.
Collapse
|
91
|
Lloyd-Evans B, Bond GR, Ruud T, Ivanecka A, Gray R, Osborn D, Nolan F, Henderson C, Mason O, Goater N, Kelly K, Ambler G, Morant N, Onyett S, Lamb D, Fahmy S, Brown E, Paterson B, Sweeney A, Hindle D, Fullarton K, Frerichs J, Johnson S. Development of a measure of model fidelity for mental health Crisis Resolution Teams. BMC Psychiatry 2016; 16:427. [PMID: 27905909 PMCID: PMC5133753 DOI: 10.1186/s12888-016-1139-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/24/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a fidelity scale to assess adherence to a model of best practice for CRTs, based on best available evidence. METHODS A concept mapping process was used to develop a CRT fidelity scale. Participants (n = 68) from a range of stakeholder groups prioritised and grouped statements (n = 72) about important components of the CRT model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day fidelity review process. Trained reviewers (n = 16) rated CRT service fidelity in a vignette exercise to test the scale's inter-rater reliability. RESULTS There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT model. A 39-item measure of CRT model fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT model fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76). CONCLUSIONS The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.
Collapse
Affiliation(s)
| | - Gary R. Bond
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766 USA
| | - Torleif Ruud
- Division Mental Health Services, Akershus Unieversity Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ada Ivanecka
- Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Richard Gray
- Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - David Osborn
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Fiona Nolan
- Research Department of Clinical, Education and Health Psychology, University College London Gower Street, London, WC1E 6BT UK
| | - Claire Henderson
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Oliver Mason
- Research Department of Clinical, Education and Health Psychology, University College London Gower Street, London, WC1E 6BT UK
- School of Psychology, University of Surrey, Guildford, Surrey GU2 7XH UK
| | - Nicky Goater
- West London Mental Health NHS Trust, Uxbridge Road, Southall, London, UB1 3EU UK
| | - Kathleen Kelly
- Oxfordshire Healthcare NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Gareth Ambler
- Department of Statistical Science, UCL, Gower Street, London, WC1E 6BT UK
| | - Nicola Morant
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Steve Onyett
- Onyett Entero Ltd, care of University of the West of England, Health and Life Sciences Coldharbour Ln, Bristol, BS16 1QY UK
| | - Danielle Lamb
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sarah Fahmy
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Ellie Brown
- Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Beth Paterson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Angela Sweeney
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - David Hindle
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Kate Fullarton
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Johanna Frerichs
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sonia Johnson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| |
Collapse
|
92
|
Hunt IM, Appleby L, Kapur N. Suicide under crisis resolution home treatment - a key setting for patient safety. BJPsych Bull 2016; 40:172-4. [PMID: 27512582 PMCID: PMC4967772 DOI: 10.1192/pb.bp.115.051227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Recent years have seen a substantial increase in the use of crisis resolution home treatment (CRHT) teams as an alternative to psychiatric in-patient admission. We discuss the functions of these services and their effectiveness. Our research suggests high rates of suicide in patients under CRHT. Specific strategies need to be developed to improve patient safety in this setting.
Collapse
Affiliation(s)
| | | | - Nav Kapur
- University of Manchester, Manchester, UK
| |
Collapse
|
93
|
Lloyd-Evans B, Fullarton K, Lamb D, Johnston E, Onyett S, Osborn D, Ambler G, Marston L, Hunter R, Mason O, Henderson C, Goater N, Sullivan SA, Kelly K, Gray R, Nolan F, Pilling S, Bond G, Johnson S. The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial. Trials 2016; 17:158. [PMID: 27004517 PMCID: PMC4804533 DOI: 10.1186/s13063-016-1283-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users' experiences of care, service use, staff well-being, and team model fidelity. METHODS/DESIGN Twenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services' electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study's primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline differences and participant characteristics using linear random effects modelling. Qualitative investigations with participating CRT managers and staff and programme facilitators will explore the experiences of the service improvement programme. DISCUSSION Our trial will show whether a theoretically underpinned and clearly defined package of resources are effective in supporting service improvement and improving outcomes for mental health crisis resolution teams. TRIAL REGISTRATION Current Controlled Trials ISRCTN47185233.
Collapse
Affiliation(s)
| | - Kate Fullarton
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Danielle Lamb
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Elaine Johnston
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Steve Onyett
- />Onyett Entero Ltd, Care of University of the West of England, Health and Life Sciences Coldharbour Ln, Bristol, BS16 1QY UK
| | - David Osborn
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Gareth Ambler
- />Department of Statistical Science, UCL, Gower Street, London, WC1E 6BT UK
| | - Louise Marston
- />Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF UK
| | - Rachael Hunter
- />Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF UK
| | - Oliver Mason
- />Department of Clinical Education and Health Psychology, UCL, Gower Street, London, WC1E 6BT UK
| | - Claire Henderson
- />Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Nicky Goater
- />West London Mental Health NHS Trust, Uxbridge Road, Southall, London, UB1 3EU UK
| | - Sarah A. Sullivan
- />Epidemiology and Health Services Research, CLAHRC West, Lewins Mead, Bristol, BS1 2NT UK
| | - Kathleen Kelly
- />Oxfordshire Healthcare NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Richard Gray
- />Mental Health Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Fiona Nolan
- />Centre for Outcomes Research and Effectiveness, Division of Psychology and language Sciences, UCL, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Stephen Pilling
- />Centre for Outcomes Research and Effectiveness, Division of Psychology and language Sciences, UCL, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Gary Bond
- />Department of Psychiatry, Dartmouth Psychiatric Research Centre, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756 USA
| | - Sonia Johnson
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| |
Collapse
|