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Lamb D, Milton A, Forsyth R, Lloyd-Evans B, Akther S, Fullarton K, O'Hanlon P, Johnson S, Morant N. Implementation of a crisis resolution team service improvement programme: a qualitative study of the critical ingredients for success. Int J Ment Health Syst 2024; 18:18. [PMID: 38704589 PMCID: PMC11069280 DOI: 10.1186/s13033-024-00638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Crisis Resolution Teams (CRTs) offer home-based care for people in mental health crisis, as an alternative to hospital admission. The success of CRTs in England has been variable. In response to this, the CRT Optimization and RElapse prevention (CORE) study developed and trialled a 12-month Service Improvement Programme (SIP) based on a fidelity model. This paper describes a qualitative evaluation of the perspectives of CRT staff, managers, and programme facilitators. We identify barriers and facilitators to implementation, and mechanisms by which service improvements took place. METHODS Managers and staff from six purposively sampled CRTs were interviewed, as well as six facilitators who were employed to support the implementation of service improvement plans. Semi-structured focus groups and individual interviews were conducted and analysed using thematic analysis. FINDINGS A majority of participants viewed all components of the SIP as helpful in improving practice, although online resources were under-used. Perceived barriers to implementation centred principally around lack of staff time and ownership. Support from both senior staff and facilitators was essential in enabling teams to undertake the work associated with the SIP. All participating stakeholder groups reported that using the fidelity model to benchmark their CRT work to best practice and feel part of a 'bigger whole' was valuable. CONCLUSION CRT staff, managers and programme facilitators thought that a structured service improvement programme helped to increase fidelity to a best practice model. Flexibility (from all stakeholders) was key to enable service improvement actions to be manageable within time- and resource-poor teams.
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Affiliation(s)
- Danielle Lamb
- Department of Applied Health Research, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Alyssa Milton
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Gillard S, Anderson K, Clarke G, Crowe C, Goldsmith L, Jarman H, Johnson S, Lomani J, McDaid D, Pariza P, Park AL, Smith J, Turner K, Yoeli H. Evaluating mental health decision units in acute care pathways (DECISION): a quasi-experimental, qualitative and health economic evaluation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-221. [PMID: 38149657 DOI: 10.3310/pbsm2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Background People experiencing mental health crises in the community often present to emergency departments and are admitted to a psychiatric hospital. Because of the demands on emergency department and inpatient care, psychiatric decision units have emerged to provide a more suitable environment for assessment and signposting to appropriate care. Objectives The study aimed to ascertain the structure and activities of psychiatric decision units in England and to provide an evidence base for their effectiveness, costs and benefits, and optimal configuration. Design This was a mixed-methods study comprising survey, systematic review, interrupted time series, synthetic control study, cohort study, qualitative interview study and health economic evaluation, using a critical interpretive synthesis approach. Setting The study took place in four mental health National Health Service trusts with psychiatric decision units, and six acute hospital National Health Service trusts where emergency departments referred to psychiatric decision units in each mental health trust. Participants Participants in the cohort study (n = 2110) were first-time referrals to psychiatric decision units for two 5-month periods from 1 October 2018 and 1 October 2019, respectively. Participants in the qualitative study were first-time referrals to psychiatric decision units recruited within 1 month of discharge (n = 39), members of psychiatric decision unit clinical teams (n = 15) and clinicians referring to psychiatric decision units (n = 19). Outcomes Primary mental health outcome in the interrupted time series and cohort study was informal psychiatric hospital admission, and in the synthetic control any psychiatric hospital admission; primary emergency department outcome in the interrupted time series and synthetic control was mental health attendance at emergency department. Data for the interrupted time series and cohort study were extracted from electronic patient record in mental health and acute trusts; data for the synthetic control study were obtained through NHS Digital from Hospital Episode Statistics admitted patient care for psychiatric admissions and Hospital Episode Statistics Accident and Emergency for emergency department attendances. The health economic evaluation used data from all studies. Relevant databases were searched for controlled or comparison group studies of hospital-based mental health assessments permitting overnight stays of a maximum of 1 week that measured adult acute psychiatric admissions and/or mental health presentations at emergency department. Selection, data extraction and quality rating of studies were double assessed. Narrative synthesis of included studies was undertaken and meta-analyses were performed where sufficient studies reported outcomes. Results Psychiatric decision units have the potential to reduce informal psychiatric admissions, mental health presentations and wait times at emergency department. Cost savings are largely marginal and do not offset the cost of units. First-time referrals to psychiatric decision units use more inpatient and community care and less emergency department-based liaison psychiatry in the months following the first visit. Psychiatric decision units work best when configured to reduce either informal psychiatric admissions (longer length of stay, higher staff-to-patient ratio, use of psychosocial interventions), resulting in improved quality of crisis care or demand on the emergency department (higher capacity, shorter length of stay). To function well, psychiatric decision units should be integrated into the crisis care pathway alongside a range of community-based support. Limitations The availability and quality of data imposed limitations on the reliability of some analyses. Future work Psychiatric decision units should not be commissioned with an expectation of short-term financial return on investment but, if appropriately configured, they can provide better quality of care for people in crisis who would not benefit from acute admission or reduce pressure on emergency department. Study registration The systematic review was registered on the International Prospective Register of Systematic Reviews as CRD42019151043. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/49/70) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 25. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Steve Gillard
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Katie Anderson
- School of Health and Psychological Sciences, City, University of London, London, UK
| | | | - Chloe Crowe
- Adult Acute Mental Health Services, North East London NHS Foundation Trust, London, UK
| | - Lucy Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Heather Jarman
- Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Jo Lomani
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - David McDaid
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Paris Pariza
- Improvement Analytics Unit, Health Foundation, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Jared Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Kati Turner
- Population Health Research Institute, St George's, University of London, London, UK
| | - Heather Yoeli
- School of Health and Psychological Sciences, City, University of London, London, UK
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Clibbens N, Booth A, Sharda L, Baker J, Thompson J, Ashman M, Berzins K, Weich S, Kendal S. Explaining context, mechanism and outcome in adult community mental health crisis care: A realist evidence synthesis. Int J Ment Health Nurs 2023; 32:1636-1653. [PMID: 37574714 DOI: 10.1111/inm.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
Mental health crises cause significant distress and disruption to the lives of individuals and their families. Community crisis care systems are complex, often hard to navigate and poorly understood. This realist evidence synthesis aimed to explain how, for whom and in what circumstances community mental health crisis services for adults work to resolve crises and is reported according to RAMESES guidelines. Using realist methodology, initial programme theories were identified and then tested through iterative evidence searching across 10 electronic databases, four expert stakeholder consultations and n = 20 individual interviews. 45 relevant records informed the three initial programme theories, and 77 documents, were included in programme theory testing. 39 context, mechanism, outcome configurations were meta-synthesized into three themes: (1) The gateway to urgent support; (2) Values based crisis interventions and (3) Leadership and organizational values. Fragmented cross-agency responses exacerbated staff stress and created barriers to access. Services should focus on evaluating interagency working to improve staff role clarity and ensure boundaries between services are planned for. Organizations experienced as compassionate contributed positively to perceived accessibility but relied on compassionate leadership. Attending to the support needs of staff and the proximity of leaders to the front line of crisis care are key. Designing interventions that are easy to navigate, prioritize shared decision-making and reduce the risk of re-traumatizing people is a priority.
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Affiliation(s)
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Leila Sharda
- School of Healthcare, University of Leeds, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Jill Thompson
- Health Sciences School, University of Sheffield, Sheffield, UK
| | | | | | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sarah Kendal
- School of Healthcare, University of Leeds, Leeds, UK
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Foye U, Appleton R, Nyikavaranda P, Lyons N, Dare C, Lynch C, Persaud K, Ahmed N, Stuart R, Schlief M, Huong X, Sevdalis N, Sheridan-Rains L, Rojas-Garcia A, Stefan M, Clark J, Simpson A, Johnson S, Lloyd-Evans B. 'Beyond places of safety' - a qualitative study exploring the implementation of mental health crisis care innovations across England. BMC Health Serv Res 2023; 23:1106. [PMID: 37848927 PMCID: PMC10583452 DOI: 10.1186/s12913-023-10058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 09/24/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Mental health acute and crisis care consumes a large share of mental health budgets internationally but is often experienced as unsatisfactory and difficult to access. As a result, there is an increasing move towards developing innovative community crisis services, to improve patient experience and relieve pressure on inpatient and emergency services. This study aims to understand what helps and hinders the implementation of innovative mental health crisis care projects in England. METHODS Using a qualitative approach, 18 interviews were conducted with crisis care service managers exploring their experiences and views of the development and implementation of their service developed with support from an English national capital funding programme. A framework analysis was conducted informed by implementation science. RESULTS Key facilitators to implementation of innovative crisis services included bottom-up development, service user involvement, strong collaborative working, and leadership and management buy-in. Key barriers that affected the projects implementation included the complexities of crisis care, workforce challenges and resourcing issues. CONCLUSION There is a recognised need to improve, update, and innovate current crisis care offers. Results from this study suggest that a range of models can help address the heterogenous needs of local populations and that new approaches can be implemented where they utilise a whole-systems approach, involving service users and relevant professional stakeholders beyond mental health services in planning and developing the service.
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Affiliation(s)
- Una Foye
- NIHR Mental Health Policy Research Unit, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Department of Mental Health Nursing Research Institute of Psychiatry, Psychology & Neuroscience, NIHR Mental Health Policy Research Unit, Kings College London, London, SE5 8AF, United Kingdom.
