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Crowley S, McDonagh S, Carolan D, O'Connor K. The clinical impact of a crisis resolution home treatment team. Ir J Psychol Med 2023:1-8. [PMID: 37929580 DOI: 10.1017/ipm.2023.45] [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] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To evaluate the impact of treatment provided by a Crisis Resolution Home Treatment Team (CRHTT) in terms of preventing hospital admission, impact on service user's symptoms and overall functioning, as well as service user's satisfaction with the service. Secondary objectives were to evaluate the patient characteristics of those attending the CRHTT. METHODS All the service users treated by the CRHTT between 2016 and 2020 were included. Service users completed the Brief Psychiatric Rating Scale (BPRS), the Health of the Nation Outcome Scale (HoNOS), and the Client Satisfaction Questionnaire-version 8 (CSQ-8) before and after treatment by the CRHTT. Admission rates were compared between areas served by the CRHTT and control, before and after the introduction of the CRHTT, using two-way ANOVA. RESULTS Between 2016 and 2020, 1041 service users were treated by the service. Inpatient admissions in the areas served by the CRHTT fell by 38.5% after its introduction. There was a statistically significant interaction between CRHTT availability and time on admission rate, F (1,28) = 8.4, p = .007. BPRS scores were reduced significantly (p < .001), from a mean score of 32.01 before treatment to 24.64 after treatment. Mean HoNOS scores were 13.6 before and 9.1 after treatment (p < .001). Of the 1041 service users receiving the CSQ-8, only 180 returned it (17.3%). Service users' median responses were "very positive" to all eight items on the CSQ-8. CONCLUSIONS Although our study design has limitations this paper provides some support that CRHTT might be effective for the prevention of inpatient admission. The study also supports that CRHTT might be an effective option for the treatment of acute mental illness and crisis, although further research is needed in this area.
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Affiliation(s)
- S Crowley
- Department of Psychiatry, Acute Mental Health Unit, Cork University Hospital, Wilton, Cork, Ireland
- Department of Psychiatry, University College Cork, Cork, Ireland
| | - S McDonagh
- Department of Psychiatry, Acute Mental Health Unit, Cork University Hospital, Wilton, Cork, Ireland
- Department of Psychiatry, University College Cork, Cork, Ireland
| | - D Carolan
- Department of Psychiatry, University College Cork, Cork, Ireland
- Home Based Treatment Team & RISE Early Intervention in Psychosis Team, South Lee Mental Health Services, Blackrock Hall Primary Care Centre, Cork, Ireland
| | - K O'Connor
- Department of Psychiatry, Acute Mental Health Unit, Cork University Hospital, Wilton, Cork, Ireland
- Department of Psychiatry, University College Cork, Cork, Ireland
- Home Based Treatment Team & RISE Early Intervention in Psychosis Team, South Lee Mental Health Services, Blackrock Hall Primary Care Centre, Cork, Ireland
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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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3
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Effectiveness of a Community-Based Crisis Resolution Team for Patients with Severe Mental Illness in Greece: A Prospective Observational Study. Community Ment Health J 2023; 59:14-24. [PMID: 35588027 PMCID: PMC9118182 DOI: 10.1007/s10597-022-00983-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/16/2022] [Accepted: 05/02/2022] [Indexed: 01/07/2023]
Abstract
This prospective observational study evaluated the effectiveness of a crisis resolution team (CRT) for outpatient treatment of psychiatric patients experiencing an acute episode of severe mental disorder. The effectiveness of the CRT (n = 65) was assessed against the care-as-usual [CAU group (n = 65)]. Patients' clinical state, overall functioning, quality of life and satisfaction were respectively evaluated at baseline, post intervention and three-month post-intervention.CRT patients compared to the CAU group, had significantly improved outcomes concerning clinical state and patient satisfaction at post intervention phase. Statistically significant improvement was also recorded for the dimensions of environment, physical and psychological health related to quality of life. No significant differences were observed between the two groups regarding overall functioning.On the basis of these results, reforming of existing crisis-management services, in Greece, using the CRT model may improve substantially the services offered to psychiatric patients.
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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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5
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Mötteli S, Schori D, Menekse J, Jäger M, Vetter S. Patients' experiences and satisfaction with home treatment for acute mental illness: a mixed-methods retrospective study. J Ment Health 2022; 31:757-764. [PMID: 32772614 DOI: 10.1080/09638237.2020.1803233] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Home treatment (HT) has been proposed as a patient-centred alternative to acute mental inpatient care although evidence of patient-reported outcomes has remained limited. AIMS The aim of this study was to examine patient experiences and satisfaction with HT. METHODS This retrospective mixed-methods study included telephone interviews of 159 patients receiving HT between 2016 and 2019. Associations between patients' characteristics and global satisfaction (ZUF-8 scale) were assessed. Differences between HT patients and inpatients were tested on a propensity score -matched inpatient sample. Qualitative analyses were conducted using thematic analysis. RESULTS Global satisfaction with HT was slightly higher than in the inpatient sample (p = 0.019). There was no relationship between satisfaction and patients' characteristics, such as gender, age, main psychiatric diagnosis, and treatment duration, but satisfaction was higher for patients who perceived HT as their only treatment option. Participants particularly appreciated the person-centred care and practical support whereas staff continuity and medical treatment were main sources of dissatisfaction. CONCLUSION The results indicate that HT seems to be a more patient-centred alternative to inpatient treatment and might close a gap in the psychiatric care of patients who preferred not to use inpatient services but needed higher treatment intensity than outpatient treatment.