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Natasha Lyons
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ceri Dare
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Chris Lynch
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Karen Persaud
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Nafiso Ahmed
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ruth Stuart
- NIHR Mental Health Policy Research Unit, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Xia Huong
- NIHR Mental Health Policy Research Unit, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Luke Sheridan-Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Antonio Rojas-Garcia
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Martin Stefan
- Central Lakes Community Mental Health, Te Whatu Ora (Southern), Dunedin, New Zealand
| | - Jeremy Clark
- Mental Health Delivery Team, Department of Health and Social Care, London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
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Vázquez ID, Tintó AL, Arjona CH, Martínez MB, Díaz AC. Accompanying mental health problems at home: Preliminary data from a crisis resolution and home treatment team in Catalonia. J Psychiatr Ment Health Nurs 2023; 30:974-982. [PMID: 36964951 DOI: 10.1111/jpm.12918] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/05/2023] [Accepted: 02/22/2023] [Indexed: 03/27/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Home treatment teams help people in a mental health crisis to recover. The staff goes to the person's home, avoiding the need to go to the hospital and providing care in the person's environment. The teams have been created in our country in recent years, becoming part of the mental health care network. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The paper presents the functioning of a CRHTT, the type of care it provides, and the coordination with the rest of the care network. It also shows the clinical results obtained in the first two years since its creation, supporting the CRHTT's effectiveness in accompanying people with mental health crises and reducing the need for hospital care. The outstanding factors in the team operation were coordination fluidity with referral services (facilitating accessibility), a prolonged care time (about two months), and continuity of care during the CRHTT intervention (the same CRHTT professionals visited the user and the family at home) and upon discharge (CRHTT staff organized joint visits with the professionals who would care for the user and the family after home treatment). The CRHTT followed a person-centered orientation based on horizontality and dialogue. The CRHTT fostered the inclusion of the family and social network in the treatment and a deep understanding of the crisis considering social determinants. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Flexibility, approach to the person's environment, dialogue, shared decision-making, and the inclusion of the family and social network in the treatment are central factors in CRHTT functioning. It helps the person regain control over their life and enhance their resources to face possible future crises. Training in crisis management, community mental health and family care, and teamwork (which implies joint home visits and co-responsibility with the rest of the staff, user, and the family) are relevant for CRHTT professionals. ABSTRACT INTRODUCTION: Crisis resolution and home treatment teams (CRHTTs) provide intensive home care to people in a mental health crisis, becoming an increasingly widespread alternative to hospital admissions. However, there are wide variations in service delivery, organization, and outcomes, and little literature on how these teams work in clinical practice and different settings. AIM To share the organizational functioning, the therapeutic approach, and the outcomes obtained in a CRHTT in Catalonia, Spain. METHOD A descriptive analysis of the functioning of a home treatment team, the characteristics of the people served, and the clinical results from November 2017 to December 2019 are presented. RESULTS One hundred and five people were served, with an average stay of 57 days. And 55.24% were women, and the mean age was 41. Most people could overcome the crisis at home, and 5.71% required hospital admission during home care. A statistically significant improvement was observed in the results of the GAF and HoNOS scales at admission and discharge. DISCUSSION Despite reduced staff, home care was an alternative to hospital admission for most people treated. IMPLICATIONS FOR PRACTICE Flexibility, teamwork, and collaboration with the social network are relevant factors when accompanying the recovery process at home.
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Affiliation(s)
| | - Alba Luque Tintó
- Mental Health and Addictions Service, Fundació Sanitària Mollet, Barcelona, Spain
| | | | - Mar Bodas Martínez
- Mental Health and Addictions Service, Fundació Sanitària Mollet, Barcelona, Spain
| | - Antoni Corominas Díaz
- Mental Health and Addictions Service, Fundació Sanitària Mollet, Barcelona, Spain
- Department of Mental Health, Fundació Althaia, Manresa, Spain
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Clibbens N, Baker J, Booth A, Berzins K, Ashman MC, Sharda L, Thompson J, Kendal S, Weich S. Explanation of context, mechanisms and outcomes in adult community mental health crisis care: the MH-CREST realist evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-161. [PMID: 37837344 DOI: 10.3310/twkk5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Background Mental health crises cause significant disruption to individuals and families and can be life-threatening. The large number of community crisis services operating in an inter-agency landscape complicates access to help. It is unclear which underpinning mechanisms of crisis care work, for whom and in which circumstances. Aim The aim was to identify mechanisms to explain how, for whom and in what circumstances adult community crisis services work. Objectives The objectives were to develop, test and synthesise programme theories via (1) stakeholder expertise and current evidence; (2) a context, intervention, mechanism and outcome framework; (3) consultation with experts; (4) development of pen portraits; (5) synthesis and refinement of programme theories, including mid-range theory; and (6) identification and dissemination of mechanisms needed to trigger desired context-specific crisis outcomes. Design This study is a realist evidence synthesis, comprising (1) identification of initial programme theories; (2) prioritisation, testing and refinement of programme theories; (3) focused realist reviews of prioritised initial programme theories; and (4) synthesis to mid-range theory. Main outcome The main outcome was to explain context, mechanisms and outcomes in adult community mental health crisis care. Data sources Data were sourced via academic and grey literature searches, expert stakeholder group consultations and 20 individual realist interviews with experts. Review methods A realist evidence synthesis with primary data was conducted to test and refine three initial programme theories: (1) urgent and accessible crisis care, (2) compassionate and therapeutic crisis care and (3) inter-agency working. Results Community crisis services operate best within an inter-agency system. This requires compassionate leadership and shared values that enable staff to be supported; retain their compassion; and, in turn, facilitate compassionate interventions for people in crisis. The complex interface between agencies is best managed through greater clarity at the boundaries of services, making referral and transition seamless and timely. This would facilitate ease of access and guaranteed responses that are trusted by the communities they serve. Strengths and limitations Strengths include the identification of mechanisms for effective inter-agency community crisis care and meaningful stakeholder consultation that grounded the theories in real-life experience. Limitations include the evidence being heavily weighted towards England and the review scope excluding full analysis of ethnic and cultural diversity. Conclusions Multiple interpretations of crises and diverse population needs present challenges for improving the complex pathways to help in a crisis. Inter-agency working requires clear policy guidance with local commissioning. Seamless transitions between services generate trust through guaranteed responses and ease of navigation. This is best achieved where there is inter-agency affiliation that supports co-production. Compassionate leaders engender staff trust, and outcomes for people in crisis improve when staff are supported to retain their compassion. Future work Further work might explore inter-agency models of crisis delivery, particularly in rural communities. Future work could focus on evaluating outcomes across crisis care provider agencies and include evaluation of individual, as well as service-level, outcomes. The implementation and effect of mental health triage could be explored further, including via telehealth. Barriers to access for marginalised populations warrant a specific focus in future research. Study registration The study is registered as PROSPERO CRD42019141680. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Leila Sharda
- School of Healthcare, University of Leeds, Leeds, UK
| | - Jill Thompson
- Health Sciences School, University of Sheffield, Sheffield, UK
| | - Sarah Kendal
- School of Healthcare, University of Leeds, Leeds, UK
| | - Scott Weich
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
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Schwarz J, Wolff J, Heinze M, von Peter S, Habicht JL. How to measure staff continuity in intensive psychiatric home treatment: a routine data and single case analysis. Front Psychiatry 2023; 14:1166197. [PMID: 37229387 PMCID: PMC10204706 DOI: 10.3389/fpsyt.2023.1166197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
Background Intensive forms of outreach mental health care (IOC) such as crisis resolution or home treatment teams are increasingly implemented as alternatives to inpatient admission, providing recovery-oriented treatment at home at comparable costs and outcomes. However, one issue with IOC is the lack of continuity regarding staff members who provide home visits, complicating relationship building and meaningful therapeutic exchange. The aim of this study is to validate existing primarily qualitative findings using performance data and to explore a possible correlation between the number of staff involved within IOC treatment and the service users' length of stay (LOS). Methods Routine data from an IOC team in a catchment area in Eastern Germany were analyzed. Basic parameters of service delivery were calculated and an in-depth descriptive analysis regarding staff continuity was performed. Further, an exploratory single case analysis was conducted, presenting the exact sequence of all treatment contacts for one case with low and one with high staff continuity. Results We analyzed 10.598 face-to-face treatment contacts based on 178 IOC users. The mean LOS was 30.99 days. About 75% of all home visits were conducted by two or more staff members simultaneously. Service users saw an average of 10.24 different staff per treatment episode. On 11% of the care days, only unknown staff, and on 34% of the care days at least one unknown staff member conducted the home visit. 83% of the contacts were performed by the same three staff members and 51% were made by one and the same staff member. A significant positive correlation (p = 0.0007) was found between the number of different practitioners seen by a service user in the first seven days of care and the LOS. Conclusion Our results suggest that a high number of different staff in the early period of IOC episodes correlates with an extended LOS. Future research must clarify the exact mechanisms of this correlation. Furthermore, it should be investigated how the multiple professions within IOC teams influence the LOS and the quality of treatment and what quality indicators may be suitable to ensure treatment processes.
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Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Center for Health Service Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Jan Wolff
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
- Evangelical Foundation Neuerkerode, Braunschweig, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Center for Health Service Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Juri Luis Habicht
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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8
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Robins JE, Morley KI, Hayes RD, Pritchard M, Kornblum D, Kalk NJ. Outcomes following suicidal crisis among hazardous and harmful alcohol users in the Crisis Resolution Team. Int J Ment Health Nurs 2023; 32:590-602. [PMID: 36594457 DOI: 10.1111/inm.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 01/04/2023]
Abstract
Despite associations between alcohol use and suicidal acts, little research measures prognoses of alcohol-using patients treated by Crisis Resolution Teams (CRTs), an intensive community-based intervention. We estimated the association of alcohol use amongst patients accepted following suicidal acts or ideation in four London-based Crisis Resolution Teams, with death-by-any-cause or recontact with crisis care. We analysed the electronic health records of 1615 CRT patients accepted following suicidal acts or ideation over 38 months, following STROBE guidelines. Using logistic regression we estimated the association of alcohol use (indicated by risk-assessment, AUDIT, or ICD-10 diagnosis) with death-or-recontact at (i) 30-days and (ii) 1-year after treatment start, adjusted for age, sex, ethnicity, psychiatric diagnosis, and severity of need. Hazardous, harmful, or dependent drinking was identified in 270 cases at baseline (16.7%); 73 (4.5%) were alcohol dependent. By 1-year, 622 patients (38.5%) had recontacted crisis care or died. After adjustment, alcohol use at a hazardous, harmful, or dependent level was not associated with increased odds of death-or-recontact at 30-days (AOR 1.17, 95%CI 0.73, 1.88) or 1-year (AOR 1.17, 95%CI 0.85, 1.60). Patients with hazardous, harmful, and dependent alcohol use are a small proportion of CRT patients, despite being more commonly encountered in emergency settings from which patients may be referred to CRTs, indicating a potential gap in provision. Those who are included in CRTs are not at increased risk of death-or-recontact within 1 year of treatment, suggesting that their inclusion can work, at least in a sample with predominantly hazardous or harmful alcohol use.
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Affiliation(s)
- John E Robins
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IOPPN) King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Katherine I Morley
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IOPPN) King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,Innovation, Health, and Science, RAND Europe, Cambridge, UK.,Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard D Hayes
- South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine and NIHR Maudsley Biomedical Research Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Megan Pritchard
- South London and Maudsley NHS Foundation Trust, London, UK.,NIHR Maudsley Biomedical Research Centre (BRC), King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Daisy Kornblum
- South London and Maudsley NHS Foundation Trust, London, UK.,NIHR Maudsley Biomedical Research Centre (BRC), King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Nicola J Kalk
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IOPPN) King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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9
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Hochwarter S, Schwarz J, Muehlensiepen F, Monteiro E. Becoming a Guest: On Proximity and Distance in Mental Health Home Treatment. Comput Support Coop Work 2022; 32:1-31. [PMID: 36531085 PMCID: PMC9744036 DOI: 10.1007/s10606-022-09456-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 12/14/2022]
Abstract
Mental health home treatment is a service where patients with severe mental illnesses are visited by a multiprofessional psychiatric care team at their homes. In Germany, inpatient-equivalent home treatment as a specialized form of home treatment has been offered by hospitals since 2018. In its early stage, the shift of care activities out of the hospital toward the patient's home opened up a new set of problems and blurred the existing boundaries. This ethnographic study follows two home treatment teams and provides an in-depth description of their work. The findings are presented by three themes from our data analysis: (i) closeness and familiarity; (ii) bridging the distance; and (iii) tensions of proximity and distance. We then discuss the findings with the guiding lens of Becoming a Guest, which refers to the ambiguity of proximity and distance. The contribution for computer-supported cooperative work (CSCW) is twofold; on the one hand, we provide a detailed account of mental health home treatment, and on the other hand, we outline a conceptual model that helps to describe and analyze similar cases. We conclude the paper with directions for further research.
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Affiliation(s)
- Stefan Hochwarter
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
- Center for Health Services Research, Brandenburg Medical School, Rüdersdorf, Germany
| | - Julian Schwarz
- Center for Health Services Research, Brandenburg Medical School, Rüdersdorf, Germany
- University Clinic for Psychiatry and Psychotherapy, Immanuel Clinic Rüdersdorf, Brandenburg Medical School, Rüdersdorf, Germany
- Faculty for Health Sciences, Brandenburg Medical School, Neuruppin, Germany
| | - Felix Muehlensiepen
- Center for Health Services Research, Brandenburg Medical School, Rüdersdorf, Germany
- Faculty for Health Sciences, Brandenburg Medical School, Neuruppin, Germany
| | - Eric Monteiro
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
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10
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Holgersen KH, Pedersen SA, Brattland H, Hynnekleiv T. A scoping review of studies into crisis resolution teams in community mental health services. Nord J Psychiatry 2022; 76:565-574. [PMID: 35148238 DOI: 10.1080/08039488.2022.2029941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE OF ARTICLE Crisis Resolution Teams (CRT) for rapid assessment and short-term treatment of mental health problems have increasingly been implemented internationally over the last decades. Among the Nordic countries, the CRT model has been particularly influential in Norway, where 'Ambulante akutteam (AAT)' is a widespread psychiatric emergency service for adult patients. However, the clinical practice of these teams varies significantly. To aid further development of the service and guide future research efforts, we carried out a scoping review to provide an up-to-date overview of research available in primary studies focusing on phenomena related to CRTs in English and Scandinavian literature. METHODS A systematic literature search was conducted in the bibliometric databases MEDLINE, Embase, PsychINFO, Scopus, and SveMed+. Included studies were thematically analyzed using a qualitative method. RESULTS The search identified 1516 unique references, of which 129 were included in the overview. Thematic analysis showed that the studies could be assigned to: (1) Characteristics of CRTs (k = 45), which described key principles or specific interventions; (2) Implementation of CRTs (k = 54), which were descriptive about implementation in different teams, or normative about what clinical practice should include; and (3) Effect of CRTs (k = 38). CONCLUSIONS The international research literature on CRTs or equivalent teams is extensive. Many sub-themes have been studied with various research methodologies. Recent studies provide a better evidence base for how to organize services and to select therapeutic interventions, but there is still a need for more controlled studies in the field.
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Affiliation(s)
- Katrine Høyer Holgersen
- Nidelv Community Mental Health Center, Tiller, Clinic of Mental Health, St Olavs Hospital, Trondheim, Norway.,Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Sindre Andre Pedersen
- Library Section for Medicine and Health Sciences, NTNU University Library, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Brattland
- Nidelv Community Mental Health Center, Tiller, Clinic of Mental Health, St Olavs Hospital, Trondheim, Norway
| | - Torfinn Hynnekleiv
- Department for Acute Psychiatry and Psychosis Treatment, Psychiatric Health Services Division, Sykehuset Innlandet Trust, Reinsvoll, Norway
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11
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Reinke B, Mahlke C, Botros C, Kläring A, Lambert M, Karow A, Gallinat J, Zapf A, Ozga AK, Höller A, Bustami N, Reimer J, Lüdtke J, Schaper O, Lison M, Bechdolf A, Baumgardt J, Spiegel J, Hardt O, Rout S, Memarzadeh S, von Peter S, Schwarz J, Langer C, Glotz S, Frasch K, Rüsch N, Künstler U, Bock T, Becker T. Study protocol of a randomized controlled trial evaluating home treatment with peer support for acute mental health crises (HoPe). BMC Psychiatry 2022; 22:619. [PMID: 36123649 PMCID: PMC9483879 DOI: 10.1186/s12888-022-04247-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Home treatment (HT) is a treatment modality for patients with severe mental illness (SMI) in acute mental crises. It is frequently considered equivalent to psychiatric inpatient treatment in terms of treatment outcome. Peer Support (PS) means that people with lived experience of a mental illness are trained to support others on their way towards recovery. While PS is growing in international importance and despite a growing number of studies supporting its benefits, it is still not comprehensively implemented into routine care. The HoPe (Home Treatment with Peer Support) study investigates a combination of both - HT and PS - to provide further evidence for a recovery-oriented treatment of psychiatric patients. METHODS In our randomized controlled trial (RCT), HT with PS is compared with HT without PS within a network of eight psychiatric clinical centers from the North, South and East of Germany. We investigate the effects of a combination of both approaches with respect to the prevention of relapse/recurrence defined as first hospitalization after randomization (primary outcome), disease severity, general functioning, self-efficacy, psychosocial health, stigma resistance, recovery support, and service satisfaction (secondary outcomes). A sample of 286 patients will be assessed at baseline after admission to HT care (data point t0) and randomized into the intervention (HT + PS) and control arm (HT). Follow-Up assessments will be conducted 2, 6 and 12 months after admission (resulting in three further data points, t1 to t3) and will be analyzed via intention-to-treat approach. DISCUSSION This study may determine the positive effects of PS added to HT, prove additional evidence for the efficacy of PS and thereby facilitate its further implementation into psychiatric settings. The aim is to improve quality of mental health care and patients' recovery as well as to reduce the risk of relapses and hospitalizations for patients with SMI. TRIAL REGISTRATION The trial is registered with ClinicalTrials.gov: NCT04336527 , April 7, 2020.