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Affiliation(s)
- Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Dominik Schori
- Directorate of Nursing, Therapies and Social Work, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Jasmin Menekse
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.,Psychiatrie Baselland, Liestal, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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6
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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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León-Caballero J, Sabaté A, Roldan M, González-Fresnedo AM, Samos P, Jerónimo MÁ, Martín LM, Pérez V, Pacchiarotti I, Córcoles D. Burden and satisfaction experienced in relatives and patients during home hospitalisation in psychiatry. ACTAS ESPANOLAS DE PSIQUIATRIA 2022; 50:226-232. [PMID: 36273382 PMCID: PMC10803838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
The role of caregivers is essential during home hospitalization since they act as co-therapists, being the level of responsibility experienced by them higher than usual.
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Affiliation(s)
- Jordi León-Caballero
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Agnès Sabaté
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain
| | - María Roldan
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain
| | - Anna María González-Fresnedo
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain
| | - Pilar Samos
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain
| | - Miguel Ángel Jerónimo
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain
| | - Luis Miguel Martín
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain
| | - Víctor Pérez
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain
- CIBERSAM (Mental Health Networking Biomedical Research Centre, Centro de Investigación Biomédica en Red de Salud Mental)
| | - Isabella Pacchiarotti
- Department of Psychiatry and Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - David Córcoles
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain
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8
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Mötteli S, Risch L, Hotzy F, Vetter S. Knowledge and attitude towards home treatment among referring healthcare professionals and self-referring patients to a psychiatric hospital: Better information is needed. Int J Soc Psychiatry 2022; 68:852-859. [PMID: 33878978 DOI: 10.1177/00207640211010848] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Home treatment (HT) is a patient-centred and cost-effective alternative to acute psychiatric inpatient care. However, the progress of its implementation and utilisation in routine care is slow. AIMS The aim of this study was to examine the knowledge and attitude towards HT among healthcare professionals. METHOD This observational study included telephone-based semi-structured interviews of 140 referring healthcare professionals including 35 self-referring patients to a large psychiatric hospital in Switzerland during 6 months in 2020. We assessed their knowledge, attitude and experience with HT along with sociodemographic characteristics, professional background and the intention for the referral. We completed the interviews with routine medical data of the referred patients such as diagnoses or symptom severity. RESULTS Regarding referrals for inpatient treatment (involuntary and voluntary), half of the referring healthcare professionals and 80% of the self-referring patients had no prior experience or knowledge of HT. Knowledge of HT differed in the order of the participants' working places. We found that most participants were uncertain about the inclusion/exclusion criteria for HT. Despite the low levels of knowledge, attitudes towards HT were overall positive. CONCLUSIONS Our results indicate that a proportion of the patients referred for inpatient treatment might have been eligible for HT too. The referring healthcare professionals' and patients' unfamiliarity and uncertainty with HT seems to be an important reason that home-based treatment approaches are still underused, although they are viewed very positively. Besides providing more information to potential referring health professionals, psychiatric hospitals should always carry out a standardized evaluation if HT is an option in patients who are referred for inpatient treatment.
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Affiliation(s)
- Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
| | - Ladina Risch
- Faculty of Medicine, University of Zurich, Switzerland
| | - Florian Hotzy
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
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9
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Hasselberg N, Klevan TG, Weimand B, Uverud GM, Holgersen KH, Siqveland J, Ruud T. Similarities and differences between service users' and carers' experiences of crisis resolution teams in Norway: a survey. BMC Psychiatry 2022; 22:266. [PMID: 35421950 PMCID: PMC9011940 DOI: 10.1186/s12888-022-03928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis resolution team (CRT) care in adult mental health services is intended to provide accessible and flexible short-term, intensive crisis intervention to service users experiencing a mental health crisis and involve their carers (next of kin). Research on users' and especially carers' experiences with CRT care is scarce and is mostly qualitative in nature. METHODS Altogether, 111 service users and 86 carers from 28 Norwegian CRTs were interviewed with The Service User and Carer Structured Interviews of the CORE Crisis Resolution Team Fidelity Scale Version 2. Their experiences with different aspects of CRT care were reported with descriptive statistics, and differences between service users' and carers' experiences were analyzed with the Mann-Whitney U Test. RESULTS The service users and carers reported that the CRT care mostly reflected their needs and what they wanted. The experiences of service users and carers were mostly similar, except for significant differences in received information and how the termination of CRT care appeared. Both groups experienced the organization of the CRT care as accessible, with continuity, reliability, and flexibility, but without a high intensity of care. Both groups found the content of the CRT care supportive, sensitive, with a choice of treatment type and a range of interventions beyond medication, but a lack of written treatment plans and discharge plans. Carers were rarely involved in discharge meetings. Regarding the role of CRTs within the care system, both groups agreed upon the lack of facilitation of early discharge from inpatient wards and lack of home treatment, but both groups confirmed some collaboration with other mental health services. CONCLUSION Service users and carers found that the CRTs were accessible, reliable, flexible, supportive, sensitive, and provided a range of interventions beyond medication. Limitations were lack of a high intensity of care, limited written treatment and discharge plans, limited provision of home treatment, and lack of gatekeeping of acute beds. Both groups experienced the CRT care as mostly similar, but with significant differences regarding involvement in care planning and discharge preparation.