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Affiliation(s)
- Britta Reinke
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christina Botros
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexa Kläring
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- grid.13648.380000 0001 2180 3484Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- grid.13648.380000 0001 2180 3484Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Höller
- grid.13648.380000 0001 2180 3484Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadia Bustami
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital Lüneburg, Lüneburg, Germany
| | - Jens Reimer
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Jenny Lüdtke
- Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Oliver Schaper
- Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Martin Lison
- Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Andreas Bechdolf
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban Und Vivantes Hospital Im Friedrichshain, Charité – Universitätsmedizin Berlin, Berlin, Germany ,grid.415085.dDepartment of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Friedrichshain Hospital, Berlin, Germany ,grid.411097.a0000 0000 8852 305XDepartment of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Johanna Baumgardt
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban Und Vivantes Hospital Im Friedrichshain, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jennifer Spiegel
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban Und Vivantes Hospital Im Friedrichshain, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Olaf Hardt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Neukölln Hospital, Berlin, Germany
| | - Sandeep Rout
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Neukölln Hospital, Berlin, Germany
| | - Sonja Memarzadeh
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Neukölln Hospital, Berlin, Germany
| | - Sebastian von Peter
- grid.473452.3Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Julian Schwarz
- grid.473452.3Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Claudia Langer
- grid.473452.3Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Sabine Glotz
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany
| | - Karel Frasch
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany ,Donauwörth Regional Hospital, Donauwörth, Germany
| | - Nicolas Rüsch
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany
| | - Ulf Künstler
- Department of Psychiatry and Psychotherapy, Asklepios Western Hospital Hamburg, Rissen, Germany
| | - Thomas Bock
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Becker
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany
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Ruud T, Holgersen KH, Hasselberg N, Siqveland J. Accessibility and interventions of crisis resolution teams: a multicenter study of team practices and team differences in Norway. BMC Psychiatry 2022; 22:350. [PMID: 35597926 PMCID: PMC9123690 DOI: 10.1186/s12888-022-03992-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/09/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Components of crisis resolution teams' (CRTs) practices have been defined in recommendations and a fidelity scale, and surveys have reported how team leaders describe CRT practices. However, studies on CRTs have not measured and reported details of the crisis intervention provided to individual service users. The present study aimed to measure how various components of CRT practice were provided to individual service users and differences in practice between CRTs. METHODS The study was exploratory and part of a prospective multicenter pre-post project on outcome of CRT treatment in Norway. Accessibility and intervention components of 25 CRTs were measured for 959 service users at the first contact after referral and in 3,244 sessions with service users. The data on CRT practice components were analyzed with descriptive statistics and factor analyses, and differences between teams were analyzed using ANOVA and calculating the proportion (intraclass correlation coefficient) of total variance that was due to differences between teams. RESULTS One-third of the service users had their first session with the CRT the day of referral and another third the following day. Treatment intensity was mean 1.8 sessions the first week, gradually decreasing over subsequent weeks. Three of ten sessions were conducted in the service user's home and six of ten in the team's location. Eight of ten sessions took place during office hours and two of ten in the evening. The CRT provided assessment and psychological interventions to all service users. Family involvement, practical support, and medication were provided to two of ten service users. Between CRTs, significant differences were identified for a substantial proportion of practice components and especially for several aspects of accessibility. Cluster analysis identified two clusters of CRTs with significant differences in accessibility but no significant differences in the use of intervention components. CONCLUSIONS Measurements of accessibility and interventions provided to individual service users gave a detailed description of CRT practices and differences between teams. Such measurements may be helpful as feedback on clinical practice, for studying and comparing crisis resolution team practices, and in future studies on the association between different outcomes and potential critical elements of crisis interventions.
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Affiliation(s)
- Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Katrine Høyer Holgersen
- grid.52522.320000 0004 0627 3560Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olavs Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina Hasselberg
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Johan Siqveland
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway ,grid.5510.10000 0004 1936 8921National Center for Suicide Research and Prevention, University of Oslo, Oslo, Norway
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13
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Toma M, Anderson J, Forster S, Shiels P, Windsor S, Gray NM. Perceived impact of formulating, implementing and enacting national mental health policies recommendations in practice: An exploratory qualitative study within child and adolescent mental health services in Scotland. J Health Serv Res Policy 2022; 27:203-210. [PMID: 35225039 PMCID: PMC9277320 DOI: 10.1177/13558196211072472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To understand the process of formulating, implementing and enacting national recommendations into practice, by exploring the interactions between government policymakers and national and local organisations supporting and delivering policy implementation within a Child and Adolescent Mental Health Service (CAMHS) context in Scotland. METHODS Data collection involved 16 semi-structured individual and four focus group interviews with a purposeful sample of policymakers, national health and social care stakeholders and local outpatient and inpatient CAMHS teams representing three NHS health boards in Scotland. RESULTS Study participants highlighted the challenges of navigating through evolving and often conflicting policy agendas, seen to not acknowledging the current evidence base or experiential learning from services and prior evaluations. Accounts of transformation fatigue often emerged from increased expectations for staff to adopt new approaches to accommodate constantly changing recommendations. Participants also reported a lack of integration and implementation support from national health and social care organisations, leading to duplication of effort and gaps in provision or waste. Policy recommendations were perceived as sometimes vague, lacking clarity about how to deliver service transformation using a whole-system approach. The collective narratives reflected increased tension between the need for local autonomy to innovate and the limitations created vertically by the relative inflexibility of policy recommendations, and horizontally by the proliferation of national organisations delivering the same transformation aims using different approaches in a resource-constrained environment. CONCLUSION The findings contribute to the wider literature by offering an exploration of importance of evaluation and evidence uptake in policy formulation; the roles and remits in supporting the implementation of policy recommendations; and how the dynamics of central control and local autonomy might impact on the local enactment of policy recommendations.
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Affiliation(s)
- Madalina Toma
- NIHR Applied Research Collaboration (ARC) Kent Surrey Sussex, Personal Social Service Research Unit (PSSRU), School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - Julie Anderson
- Performance, Planning and Quality Manager, 130121NHS National Services Scotland, Edinburgh, UK
| | - Sarah Forster
- Head of Service Design and Transformational Change, 102585Aberlour Childcare Trust, Stirling, UK
| | - Paula Shiels
- Senior Nurse Mental Health, 1442NHS Ayrshire & Arran, Crosshouse, Kilmarnock, UK
| | - Shirley Windsor
- Organisational Lead Public Mental Health (Implementation), 578987Public Health Scotland, Edinburgh, UK
| | - Nicola M Gray
- Scottish Improvement Science Collaborating Centre (SISCC), School Health Sciences, 3042University of Dundee, Dundee, UK
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14
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Giménez-Díez D, Maldonado-Alía R, Torrent-Solà L, Granel N, Bernabeu-Tamayo MD. Nurses' Experiences of Care at Crisis Resolution Home Treatment Teams: A case study research. J Psychiatr Ment Health Nurs 2022; 29:48-56. [PMID: 33556217 DOI: 10.1111/jpm.12738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 01/04/2021] [Accepted: 01/28/2021] [Indexed: 01/31/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: There are many international studies on CRHTTs; however, there has been little research on nurses' experiences of working with CRHTTs. Earlier studies focused on the nurses' gatekeeping role but did not explore nurses' perception of care as a construct. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This study provides information based on mental health nurses' experiences. It explains the home environment, the therapeutic relationship and the process of mental health nursing care during a crisis. Also, the study explains nurses' satisfaction with care provided at patients' home. Unlike other studies, this study focused on nurses' experiences while providing care, rather than on nurses' general responsibilities and the services they provide. This study is the first of its kind in Spain with such a focus. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Acknowledging nurses' experiences and their perspectives about the care they provide could help shift mental health nursing paradigms from those based on biomedical models to newer perspectives found in recovery models. Furthermore, this knowledge could improve the quality of care in mental health settings due to its potential to guide nursing practices. Raising mental health care providers' awareness of mental health nurses' personal and professional care constructs would help implement support systems to meet the professional's needs. Meeting the needs of nurses related to the care they provide is likely to impact patient care positively. ABSTRACT INTRODUCTION: Crisis resolution home treatment teams (CRHTTs) provide short-term, intensive home treatment to people experiencing mental health crises. There is limited research on nurses' experiences with CRHTTs. While earlier studies mainly focussed on mental health nurses' gatekeeping responsibilities, more investigation is needed in this field. AIM To explore nurses' perceptions and constructions about care in CRHTT services. METHOD A qualitative case study was employed. Ten semi-structured interviews were performed to nursing staff working in CRHTT services. RESULTS Three main categories emerged from the data analysis: nurses' perspectives of the care provided, nursing setting of care at home and nursing care plan at home. DISCUSSIONS Findings revealed that nurses experienced greater satisfaction providing care in the home settings, and therefore, it positively impacted the quality of care and reduced patient's stigma. This study also relates the value of developing care plans centred on patients' environments increasing Mental Health Nursing (MHN) work satisfaction. IMPLICATIONS FOR PRACTICE Knowledge of the intrinsic experiences of care provided by nurses in CRHTTs may help facilitate the development of the nursing role in CRHTT by improving understanding of care in mental health settings.
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Affiliation(s)
- David Giménez-Díez
- CPB Serveis de Salut Mental, Barcelona, Spain.,Nursing Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Lídia Torrent-Solà
- Consorci Corporació Sanitària Parc Taulí, Centre de Salut Mental, Barcelona, Spain
| | - Nina Granel
- Nursing Department, Universitat Autònoma de Barcelona, Barcelona, Spain
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15
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Schwarz J, Cechnicki A, Godyń J, Galbusera L, Biechowska D, Galińska-Skok B, Ciunczyk I, Ignatyev Y, Muehlensiepen F, Soltmann B, Timm J, von Peter S, Balicki M, Wciórka J, Heinze M. Flexible and Integrative Psychiatric Care Based on a Global Treatment Budget: Comparing the Implementation in Germany and Poland. Front Psychiatry 2022; 12:760276. [PMID: 35069275 PMCID: PMC8777040 DOI: 10.3389/fpsyt.2021.760276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany. Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared. Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition. Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems.
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Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Andrzej Cechnicki
- Community Psychiatry and Psychosis Research Centre, Jagiellonian University Medical College, Krakow, Poland
| | - Jan Godyń
- Psychosis Research Unit, Association for the Development of Community Psychiatry and Care, Krakow, Poland
| | - Laura Galbusera
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Daria Biechowska
- Department of Public Health, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Beata Galińska-Skok
- Department of Psychiatry, Medical University of Bialystok, Białystok, Poland
| | - Izabela Ciunczyk
- Middle Pomeranian Mental Health Centre “Medison”, Koszalin, Poland
| | - Yuriy Ignatyev
- Centre for Health Services Research Brandenburg, Brandenburg Medical School, Rüdersdorf, Germany
| | - Felix Muehlensiepen
- Centre for Health Services Research Brandenburg, Brandenburg Medical School, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Bettina Soltmann
- Department of Psychiatry and Psychotherapy, Medical Faculty, Carl Gustav Carus University Hospital, Technical University Dresden, Dresden, Germany
| | - Jürgen Timm
- Biometry Section, Competence Centre for Clinical Trials, University of Bremen, Bremen, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Marek Balicki
- Pilot Program Office of the National Mental Health Program, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jacek Wciórka
- Pilot Program Office of the National Mental Health Program, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
- Centre for Health Services Research Brandenburg, Brandenburg Medical School, Rüdersdorf, Germany
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16
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Pilar M, Jost E, Walsh-Bailey C, Powell BJ, Mazzucca S, Eyler A, Purtle J, Allen P, Brownson RC. Quantitative measures used in empirical evaluations of mental health policy implementation: A systematic review. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221141116. [PMID: 37091091 PMCID: PMC9924289 DOI: 10.1177/26334895221141116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Mental health is a critical component of wellness. Public policies present an opportunity for large-scale mental health impact, but policy implementation is complex and can vary significantly across contexts, making it crucial to evaluate implementation. The objective of this study was to (1) identify quantitative measurement tools used to evaluate the implementation of public mental health policies; (2) describe implementation determinants and outcomes assessed in the measures; and (3) assess the pragmatic and psychometric quality of identified measures. Method Guided by the Consolidated Framework for Implementation Research, Policy Implementation Determinants Framework, and Implementation Outcomes Framework, we conducted a systematic review of peer-reviewed journal articles published in 1995-2020. Data extracted included study characteristics, measure development and testing, implementation determinants and outcomes, and measure quality using the Psychometric and Pragmatic Evidence Rating Scale. Results We identified 34 tools from 25 articles, which were designed for mental health policies or used to evaluate constructs that impact implementation. Many measures lacked information regarding measurement development and testing. The most assessed implementation determinants were readiness for implementation, which encompassed training (n = 20, 57%) and other resources (n = 12, 34%), actor relationships/networks (n = 15, 43%), and organizational culture and climate (n = 11, 31%). Fidelity was the most prevalent implementation outcome (n = 9, 26%), followed by penetration (n = 8, 23%) and acceptability (n = 7, 20%). Apart from internal consistency and sample norms, psychometric properties were frequently unreported. Most measures were accessible and brief, though minimal information was provided regarding interpreting scores, handling missing data, or training needed to administer tools. Conclusions This work contributes to the nascent field of policy-focused implementation science by providing an overview of existing measurement tools used to evaluate mental health policy implementation and recommendations for measure development and refinement. To advance this field, more valid, reliable, and pragmatic measures are needed to evaluate policy implementation and close the policy-to-practice gap. Plain Language Summary Mental health is a critical component of wellness, and public policies present an opportunity to improve mental health on a large scale. Policy implementation is complex because it involves action by multiple entities at several levels of society. Policy implementation is also challenging because it can be impacted by many factors, such as political will, stakeholder relationships, and resources available for implementation. Because of these factors, implementation can vary between locations, such as states or countries. It is crucial to evaluate policy implementation, thus we conducted a systematic review to identify and evaluate the quality of measurement tools used in mental health policy implementation studies. Our search and screening procedures resulted in 34 measurement tools. We rated their quality to determine if these tools were practical to use and would yield consistent (i.e., reliable) and accurate (i.e., valid) data. These tools most frequently assessed whether implementing organizations complied with policy mandates and whether organizations had the training and other resources required to implement a policy. Though many were relatively brief and available at little-to-no cost, these findings highlight that more reliable, valid, and practical measurement tools are needed to assess and inform mental health policy implementation. Findings from this review can guide future efforts to select or develop policy implementation measures.
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Affiliation(s)
- Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Infectious Diseases, Washington University School of Medicine,
Washington University in St. Louis, St. Louis, MO, USA
| | - Eliot Jost
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of
Medicine, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Amy Eyler
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, New York
University School of Global Public Health, Global Center for Implementation Science, New York University, New York, NY, USA
| | - Peg Allen
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin
J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
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17
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Dalton-Locke C, Johnson S, Harju-Seppänen J, Lyons N, Sheridan Rains L, Stuart R, Campbell A, Clark J, Clifford A, Courtney L, Dare C, Kelly K, Lynch C, McCrone P, Nairi S, Newbigging K, Nyikavaranda P, Osborn D, Persaud K, Stefan M, Lloyd-Evans B. Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems. BMC Health Serv Res 2021; 21:1174. [PMID: 34711222 PMCID: PMC8553397 DOI: 10.1186/s12913-021-07181-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Inpatient psychiatric care is unpopular and expensive, and development and evaluation of alternatives is a long-standing policy and research priority around the world. In England, the three main models documented over the past fifty years (teams offering crisis assessment and treatment at home; acute day units; and residential crisis services in the community) have recently been augmented by several new service models. These are intended to enhance choice and flexibility within catchment area acute care systems, but remain largely undocumented in the research literature. We therefore aimed to describe the types and distribution of crisis care models across England through a national survey. Methods We carried out comprehensive mapping of crisis resolution teams (CRTs) using previous surveys, websites and multiple official data sources. Managers of CRTs were invited to participate as key informants who were familiar with the provision and organisation of crisis care services within their catchment area. The survey could be completed online or via telephone interview with a researcher, and elicited details about types of crisis care delivered in the local catchment area. Results We mapped a total of 200 adult CRTs and completed the survey with 184 (92%). Of the 200 mapped adult CRTs, there was a local (i.e., within the adult CRT catchment area) children and young persons CRT for 84 (42%), and an older adults CRT for 73 (37%). While all but one health region in England provided CRTs for working age adults, there was high variability regarding provision of all other community crisis service models and system configurations. Crisis cafes, street triage teams and separate crisis assessment services have all proliferated since a similar survey in 2016, while provision of acute day units has reduced. Conclusions The composition of catchment area crisis systems varies greatly across England and popularity of models seems unrelated to strength of evidence. A group of emerging crisis care models with varying functions within service systems are increasingly prevalent: they have potential to offer greater choice and flexibility in managing crises, but an evidence base regarding impact on service user experiences and outcomes is yet to be established. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07181-x.
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Affiliation(s)
- Christian Dalton-Locke
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Jasmine Harju-Seppänen
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Natasha Lyons
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ruth Stuart
- NIHR Mental Health Policy Research Unit, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Amelia Campbell
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK
| | - Jeremy Clark
- Mental Health Policy Branch, Department of Health and Social Care, London, UK
| | | | - Laura Courtney
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ceri Dare
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK
| | | | - Chris Lynch
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK
| | - Paul McCrone
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - Shilpa Nairi
- Camden and Islington NHS Foundation Trust, London, UK
| | - Karen Newbigging
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK
| | - David Osborn
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Karen Persaud
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK
| | - Martin Stefan
- Southern District Health Board, Southern Health, Dunedin, New Zealand
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
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18
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Osborn D, Lamb D, Canaway A, Davidson M, Favarato G, Pinfold V, Harper T, Johnson S, Khan H, Kirkbride J, Lloyd-Evans B, Madan J, Mann F, Marston L, McKay A, Morant N, Smith D, Steare T, Wackett J, Weich S. Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
For people in mental health crisis, acute day units provide daily structured sessions and peer support in non-residential settings as an alternative to crisis resolution teams.
Objectives
To investigate the provision, effectiveness, intervention acceptability and re-admission rates of acute day units.
Design
Work package 1 – mapping and national questionnaire survey of acute day units. Work package 2.1 – cohort study comparing outcomes during a 6-month period between acute day unit and crisis resolution team participants. Work package 2.2 – qualitative interviews with staff and service users of acute day units. Work package 3 – a cohort study within the Mental Health Minimum Data Set exploring re-admissions to acute care over 6 months. A patient and public involvement group supported the study throughout.
Setting and participants
Work package 1 – all non-residential acute day units (NHS and voluntary sector) in England. Work packages 2.1 and 2.2 – four NHS trusts with staff, service users and carers in acute day units and crisis resolution teams. Work package 3 – all individuals using mental health NHS trusts in England.
Results
Work package 1 – we identified 27 acute day units in 17 out of 58 trusts. Acute day units are typically available on weekdays from 10 a.m. to 4 p.m., providing a wide range of interventions and a multidisciplinary team, including clinicians, and having an average attendance of 5 weeks. Work package 2.1 – we recruited 744 participants (acute day units, n = 431; crisis resolution teams, n = 312). In the primary analysis, 21% of acute day unit participants (vs. 23% of crisis resolution team participants) were re-admitted to acute mental health services over 6 months. There was no statistically significant difference in the fully adjusted model (acute day unit hazard ratio 0.78, 95% confidence interval 0.54 to 1.14; p = 0.20), with highly heterogeneous results between trusts. Acute day unit participants had higher satisfaction and well-being scores and lower depression scores than crisis resolution team participants. The health economics analysis found no difference in resource use or cost between the acute day unit and crisis resolution team groups in the fully adjusted analysis. Work package 2.2 – 36 people were interviewed (acute day unit staff, n = 12; service users, n = 21; carers, n = 3). There was an overwhelming consensus that acute day units are highly valued. Service users found the high amount of contact time and staff continuity, peer support and structure provided by acute day units particularly beneficial. Staff also valued providing continuity, building strong therapeutic relationships and providing a variety of flexible, personalised support. Work package 3 – of 231,998 individuals discharged from acute care (crisis resolution team, acute day unit or inpatient ward), 21.4% were re-admitted for acute treatment within 6 months, with women, single people, people of mixed or black ethnicity, those living in more deprived areas and those in the severe psychosis care cluster being more likely to be re-admitted. Little variation in re-admissions was explained at the trust level, or between trusts with and trusts without acute day units (adjusted odds ratio 0.96, 95% confidence interval 0.80 to 1.15).