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Affiliation(s)
- Nina Hasselberg
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Trude Gøril Klevan
- grid.463530.70000 0004 7417 509XFaculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Bente Weimand
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway ,grid.463530.70000 0004 7417 509XFaculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Gunn-Marit Uverud
- grid.463530.70000 0004 7417 509XUniversity of South-Eastern Norway, Notodden, Vestfold 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
| | - 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
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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10
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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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11
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Mötteli S, Jäger M, Hepp U, Wyder L, Vetter S, Seifritz E, Stulz N. Home Treatment for Acute Mental Healthcare: Who Benefits Most? Community Ment Health J 2021; 57:828-835. [PMID: 32279118 DOI: 10.1007/s10597-020-00618-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
Home treatment (HT) has been proposed as an alternative to inpatient treatment for individuals in acute mental crises. However, there is limited evidence concerning the effectiveness of HT to date. The aim of this study was to investigate which patients benefit most from HT. The concept and utilization of two HT services in Switzerland were retrospectively compared based on routine medical data of all patients who were treated in one of the two HT services between July 2016 and December 2017. We examined which patient characteristics were related to successful replacement of hospital care by HT based on a calculated success score using binary regression analyses. The whole sample included 408 individuals with an average age of 43 years and of whom 68% were female. As a result of conceptual similarities, in both HT settings, the typical patient was middle-aged, female and having an affective disorder as the main diagnosis. Half of the treatment cases met the criteria of successful replacement of hospital care (> 50% of the total treatment episodes in HT, treatment duration < 40 days and treatment terminated by mutual agreement). The results of the regression analyses indicated that patients with a lower symptom severity at admission (lower HoNOS score) and those who were employed had more likely a successful replacement of hospital care.The findings suggest that patients with acute mental disorders who have a certain level of functioning and social support might benefit most from HT in the sense of successful replacement of hospital care.
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Affiliation(s)
- Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.
| | | | - Urs Hepp
- Integrated Psychiatric Services Winterthur - Zurcher Unterland, Winterthur, Switzerland
| | - Lea Wyder
- Psychiatric Services Aargau AG, Königsfelden, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Niklaus Stulz
- Integrated Psychiatric Services Winterthur - Zurcher Unterland, Winterthur, Switzerland
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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] [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
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - K. H. Holgersen
- grid.52522.320000 0004 0627 3560Tiller Community Mental Health Centre, Department of Mental Health, St. Olavs Hospital, Trondheim, Norway
| | - G. M. Uverud
- grid.463530.70000 0004 7417 509XUniversity of South-Eastern Norway, Vestfold, Norway
| | - J. 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
| | - B. Lloyd-Evans
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - S. Johnson
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - T. Ruud
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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13
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Klevan T, Karlsson B, Hasselberg N, Ruud T. 'No service is an island': experiences of collaboration with crisis resolution teams in Norway. J Interprof Care 2021; 36:195-201. [PMID: 33853485 DOI: 10.1080/13561820.2021.1888900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Crisis resolution teams (CRTs) are a community-based service targeting adults experiencing acute mental health crises. The rationale for the development of CRTs is both value and efficacy based, suggesting that CRTs should contribute to the humanizing of mental health services and replace some acute hospital-based services with services in the community. Despite the collaborative nature of CRT work, how professionals from health and social services experience collaboration with CRTs is scantly explored. In the current study, semi-structured focus group interviews with eight different groups of 44 clinicians collaborating with CRTs in Norway were conducted. Data were analyzed using thematic analysis and categorized into four themes: (1) 'The accessible experts', (2) 'A broad and deep expertise', (3) 'Doing it together' and (4) 'Toward a new culture?'. The themes elaborate on issues related to the content and organization of CRT services, emphasizing the need for CRTs to be able to contribute their professional expertise in accessible, flexible and collaborative ways. A diversity in the knowledge base and in how services are organized may pose a challenge in interprofessional mental health crisis collaboration and mutual expectations. The study suggests that a shift toward a value-based and coherent mental health and social system could be a purposeful direction.
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Affiliation(s)
- Trude Klevan
- Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Drammen, Norway.,Mental Health Services, Akershus University Hospital, Lillestrøm, Lørenskog, Norway
| | - Bengt Karlsson
- Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Drammen, Norway
| | - Nina Hasselberg
- Mental Health Services, Akershus University Hospital, Lillestrøm, Lørenskog, Norway
| | - Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lillestrøm, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Stulz N, Kawohl W, Jäger M, Mötteli S, Schnyder U, Hepp U. From research to practice: Implementing an experimental home treatment model into routine mental health care. Eur Psychiatry 2020; 63:e94. [PMID: 33168129 PMCID: PMC7681154 DOI: 10.1192/j.eurpsy.2020.91] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In line with previous findings, in a recent randomized controlled trial (RCT), we found that home treatment (HT) for acute mental health care can reduce (substitute) hospital use among severely ill patients in crises. This study examined whether the findings of the RCT generalize to HT services provided under routine care conditions. Methods We compared patients who received HT during the RCT study phase with patients who received the same HT service after it had become part of routine mental health services in the same catchment area. Sociodemographic and clinical characteristics as well as service use (HT and hospital bed days) were compared between the RCT and the subsequent routine care study period. Results Compared to patients who received HT during the RCT, routine care HT patients were more often living with others, less often admitted compulsorily, more often diagnosed with anxiety and stress-related disorders (ICD-10 F4) and less often diagnosed with schizophrenia spectrum disorders (F2). When compared to patients who were exclusively treated on hospital wards, involvement of the HT team in patients’ care was associated with a clear-cut reduction of hospital bed days both during the RCT and under routine care conditions. However, unlike during the RCT study period, involvement of HT was associated with longer overall treatment episodes (inpatient + HT days) under routine care conditions. Conclusions HT seems to reduce the use of hospital bed days even under routine care conditions but is at risk of producing longer overall acute treatment episodes.
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Affiliation(s)
- N Stulz
- Integrated Psychiatric Services Winterthur-Zurcher Unterland, P.O. Box 144, CH-8408Winterthur, Switzerland
| | - W Kawohl
- Psychiatric Services Aargau, P.O. Box 432, CH-5201Brugg, Switzerland.,KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland
| | - M Jäger
- KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland.,Psychiatrie Baselland, Bienentalstrasse 7, CH-4410Liestal, Switzerland
| | - S Mötteli
- KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland
| | - U Schnyder
- University of Zurich, CH-8001Zurich, Switzerland
| | - U Hepp
- Integrated Psychiatric Services Winterthur-Zurcher Unterland, P.O. Box 144, CH-8408Winterthur, Switzerland
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15
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Stulz N, Wyder L, Maeck L, Hilpert M, Lerzer H, Zander E, Kawohl W, Grosse Holtforth M, Schnyder U, Hepp U. Home treatment for acute mental healthcare: randomised controlled trial. Br J Psychiatry 2020; 216:323-330. [PMID: 30864532 DOI: 10.1192/bjp.2019.31] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Home treatment has been proposed as an alternative to acute in-patient care for mentally ill patients. However, there is only moderate evidence in support of home treatment. AIMS To test whether and to what degree home treatment services would enable a reduction (substitution) of hospital use. METHOD A total of 707 consecutively admitted adult patients with a broad spectrum of mental disorders (ICD-10: F2-F6, F8-F9, Z) experiencing crises that necessitated immediate admission to hospital, were randomly allocated to either a service model including a home treatment alternative to hospital care (experimental group) or a conventional service model that lacked a home treatment alternative to in-patient care (control group) (trial registration at ClinicalTrials.gov: NCT02322437). RESULTS The mean number of hospital days per patient within 24 months after the index crisis necessitating hospital admission (primary outcome) was reduced by 30.4% (mean 41.3 v. 59.3, P<0.001) when a home treatment team was available (intention-to-treat analysis). Regarding secondary outcomes, average overall treatment duration (hospital days + home treatment days) per patient (mean 50.4 v. 59.3, P = 0.969) and mean number of hospital admissions per patient (mean 1.86 v. 1.93, P = 0.885) did not differ statistically significantly between the experimental and control groups within 24 months after the index crisis. There were no significant between-group differences regarding clinical and social outcomes (Health of the Nation Outcome Scales: mean 9.9 v. 9.7, P = 0.652) or patient satisfaction with care (Perception of Care questionnaire: mean 0.78 v. 0.80, P = 0.242). CONCLUSIONS Home treatment services can reduce hospital use among severely ill patients in acute crises and seem to result in comparable clinical/social outcomes and patient satisfaction as standard in-patient care.
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Affiliation(s)
- Niklaus Stulz
- Head of Research, Integrated Psychiatric Services Winterthur - Zurcher Unterland; Senior Researcher (Former Head of Research), Psychiatric Services Aargau; and Research Associate, Department of Psychology, University of Berne, Switzerland
| | - Lea Wyder
- Research Associate, Psychiatric Services Aargau; and Former PhD Student, Department of Psychology, University of Berne, Switzerland
| | - Lienhard Maeck
- Senior Physician, Psychiatric Services Aargau, Switzerland
| | - Matthias Hilpert
- Deputy Head of Department, Psychiatric Services Aargau, Switzerland
| | - Helmut Lerzer
- Deputy Head of Nursing Services, Psychiatric Services Aargau, Switzerland
| | - Eduard Zander
- Senior Physician, Psychiatric Services Aargau, Switzerland
| | - Wolfram Kawohl
- Head of Department, Psychiatric Services Aargau, Switzerland
| | - Martin Grosse Holtforth
- Associate Professor, Department of Psychology, University of Berne; and Head Researcher, Division of Psychosomatic Medicine, Department of Neurology, Inselspital, University Hospital Berne, Switzerland
| | | | - Urs Hepp
- Medical Director, Integrated Psychiatric Services Winterthur - Zurcher Unterland, Switzerland
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16
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Lamb D, Lloyd-Evans B, Fullarton K, Kelly K, Goater N, Mason O, Gray R, Osborn D, Nolan F, Pilling S, Sullivan SA, Henderson C, Milton A, Burgess E, Churchard A, Davidson M, Frerichs J, Hindle D, Paterson B, Brown E, Piotrowski J, Wheeler C, Johnson S. Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology. Int J Ment Health Nurs 2020; 29:187-201. [PMID: 31566846 DOI: 10.1111/inm.12658] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2019] [Indexed: 11/27/2022]
Abstract
Crisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. Previous UK research, based on self-report surveys, suggests that a loosely specified model has resulted in wide variations in CRTs' service delivery, organization and outcomes. A fidelity scale (developed through evidence review and stakeholder consensus) provided a means of objectively measuring adherence to a model of good practice for CRTs, via one-day fidelity reviews of UK crisis teams. Reviews included interviews with service users, carers, staff and managers, and examination of data, policies, protocols and anonymized case notes. Of the 75 teams reviewed, 49 (65%) were assessed as being moderate fidelity and the rest as low fidelity, with no team achieving high fidelity. The median score was 122 (range: 73-151; inter-quartile range: 111-132). Teams achieved higher scores on items about structure and organization, for example ease of referral, medication and safety systems, but scored poorly on items about the content of care and interventions. Despite a national mandate to implement the CRT model, there are wide variations in implementation in the UK and no teams in our sample achieved overall high fidelity. This suggests that a mandatory national policy is not in itself sufficient to achieve good quality implementation of a service model. The CRT Fidelity Scale provides a feasible and acceptable means to objectively assess model fidelity in CRTs. There is a need for development and testing of interventions to enhance model fidelity and facilitate improvements to these services.