Limitations
In work package 1, some of the information is likely to be incomplete as a result of trusts’ self-reporting. There may have been recruitment bias in work packages 2.1 and 2.2. Part of the health economics analysis relied on clinical Health of the Nations Outcome Scale ratings. The Mental Health Minimum Data Set did not contain a variable identifying acute day units, and some covariates had a considerable number of missing data.
Conclusions
Acute day units are not provided routinely in the NHS but are highly valued by staff and service users, giving better outcomes in terms of satisfaction, well-being and depression than, and no significant differences in risk of re-admission or increased costs from, crisis resolution teams. Future work should investigate wider health and care system structures and the place of acute day units within them; the development of a model of best practice for acute day units; and staff turnover and well-being (including the impacts of these on care).
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David Osborn
- Division of Psychiatry, University College London, London, UK
| | - Danielle Lamb
- Division of Psychiatry, University College London, London, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | | | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | | | - James Kirkbride
- Division of Psychiatry, University College London, London, UK
| | | | - Jason Madan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Farhana Mann
- Division of Psychiatry, University College London, London, UK
| | - Louise Marston
- Division of Psychiatry, University College London, London, UK
| | - Adele McKay
- Camden and Islington NHS Foundation Trust, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | | | - Thomas Steare
- Division of Psychiatry, University College London, London, UK
| | | | - Scott Weich
- Mental Health Research Unit, University of Sheffield, Sheffield, UK
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19
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Goldsmith LP, Anderson K, Clarke G, Crowe C, Jarman H, Johnson S, Lloyd-Evans B, Lomani J, McDaid D, Park AL, Smith JA, Turner K, Gillard S. The psychiatric decision unit as an emerging model in mental health crisis care: a national survey in England. Int J Ment Health Nurs 2021; 30:955-962. [PMID: 33630402 DOI: 10.1111/inm.12849] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/14/2021] [Accepted: 01/31/2021] [Indexed: 12/25/2022]
Abstract
Psychiatric decision units have been developed in many countries internationally to address the pressure on inpatient services and dissatisfactory, long waits people in mental health crisis can experience in emergency departments. Research into these units lags behind their development, as they are implemented by healthcare providers to address these problems. This is the first-ever national survey to identify their prevalence, structure, activities, and contextual setting within health services, in order to provide a robust basis for future research. The response rate was high (94%), and six PDUs in England were identified. The results indicated that PDUs open 24/7, accept only voluntary patients, provide recliner chairs for sleeping rather than beds, and limit stays to 12-72 hours. PDUs are predominantly staffed by senior, qualified mental health nurses and healthcare assistants, with psychiatry input. Staff:patient ratios are high (1:2.1 during the day shift). Differences in PDU structure and activities (including referral pathway, length of stay, and staff:patient ratios) were identified, suggesting the optimal configuration for PDUs has not yet been established. Further research into the efficacy of this innovation is needed; PDUs potentially have a role in an integrated crisis care pathway which provides a variety of care options to service users.
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Affiliation(s)
- Lucy P Goldsmith
- Division of Nursing, School of Health Sciences, City, University of London, London, UK.,Population Health Research Institute, St George's, University of London, London, UK
| | - Katie Anderson
- Division of Nursing, School of Health Sciences, City, University of London, London, UK
| | | | - Chloe Crowe
- North East London NHS Foundation Trust, CEME Centre- West Wing, Rainham, Essex, UK
| | - Heather Jarman
- Division of Nursing, School of Health Sciences, City, University of London, London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jo Lomani
- Division of Nursing, School of Health Sciences, City, University of London, London, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Jared A Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Kati Turner
- Population Health Research Institute, St George's, University of London, London, UK
| | - Steve Gillard
- Division of Nursing, School of Health Sciences, City, University of London, London, UK
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20
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Hopkinson J, King A, Young L, McEwan K, Elliott F, Hydon K, Muthukrishnan S, Tope R, Veitch AM, Howells C, Hoskins M. Crisis management for people with dementia at home: Mixed-methods case study research to identify critical factors for successful home treatment. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1072-1082. [PMID: 32856348 DOI: 10.1111/hsc.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 05/04/2023]
Abstract
Best practice in dementia care is support in the home. Yet, crisis is common and can often result in hospital admission with adverse consequences. The objective of this mixed-methods case study research was to identify the critical factors for resolving crisis for a person with dementia living at home. The research was an in-depth investigation of what happens during crisis for people with dementia and how it is managed by a Home Treatment Crisis Team to resolution and outcome at 6 weeks and 6 months. The methods were; observation of crisis management for 15 patients with dementia (max three observations per patient, total 41), interviews with patients with dementia (n = 5), carers (n = 13) and professionals (n = 14, range one to six interviews per person, total 29), focus group (nine professionals), and extraction of demographics and medical history from medical records. Analysis focused on the identification of factors important for crisis resolution and avoidance of hospital admission. Critical factors for the Home Treatment Crisis Team to enable successful crisis resolution were: immediate action to reduce risk of harm, expertise in dementia care and carer education, communication skills to establish trust and promote benefits of home treatment, shared decision-making, medication management, addressing the needs of carers independently of the person with dementia and, local availability of respite and other community services. The Home Treatment Crisis Team integrated the seven factors to deploy a biopsychosocial systems approach with embedded respect for personhood. This approach enabled crisis resolution for a person with dementia by creating a system of services, treatments, resources and relationships, 'Safe Dementia Space', in the community with avoidance of hospital admission in more than 80% of referrals. The identified critical factors for crisis resolution are important considerations in the design and delivery of home treatment services for people with dementia.
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Affiliation(s)
- Jane Hopkinson
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Amanda King
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Lucy Young
- Elysium Healthcare, Ty Gwyn Hall, Abergavenny, UK
| | - Kirsten McEwan
- University of Derby, Centre for Health and Social Care Research, Derby, UK
| | - Fiona Elliott
- Aneurin Bevin University Health Board, Serennu Children's Centre, Newport, UK
| | - Kate Hydon
- Avon and Wiltshire Mental Health Partnership, NHS Trust, Bristol, UK
| | | | | | - Anne-Marie Veitch
- Mental Health Services for Older People, Cardiff & Vale University Health Board, Cardiff, UK
| | - Cristie Howells
- Mental Health Services for Older People, Cardiff & Vale University Health Board, Cardiff, UK
| | - Mathew Hoskins
- Mental Health Services for Older People, Cardiff & Vale University Health Board, Cardiff, UK
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
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21
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Hasselberg N, Holgersen KH, Uverud GM, Siqveland J, Lloyd-Evans B, Johnson S, Ruud T. Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway. BMC Psychiatry 2021; 21:231. [PMID: 33947362 PMCID: PMC8094557 DOI: 10.1186/s12888-021-03237-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/16/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown. METHODS We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT. RESULTS The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users' choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support. CONCLUSIONS The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.
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Affiliation(s)
- N Hasselberg
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - K H Holgersen
- Tiller Community Mental Health Centre, Department of Mental Health, St. Olavs Hospital, Trondheim, Norway
| | - G M Uverud
- University of South-Eastern Norway, Vestfold, Norway
| | - J Siqveland
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- National Center for Suicide Research and Prevention, University of Oslo, Oslo, Norway
| | - B Lloyd-Evans
- Division of Psychiatry, University College London, London, UK
| | - S Johnson
- Division of Psychiatry, University College London, London, UK
| | - T Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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22
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Morant N, Davidson M, Wackett J, Lamb D, Pinfold V, Smith D, Johnson S, Lloyd-Evans B, Osborn DPJ. Acute day units for mental health crises: a qualitative study of service user and staff views and experiences. BMC Psychiatry 2021; 21:146. [PMID: 33691668 PMCID: PMC7944597 DOI: 10.1186/s12888-021-03140-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acute Day Units (ADUs) provide intensive, non-residential, short-term treatment for adults in mental health crisis. They currently exist in approximately 30% of health localities in England, but there is little research into their functioning or effectiveness, and how this form of crisis care is experienced by service users. This qualitative study explores the views and experiences of stakeholders who use and work in ADUs. METHODS We conducted 36 semi-structured interviews with service users, staff and carers at four ADUs in England. Data were analysed using thematic analysis. Peer researchers collected data and contributed to analysis, and a Lived Experience Advisory Panel (LEAP) provided perspectives across the whole project. RESULTS Both service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within an environment that felt safe. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems. CONCLUSIONS Multi-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice and effective support within local acute care systems.
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Affiliation(s)
- Nicola Morant
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Michael Davidson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Jane Wackett
- McPin Foundation, 7-14 Great Dover St, London, SE1 4YR, UK
| | - Danielle Lamb
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | | | - Deb Smith
- McPin Foundation, 7-14 Great Dover St, London, SE1 4YR, UK
| | - Sonia Johnson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - David P J Osborn
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
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23
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Rubio L, Lever Taylor B, Morant N, Johnson S. Experiences of intensive home treatment for a mental health crisis during the perinatal period: A UK qualitative study. Int J Ment Health Nurs 2021; 30:208-218. [PMID: 32816376 DOI: 10.1111/inm.12774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
Some women with severe perinatal mental health difficulties in England are cared for by acute home treatment services, known as Crisis Resolution Teams (CRTs), which provide short-term home-based treatment for adults experiencing a mental health crisis. Intensive home treatment has been trialed in a number of countries, but it is not known how well suited it is to the needs of perinatal women. This qualitative study aimed to explore how women and practitioners experience the provision of intensive home treatment for perinatal mental health problems. Semi-structured interviews were conducted with women who had received intensive home treatment in the perinatal period (n = 15), and focus groups were held with practitioners working in CRTs or in specialist perinatal mental health services (3 groups, n = 25). Data were analysed thematically. Women commonly found intensive home treatment problematic, experiencing it as intrusive and heavily risk-focused, with poor staff continuity and little tailoring to the perinatal context. However, women valued emotional support when provided, particularly when it had a perinatal focus, sometimes based on practitioners sharing their own experiences. Some women also appreciated avoiding hospital admission, but choice was often limited. Practitioners reported a lack of perinatal training among CRT staff and described difficulties tailoring treatment to perinatal women's needs. Currently, intensive home treatment, as offered by CRTs, may not be well suited to women with perinatal mental health difficulties. Findings suggest a need to develop community crisis responses that are better tailored to the needs of this population.
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Affiliation(s)
- Luisa Rubio
- Division of Psychiatry, University College London, London, UK
| | | | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
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24
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Schwarz J, Bechdolf A, Hirschmeier C, Hochwarter S, Holthoff-Detto V, Mühlensiepen F, Richter C, Rout S, Weinmann S, Heinze M, von Peter S. „Ich sehe es tatsächlich als Zwischenschritt“ – eine qualitative Analyse der Implementierungsbedingungen und -hürden von Stationsäquivalenter Behandlung in Berlin und Brandenburg. PSYCHIATRISCHE PRAXIS 2020; 48:193-200. [DOI: 10.1055/a-1274-3662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Ziel Untersucht werden die Bedingungen und Hürden der Einführung von Stationsäquivalenter Behandlung nach § 115d SGB V (StäB).
Methode Qualitative Analyse von Interviews und Fokusgruppen mit Mitarbeitenden (n = 43) an 11 psychiatrischen Kliniken in Berlin/Brandenburg.
Ergebnisse Auf Systemebene wird die Implementierung u. a. durch eine inadäquate Leistungsdefinition, fehlende Vorgaben auf Landesebene, Personalmangel und MDK-Prüfungen erschwert. Dies führt bei Kliniken zu zurückhaltender Umsetzung mit teilweise unzureichender personeller Ausstattung der StäB-Teams. Weitere Barrieren betreffen das Fehlen mobiler Lösungen zur Dokumentation und Teamkommunikation. Auf Ebene der Mitarbeitenden wirken sich ein Mangel an Information und Kooperation sowie unklare Aufgaben und Rollen hinderlich aus.
Schlussfolgerungen Für eine bedürfnisorientierte, flexible und flächendeckende Einführung von StäB sind Nachbesserungen an den Rahmenbedingungen sowie weitere Forschung zur Wirksamkeit und Implementierung notwendig.
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Affiliation(s)
- Julian Schwarz
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg, Immanuel Klinik Rüdersdorf
| | - Andreas Bechdolf
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain, Akademische Lehrkrankenhäuser der Charité – Universitätsmedizin Berlin
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln
- ORYGEN, National Center of Excellence of Youth Mental Health, University of Melbourne, Melbourne, Australien
| | - Constance Hirschmeier
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin
| | - Stefan Hochwarter
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg, Neuruppin
- Norwegian University of Science and Technology, Trondheim, Norwegen
| | - Vjera Holthoff-Detto
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Alexianer Krankenhaus Hedwigshöhe, St. Hedwig Kliniken Berlin
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Dresden, Deutschland
| | - Felix Mühlensiepen
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg, Neuruppin
- Fakultät für Gesundheitswissenschaften Brandenburg, Potsdam
| | - Christoph Richter
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Kaulsdorf, Berlin
| | - Sandeep Rout
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Neukölln, Berlin
| | - Stefan Weinmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Rudolf-Sophien-Stift, Stuttgart
| | - Martin Heinze
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg, Immanuel Klinik Rüdersdorf
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg, Neuruppin
| | - Sebastian von Peter
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg, Immanuel Klinik Rüdersdorf
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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.
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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
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Hassiotis A, Walsh A, Budgett J, Harrison I, Jones R, Morant N, Courtenay K, Crossey EV, Hall I, Romeo R, Taggart LG, Langdon PE, Ratti V, Kirchner V, Lloyd-Evans B. Intensive support for adults with intellectual disability and behaviours that challenge: a survey of provision and service typologies in England. BJPsych Open 2020; 6:e20. [PMID: 32043438 PMCID: PMC7176866 DOI: 10.1192/bjo.2020.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Approximately 18% of adults with intellectual disabilities living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy in-patient stays. AIMS To identify and describe the geographical distribution and characteristics of ISTs, and to develop a typology of IST service models in England. METHOD We undertook a national cross-sectional survey of 73 ISTs. A hierarchical cluster analysis was performed based on six prespecified grouping factors (mode of referrals, size of case-load, use of outcome measures, staff composition, hours of operation and setting of service). A simplified form of thematic analysis was used to explore free-text responses. RESULTS Cluster analysis identified two models of IST provision: (a) independent and (b) enhanced provision based around a community intellectual disability service. ISTs aspire to adopt person-centred care, mostly use the framework of positive behaviour support for behaviour that challenges, and report concerns about organisational and wider context issues. CONCLUSIONS This is the first study to examine the delivery of intensive support to people with intellectual disability and behaviour that challenges. A two-cluster model of ISTs was found to have statistical validity and clinical utility. The clinical heterogeneity indicates that further evaluation of these service models is needed to establish their clinical and cost-effectiveness.
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Affiliation(s)
- Angela Hassiotis
- Professor, Division of Psychiatry, University College London, UK
| | - Amy Walsh
- Research Assistant, Division of Psychiatry, University College London, UK
| | - Jessica Budgett
- Research Assistant, Division of Psychiatry, University College London, UK
| | - Isobel Harrison
- Project Manager, Division of Psychiatry, University College London, UK
| | - Rebecca Jones
- Statistician, Division of Psychiatry, University College London, UK
| | - Nicola Morant
- Qualitative Researcher, Division of Psychiatry, University College London, UK
| | - Ken Courtenay
- Consultant Psychiatrist, Haringey Learning Disability Partnership, Wood Green, London, UK
| | | | - Ian Hall
- Consultant Psychiatrist, East London NHS Foundation Trust, UK
| | | | | | - Peter E Langdon
- Professor, University of Warwick; and Coventry and Warwickshire Partnership NHS Trust, UK
| | - Victoria Ratti
- Project Manager, Division of Psychiatry, University College London, UK
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Hopkinson JB, King A, Mullins J, Young L, Kumar S, Hydon K, Muthukrishnan S, Elliott F, Hopkinson M. What happens before, during and after crisis for someone with dementia living at home: A systematic review. DEMENTIA 2020; 20:570-612. [PMID: 32013558 DOI: 10.1177/1471301220901634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND People living with dementia often experience crisis. Home treatment of crisis is an alternative to hospital admission that can have better outcomes. This systematic review is about people with dementia living at home and in crisis. It identifies modifiable factors in the crisis process that may facilitate crisis resolution. METHODS The protocol is registered on PROSPERO. A systematic search of MEDLINE, EMBASE, CINAHL, AHMED, PsycINFO, Cochrane Library and references of retrieved publications, identified empirical research in English language and date range January 2000 to February 2019. Two researchers independently screened abstracts, selected publications and extracted data using a framework based on published guidelines. This is a report of the analysis and narrative synthesis. RESULTS The search identified 2755 titles and abstracts, 76 were selected for full-text examination and 13 agreed for inclusion. The included studies evidence that: for a person with dementia, crisis is a process that begins with a problem judged to put them or others at risk of harm. It leads to decision and action to treat this risk, thus resolve the crisis. Such crisis can be predicted or unpredicted and progress quickly or slowly. Medical treatment, community resources and psychosocial support of personal resources, decision making, relationships and social networks, are all modifiable factors that can treat the risk of harm during crisis. Carers' and professionals' knowledge and skills in dementia care are likely to play a key role in crisis resolution in the home. CONCLUSION There has been limited investigation of the process and management of crisis at home for people living with dementia. The results of this review provide a foundation for future research. There is no consensus on critical components of home treatment to facilitate crisis resolution. However, education in dementia care for carers and professionals is likely to prove essential to successful home treatment.