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Affiliation(s)
| | - Brynmor Lloyd-Evans
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | | | - Kathleen Kelly
- Northamptonshire Healthcare NHS Foundation Trust, London, UK
| | | | - Oliver Mason
- North East London NHS Foundation Trust, London, UK
| | | | - David Osborn
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Fiona Nolan
- Camden and Islington NHS Foundation Trust, London, UK
| | - Steve Pilling
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sonia Johnson
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
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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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Alba Palé L, León Caballero J, Córcoles Martínez D, González Fresnedo AM, Bellsolà Gonzalez M, Martín López LM, Pérez Solà V. Psychiatric Home Hospitalization Unit of the Hospital del Mar. A crisis resolution and home treatment team in Barcelona. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 12:207-212. [PMID: 30670368 DOI: 10.1016/j.rpsm.2018.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/08/2018] [Accepted: 09/11/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although home hospitalization has begun to develop widely in recent years there is a notable lack of studies. The following study includes data from the Psychiatric Home Hospitalization Unit of the Hospital del Mar (HADMar). This program has been running for 2years and takes place in a socio-demographically depressed area in Barcelona. It receives patients from community and hospital services. Monitoring is limited in time and at discharge patient are referred to the ambulatory unit. MATERIAL AND METHODS All patients visited from 2015 to the present time were selected. A total of 135 patients were included in the sample. A qualitative descriptive study was carried out in order to define the socio-demographic characteristics. The severity of symptoms, suicidal risk and changes in the functionality were considered as clinical outcomes. RESULTS The mean age of patients was 44.6 years and there were no gender differences. A total of 26 patients had a history of suicidal attempts and 11.1% lived alone; 51.1% were diagnosed with a psychotic disorder. The mean GEP score for the severity of the psychiatric symptoms was 2.39 and the mean risk of suicide was 0.49. There is an increase in the EEAG score from admission to discharge, which means an improvement in the functionality of patients. CONCLUSIONS The results obtained in our study are consistent with previous results. Home crisis intervention teams have proved to be an alternative to traditional hospitalization. However, more studies are needed to support these results.
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Affiliation(s)
- Leila Alba Palé
- Unidad de hospitalización domiciliaria de CASM Benito Menni, Germanes Hospitalaries, Sant Boi de Llobregat, Barcelona, España.
| | - Jordi León Caballero
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, España; Departamento de Psiquiatría y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, España
| | | | | | | | | | - Víctor Pérez Solà
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, España; Medical Research Institute (IMIM), Hospital del Mar , Barcelona; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), España
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Abstract
SummaryCrisis resolution and home treatment teams have been introduced throughout England as part of a transformation of the community mental healthcare system. They aim to assess all patients being considered for acute hospital admission, to offer intensive home treatment rather than hospital admission if feasible, and to facilitate early discharge from hospital. Key features include 24-hour availability and intensive contact in the community, with visits twice daily if needed. This article describes the main characteristics and core interventions of these teams, and reviews the impact of their nationwide introduction. The model has evolved as a pragmatic response to difficulties in the acute care system, and its adaptation continues. Key challenges include achieving close integration with the rest of the mental health system and delivering continuity of care and effective therapeutic relationships despite the involvement of multiple workers in each crisis.
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20
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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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21
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Zanello A, Berthoud L, Bacchetta JP. Emotional crisis in a naturalistic context: characterizing outpatient profiles and treatment effectiveness. BMC Psychiatry 2017; 17:130. [PMID: 28388881 PMCID: PMC5384152 DOI: 10.1186/s12888-017-1293-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis happens daily yet its understanding is often limited, even in the field of psychiatry. Indeed, a challenge is to assess the potential for change of patients so as to offer appropriate therapeutic interventions and enhance treatment program efficacy. This naturalistic study aimed to identify the socio-demographical characteristics and clinical profiles at admission of patients referred to a specialized Crisis Intervention Center (CIC) and to examine the effectiveness of the intervention. METHOD The sample was composed of 352 adult outpatients recruited among the referrals to the CIC. Assessment completed at admission and at discharge examined psychiatric symptoms, defense mechanisms, recovery styles and global functioning. The crisis intervention consisted in a psychodynamically oriented multimodal approach associated with medication. RESULTS Regarding the clinical profiles at intake, patients were middle-aged (M = 38.56, SD = 10.91), with a higher proportion of women (62.22%). They were addressed to the CIC because they had attempted to commit suicide or had suicidal ideation or presented depressed mood related to interpersonal difficulties. No statistical differences were found between patients dropping out (n = 215) and those attending the crisis intervention (n = 137). Crisis intervention demonstrated a beneficial effect (p < 0.01) on almost all variables, with Effect Sizes (ES) ranging from small to large (0.12 < ES < 0.75; median = 0.49). However, the Reliable Change Index indicated that most of the issues fall into the undetermined category (range 41.46 to 96.35%; median = 66.20%). CONCLUSIONS This study establishes the profile of patients referred to the CIC and shows that more than half of the patients dropped out from the crisis intervention before completion. Our findings suggest that people presenting an emotional crisis benefit from crisis intervention. However, given methodological constraints, these results need to be considered with caution. Moreover, the clinical significance of the improvements is not confirmed. Thus, the effectiveness of crisis intervention in naturalistic context is not fully determined and should be more rigorously studied in future research.
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Affiliation(s)
- Adriano Zanello
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland. .,HUG Département de Santé Mentale et de Psychiatrie, Site Belle-Idée, Ch. du Petit-Bel-Air 2, CH-1225, Chêne-Bourg, Switzerland.
| | - Laurent Berthoud
- grid.9851.5Department of Psychiatry, University of Lausanne, Lausanne, Switzerland
| | - Jean-Pierre Bacchetta
- grid.150338.cDepartment of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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Clausen H, Landheim A, Odden S, Šaltytė Benth J, Heiervang KS, Stuen HK, Killaspy H, Ruud T. Hospitalization of high and low inpatient service users before and after enrollment into Assertive Community Treatment teams: a naturalistic observational study. Int J Ment Health Syst 2016; 10:14. [PMID: 26933446 PMCID: PMC4772328 DOI: 10.1186/s13033-016-0052-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 02/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Assertive Community Treatment (ACT) is more successful in reducing hospitalization when baseline use is high. However, with a growing recovery-focus, ACT may be useful for people with severe mental illness who are difficult to engage but not high users of inpatient services. This study investigated hospitalization 2 years before and 2 years after ACT enrollment amongst patients both with and without high inpatient services use before enrollment into ACT. Methods This naturalistic observational study included 142 patients from 12 different ACT teams throughout Norway. Of these, 74 (52 %) were high users of inpatient services before ACT. The teams assessed the patients upon enrollment using clinician-rated and self-reported questionnaires. Hospitalization data from 2 years before and 2 years after enrollment into ACT were obtained from the Norwegian Patient Registry. Linear mixed models were used to assess changes in hospitalization and to explore associations between these changes and patient characteristics. Results When the participants enrolled into the ACT teams, high users of inpatient care were younger, more often living alone and more often subject to involuntary outpatient treatment than low users. The participants spent significantly fewer days in hospital during the 2 years of ACT follow-up compared to the 2 years before enrollment. The reduction was more evident amongst high users, whereas low users had an initial increase in inpatient days in the first year of ACT and a subsequent decrease in the second year. More severe negative symptoms and previous high use of inpatient care were associated with a reduction in both total and involuntary inpatient days. Additionally, a reduction in involuntary inpatient days was associated with being subject to involuntary outpatient treatment upon enrollment into ACT. Conclusion The findings in this study may suggest that ACT contributes to more appropriate use of inpatient care, possibly by reducing the presumably avoidable hospitalization of high users and increasing the presumably needed inpatient care of low users.
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Affiliation(s)
- Hanne Clausen
- Department of Research and Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway ; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Landheim
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway ; Addiction Research, University of Oslo, Oslo, Norway
| | - Sigrun Odden
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway ; HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Sverdvik Heiervang
- Department of Research and Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Hanne Kilen Stuen
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, UK
| | - Torleif Ruud
- Department of Research and Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway ; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Wheeler C, Lloyd-Evans B, Churchard A, Fitzgerald C, Fullarton K, Mosse L, Paterson B, Zugaro CG, Johnson S. Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review. BMC Psychiatry 2015; 15:74. [PMID: 25879674 PMCID: PMC4405828 DOI: 10.1186/s12888-015-0441-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/16/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users' satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs. METHODS A systematic review was conducted. MEDLINE, Embase, PsycINFO, CINAHL and Web of Science were searched to November 2013. A further web-based search was conducted for government and expert guidelines on CRTs. We analysed studies separately as: comparing CRTs to Treatment as Usual; comparing two or more CRT models; national or regional surveys of CRT services; qualitative studies of stakeholders' views regarding best practice in CRTs; and guidelines from government and expert organisations regarding CRT service delivery. Quality assessment and narrative synthesis were conducted. Statistical meta-analysis was not feasible due to the variety of design of retrieved studies. RESULTS Sixty-nine studies were included. Studies varied in quality and in the composition and activities of the clinical services studied. Quantitative studies suggested that longer opening hours and the presence of a psychiatrist in the team may increase CRTs' ability to prevent hospital admissions. Stakeholders emphasised communication and integration with other local mental health services; provision of treatment at home; and limiting the number of different staff members visiting a service user. Existing guidelines prioritised 24-hour, seven-day-a-week CRT service provision (including psychiatrist and medical prescriber); and high quality of staff training. CONCLUSIONS We cannot draw confident conclusions about the critical components of CRTs from available quantitative evidence. Clearer definition of the CRT model is required, informed by stakeholders' views and guidelines. Future studies examining the relationship of overall CRT model fidelity to outcomes, or evaluating the impact of key aspects of the CRT model, are desirable. TRIAL REGISTRATION Prospero CRD42013006415 .