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Affiliation(s)
| | | | - Jane Mullins
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Wales
| | | | - Sugandha Kumar
- Mental Health Services for Older People, Cardiff & Vale University Health Board, Wales
| | | | | | - Fiona Elliott
- Sparkle, Serennu Children's Centre, Aneurin Bevin University Health Board, Wales
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Lykomitrou A, Geitona M, Stylianidis S, Pantelidou S, Souliotis K. Economic Evaluation of Mobile Mental Health Units in Greece: The Case of Cyclades Islands. Health (London) 2020. [DOI: 10.4236/health.2020.127066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lamb D, Davidson M, Lloyd-Evans B, Johnson S, Heinkel S, Steare T, Pinfold V, Weich S, Morant N, Kirkbride J, Marston L, Canaway A, Madan J, Osborn D. Adult mental health provision in England: a national survey of acute day units. BMC Health Serv Res 2019; 19:866. [PMID: 31752861 PMCID: PMC6868849 DOI: 10.1186/s12913-019-4687-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Acute Day Units (ADUs) exist in some English NHS Trusts as an alternative to psychiatric inpatient admission. However, there is a lack of information about the number, configuration, and functioning of such units, and about the extent to which additional units might reduce admissions. This cross-sectional survey and cluster analysis of ADUs aimed to identify, categorise, and describe Acute Day Units (ADUs) in England. Methods English NHS Mental Health Trusts with ADUs were identified in a mapping exercise, and a questionnaire was distributed to ADU managers. Cluster analysis was used to identify distinct models of service, and descriptive statistics are given to summarise the results of the survey questions. Results Two types of service were identified by the cluster analysis: NHS (n = 27; and voluntary sector services (n = 18). Under a third of NHS Trusts have access to ADUs. NHS services typically have multi-disciplinary staff teams, operate during office hours, offer a range of interventions (medication, physical checks, psychological interventions, group sessions, peer support), and had a median treatment period of 30 days. Voluntary sector services had mostly non-clinically qualified staff, and typically offered supportive listening on a one-off, drop-in basis. Nearly all services aim to prevent or reduce inpatient admissions. Voluntary sector services had more involvement by service users and carers in management and running of the service than NHS services. Conclusions The majority of NHS Trusts do not provide ADUs, despite their potential to reduce inpatient admissions. Further research of ADUs is required to establish their effectiveness and acceptability to service users, carers, and staff.
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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.
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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.
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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
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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.
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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
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Clibbens N, Harrop D, Blackett S. Early discharge in acute mental health: A rapid literature review. Int J Ment Health Nurs 2018; 27:1305-1325. [PMID: 29949227 DOI: 10.1111/inm.12515] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 11/28/2022]
Abstract
Long psychiatric hospital stays are unpopular with services users, harmful, and costly. Economic pressures alongside a drive for recovery-orientated care in the least restrictive contexts have led to increasing pressure to discharge people from hospital early. Hospital discharge is, however, complex, stressful, and risky for service users and families. This rapid literature review aimed to assess what is known about early discharge in acute mental health. Searches were conducted in nine bibliographic databases, reference lists, and targeted grey literature sources. Fourteen included papers focused on early discharge in mental health, a population over 18 years with a mental health condition, and reported outcomes on therapeutic care or service delivery. Quality appraisal was undertaken using The Mixed Method Appraisal Tool. The meta-summary of the literature found that early discharge was neither provided to all inpatients nor limited to the Crisis Resolution and Home Treatment (CRHT) service model internationally. Early discharge interventions required collaborative working and discharge planning. It was not associated with unplanned readmissions and had a small effect on length of stay. Most studies reported service outcomes, whereas health outcomes were underreported. Professionals and service users were positive about early discharge and service users asked for peer support. Carers preferred hospital or day hospital care suggesting their need for respite. Limitations in the scope, detail, and quality of the evidence about early discharge leave an unclear picture of the components of early discharge as an intervention, its effectiveness, cost-effectiveness, or outcomes.
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Affiliation(s)
| | - Deborah Harrop
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Sally Blackett
- South Humber NHS Foundation Trust, Rotherham, Doncaster, UK
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Johne J, von Peter S, Schwarz J, Timm J, Heinze M, Ignatyev Y. Evaluation of new flexible and integrative psychiatric treatment models in Germany- assessment and preliminary validation of specific program components. BMC Psychiatry 2018; 18:278. [PMID: 30176836 PMCID: PMC6122621 DOI: 10.1186/s12888-018-1861-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flexible and integrative treatment (FIT) models are rather novel in German mental health care. This study aimed at identifying and evaluating empirically based, practicable, and quantifiable program components that describe the specific treatment structures and processes of German FIT models. METHODS A multi-step, iterative research process, based on Grounded Theory Methodology (GTM), was used to identify and operationalise components. A complex algorithm and expert-interviews were applied to quantify the relative weight of each component and to develop a sum score. Face and content validity were examined and internal consistency was tested by Cronbach's α coefficient. RESULTS Ten of eleven FIT components could be operationalised, quantified and united in the total score. All operationalised components showed sufficient face and content validity and eight components had a good reliability. CONCLUSIONS The components are a first step in the process of operationally defining German FIT models. They considerably overlap with various critical ingredients of international FIT models and may serve as a theoretical basis for constructing fidelity tools and research guides to enable process and outcome evaluation of German FIT models.
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Affiliation(s)
- Jakob Johne
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian von Peter
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Julian Schwarz
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Jürgen Timm
- Biometry Section, Competence Center for Clinical Trials, University of Bremen, Bremen, Germany
| | - Martin Heinze
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Yuriy Ignatyev
- Brandenburg Medical School Theodor Fontane, Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Germany
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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.
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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]
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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.
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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
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Milton A, Lloyd-Evans B, Fullarton K, Morant N, Paterson B, Hindle D, Kelly K, Mason O, Lambert M, Johnson S. Development of a peer-supported, self-management intervention for people following mental health crisis. BMC Res Notes 2017; 10:588. [PMID: 29122001 PMCID: PMC5680762 DOI: 10.1186/s13104-017-2900-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 11/01/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A documented gap in support exists for service users following discharge from acute mental health services, and structured interventions to reduce relapse are rarely provided. Peer-facilitated self-management interventions have potential to meet this need, but evidence for their effectiveness is limited. This paper describes the development of a peer-provided self-management intervention for mental health service users following discharge from crisis resolution teams (CRTs). METHODS A five-stage iterative mixed-methods approach of sequential data collection and intervention development was adopted, following the development and piloting stages of the MRC framework for developing and evaluating complex interventions. Evidence review (stage 1) included systematic reviews of both peer support and self-management literature. Interviews with CRT service users (n = 41) regarding needs and priorities for support following CRT discharge were conducted (stage 2). Focus group consultations (n = 12) were held with CRT service-users, staff and carers to assess the acceptability and feasibility of a proposed intervention, and to refine intervention organisation and content (stage 3). Qualitative evaluation of a refined, peer-provided, self-management intervention involved qualitative interviews with CRT service user participants (n = 9; n = 18) in feasibility testing (stage 4) and a pilot trial (stage 5), and a focus group at each stage with the peer worker providers (n = 4). RESULTS Existing evidence suggests self-management interventions can reduce relapse and improve recovery. Initial interviews and focus groups indicated support for the overall purpose and planned content of a recovery-focused self-management intervention for people leaving CRT care adapted from an existing resource: The personal recovery plan (developed by Repper and Perkins), and for peer support workers (PSWs) as providers. Participant feedback after feasibility testing was positive regarding facilitation of the intervention by PSWs; however, the structured self-management booklet was underutilised. Modifications to the self-management intervention manual and PSWs' training were made before piloting, which confirmed the acceptability and feasibility of the intervention for testing in a future, definitive trial. CONCLUSIONS A manualised intervention and operating procedures, focusing on the needs and priorities of the target client group, have been developed through iterative stages of intervention development and feedback for testing in a trial context. Trial Registration ISRCTN01027104 date of registration: 11/10/2012.
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Affiliation(s)
- Alyssa Milton
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
- Brain and Mind Centre, The University of Sydney, Sydney, NSW 2006 Australia
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Kate Fullarton
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Nicola Morant
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Bethan Paterson
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - David Hindle
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Kathleen Kelly
- Oxford Health NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Oliver Mason
- Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1N 6BT UK
- School of Psychology, University of Surrey, Guildford, Surrey GU2 7XH UK
| | - Marissa Lambert
- The Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
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Streater A, Coleston-Shields DM, Yates J, Stanyon M, Orrell M. A scoping review of crisis teams managing dementia in older people. Clin Interv Aging 2017; 12:1589-1603. [PMID: 29042760 PMCID: PMC5633275 DOI: 10.2147/cia.s142341] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Research on crisis teams for older adults with dementia is limited. This scoping review aimed to 1) conduct a systematic literature review reporting on the effectiveness of crisis interventions for older people with dementia and 2) conduct a scoping survey with dementia crisis teams mapping services across England to understand operational procedures and identify what is currently occurring in practice. METHODS For the systematic literature review, included studies were graded using the Critical Appraisal Skills Programme checklist. For the scoping survey, Trusts across England were contacted and relevant services were identified that work with people with dementia experiencing a mental health crisis. RESULTS The systematic literature review demonstrated limited evidence in support of crisis teams reducing the rate of hospital admissions, and despite the increase in number of studies, methodological limitations remain. For the scoping review, only half (51.8%) of the teams had a care pathway to manage crises and the primary need for referral was behavioral or psychological factors. CONCLUSION Evidence in the literature for the effectiveness of crisis teams for older adults with dementia remains limited. Being mainly cohort designs can make it difficult to evaluate the effectiveness of the intervention. In practice, it appears that the pathway for care managing crisis for people with dementia varies widely across services in England. There was a wide range of names given to the provision of teams managing crisis for people with dementia, which may reflect the differences in the setup and procedures of the service. To provide evidence on crisis intervention teams, a comprehensive protocol is required to deliver a standardized care pathway and measurable intervention as part of a large-scale evaluation of effectiveness.
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Affiliation(s)
- Amy Streater
- Research and Development, North East London NHS Foundation Trust, Ilford.,Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Jennifer Yates
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Miriam Stanyon
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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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.
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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
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