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Affiliation(s)
- Claire Wheeler
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Alasdair Churchard
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Caroline Fitzgerald
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Kate Fullarton
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Liberty Mosse
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Bethan Paterson
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Clementina Galli Zugaro
- Department of Psychology, University of Bath, Claverton Down, Bath, North East Somerset, BA2 7AY, UK.
| | - Sonia Johnson
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
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Tøgersen K, Bjerke E, Gjelstad K, Ruud T. Psykiatriske tvangsinnleggelser i Østfold i 2000 og 2010. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:31-4. [PMID: 25589125 DOI: 10.4045/tidsskr.13.1547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
| | | | | | - Torleif Ruud
- Divisjon psykisk helsevern Akershus universitetssykehus og Institutt for klinisk medisin Universitetet i Oslo
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Sebergsen K, Norberg A, Talseth AG. Being in a process of transition to psychosis, as narrated by adults with psychotic illnesses acutely admitted to hospital. J Psychiatr Ment Health Nurs 2014; 21:896-905. [PMID: 24784573 PMCID: PMC4263308 DOI: 10.1111/jpm.12158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2014] [Indexed: 12/01/2022]
Abstract
To assist in improving early interventions for psychosis, this study explored how adult people narrated their experience of becoming psychotic, and how contact with mental health personnel was established. Narrative interviews were conducted with 12 participants with psychotic illnesses recruited from acute psychiatric wards. The interviews were content analysed. Participants described being in a process of transition to psychosis as follows: experiencing changes as well-known signs of psychosis, experiencing sudden unexpected changes as signs of psychosis and experiencing unidentified changes as signs of illness. Our results show that participants and their close others who knew the signs of psychosis established a dialogue with mental health personnel and were better equipped to prevent and mitigate the psychosis. Our results demonstrate that participants who did not perceive the signs of psychosis and did not have other people to advocate for them were at risk for delayed treatment, poor communication and coercive interventions. Furthermore, participants who did not know the signs of psychosis perceived these changes as deterioration in their health and awareness of illness. We suggest that participants' experiential knowledge of transitioning to psychosis and an awareness of illness can be used to improve the communication during interventions for psychosis.
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Affiliation(s)
- K Sebergsen
- Division of General Psychiatry, University Hospital of North Norway, Tromsø, Norway
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26
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Nwachukwu I, Nkire N, Russell V. Profile and activities of a rural home-based psychiatric treatment service in Ireland. Int J Psychiatry Clin Pract 2014; 18:125-30. [PMID: 23980533 DOI: 10.3109/13651501.2013.838631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study described the profile, activities and patient-related outcomes of a long-established home-based treatment (HBT) service in Ireland. METHODS A retrospective descriptive study design was adopted to review and describe the activities of the Cavan HBT team over a 5-year period. Data including demographics, referral details, duration of admissions and outcome/disposal were retrospectively collected from the home treatment team mental health register of admissions between 2006 and 2010. Data were analysed using SPSS version 15 for windows. RESULTS A total of 783 patients were referred to the team over the study period, of which 722 were admitted for home treatment. Most referrals (51%) were from General Practitioners and the commonest reason for referral/admission for home treatment was low mood (26%). While 10% required stepped-up care to the psychiatric inpatient unit, 77% were successfully discharged to the out-patient clinic for routine follow-up care. CONCLUSIONS Common psychiatric illnesses can be safely and effectively managed with HBT within the context of a spectrum of therapeutic options in a community psychiatric service.
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Affiliation(s)
- Izu Nwachukwu
- Department of Psychiatry, St. Senan's Hospital, Wexford Mental Health Service , Enniscorthy, Wexford , Ireland
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27
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Hasselberg N, Gråwe RW, Johnson S, Šaltytė-Benth J, Ruud T. Psychiatric admissions from crisis resolution teams in Norway: a prospective multicentre study. BMC Psychiatry 2013; 13:117. [PMID: 23594922 PMCID: PMC3637541 DOI: 10.1186/1471-244x-13-117] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 04/08/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Crisis resolution teams (CRTs) provide intensive alternative care to hospital admission for patients with mental health crises. The aims of this study were to describe the proportions and characteristics of patients admitted to in-patient wards from CRTs, to identify any differences in admission practices between CRTs, and to identify predictors of admissions from CRTs. METHODS A naturalistic prospective multicentre design was used to study 680 consecutive patients under the care of eight CRTs in Norway over a 3-month period in 2005/2006. Socio-demographic and clinical data were collected on the patients, and on the organization and operation of the CRTs. Logistic regression analysis for hierarchical data was used to test potential predictors of admission at team and patient level. RESULTS One hundred and forty-six patients (21.5%) were admitted to in-patient wards. There were significant differences in admission rates between the CRTs. The likelihood of being admitted to an in-patient ward was significantly lower for patients treated by CRTs that operated during extended opening hours than CRTs that operated during office hours only. Those most likely to be admitted were patients with psychotic symptoms, suicidal risk, and a prior history of admissions. CONCLUSIONS Extended opening hours may help CRTs to prevent more admissions for patients with moderately severe and relapsing mental illnesses. Patients with severe psychosis seem to be difficult to treat in the community by Norwegian CRTs even with extended opening hours.
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Affiliation(s)
- Nina Hasselberg
- Department of Research and Development, Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
| | - Rolf W Gråwe
- Department of Research and Development, Alcohol and Drug Treatment Health Trust in Central Norway, Trondheim, Norway,Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sonia Johnson
- Department of Mental Health Sciences, University College London, London, UK
| | - Jūratė Šaltytė-Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Torleif Ruud
- Department of Research and Development, Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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28
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Ness O, Karlsson B, Borg M, Biong S, Hesook SK. A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 1. Patient characteristics at admission and referral. Int J Ment Health Syst 2012; 6:18. [PMID: 22992415 PMCID: PMC3565959 DOI: 10.1186/1752-4458-6-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 09/04/2012] [Indexed: 12/01/2022] Open
Abstract
Background Crisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the first paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on describing the characteristics of the patients at admission. Methods The study was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, were the complete registration of patients of this team in the period from February 2008 to July 2009. Results Although diverse in their characteristics, the patients were over represented by females, young to middle aged, and people on public support. The patients were mostly referred to the team by self/family members and primary care physicians. At admission, depression was the most prevalent symptom, the overall intensity level of mental health problems was low, and most of the patients had long-standing mental health problems. Conclusions Self/family referral seems to be a critical route to receive services by CRTH teams as shown in our study, suggesting a need to examine policies that disallow this form of referral in some communities. The findings from our study show that the patients of the CRHT team, while mostly having long-standing mental health problems and had been receiving healthcare for them, did not have severe mental health problems at admission, although could have been in crises. There is a need for further studies to examine how people with severe mental health problems obtain services in time of crises, and to address the need to gain a greater understanding of the role of CRHT.
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Affiliation(s)
- Ottar Ness
- Faculty of Health Sciences, Buskerud University College, Box 7053, 3007, Drammen, Norway.
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29
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Biong S, Ness O, Karlsson B, Borg M, Kim HS. A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 3. Changes in morbidity and clinical problems from admission to discharge. Int J Ment Health Syst 2012; 6:17. [PMID: 22967433 PMCID: PMC3459812 DOI: 10.1186/1752-4458-6-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 09/04/2012] [Indexed: 12/04/2022] Open
Abstract
Background Crisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the third paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the changes in morbidity and clinical problems from admission to discharge and the length of service. Methods The study was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, were the complete registration of patients of this team in the period from February 2008 to July 2009. Results The findings indicate that the patients´ mental health status improved from admission to discharge, although many patients were discharged with the same mental health symptoms as those present at admission. However, one third of the patients were discharged with no clinically significant mental health problems. The majority of the patients of the CRHT team on the other hand seemed to be those with long-standing mental health problems, who were likely to be in need of continuing mental health care even after the resolution of mental health crises. There is a need for a coordinated system of community-based mental health services for patients with long-standing mental health problems, within which CRHT teams can play a pivotal role in making connections between the crisis-care and the recovery-oriented care. The mean length of service was around 15 days with variations by the clinical problem types, with the patients in the psychosis group having the shortest duration and the patients in the depression group having the longest duration.
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Affiliation(s)
- Stian Biong
- Faculty of Health Sciences, Buskerud University College, Box 7053, Drammen 3007, Norway.
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30
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Karlsson B, Borg M, Biong S, Ness O, Kim HS. A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 2. Provision of professional services. Int J Ment Health Syst 2012; 6:14. [PMID: 22958549 PMCID: PMC3487748 DOI: 10.1186/1752-4458-6-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 09/04/2012] [Indexed: 12/01/2022] Open
Abstract
Background Crisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the second paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the provision of professional services by the team. Methods The project was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, constituted the complete registration of patients of this team in the period from February 2008 to July 2009. Results The average length of service by the team was about 15 days, and those with depression as the major symptom had the longest mean length of stay on the team. The team was engaged in providing a variety of services including individual treatments involving multiple professionals, group treatment meetings, and coordination activities involving external service sectors. While the type of professionals providing individual treatment was not associated with the severity level of clinical problems, those receiving various group treatment meetings had more serious level of clinical symptoms than those not receiving group treatment meetings. In addition coordination activities involving healthcare professionals and social services in the community were in line with the patients' clinical and social needs. The results of the study show that the team functioned effectively in addressing the general guidelines for the functioning of CRHT teams.
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Affiliation(s)
- Bengt Karlsson
- Faculty of Health Sciences, Buskerud University College, Box 7053, Drammen, 3007, Norway.
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31
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Johansen IH, Morken T, Hunskaar S. How Norwegian casualty clinics handle contacts related to mental illness: A prospective observational study. Int J Ment Health Syst 2012; 6:3. [PMID: 22520067 PMCID: PMC3434113 DOI: 10.1186/1752-4458-6-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 04/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-threshold and out-of-hours services play an important role in the emergency care for people with mental illness. In Norway casualty clinic doctors are responsible for a substantial share of acute referrals to psychiatric wards. This study's aim was to identify patients contacting the casualty clinic for mental illness related problems and study interventions and diagnoses. METHODS At four Norwegian casualty clinics information on treatment, diagnoses and referral were retrieved from the medical records of patients judged by doctors to present problems related to mental illness including substance misuse. Also, routine information and relation to mental illness were gathered for all consecutive contacts to the casualty clinics. RESULTS In the initial contacts to the casualty clinics (n = 28527) a relation to mental illness was reported in 2.5% of contacts, whereas the corresponding proportion in the doctor registered consultations, home-visits and emergency call-outs (n = 9487) was 9.3%. Compared to other contacts, mental illness contacts were relatively more urgent and more frequent during night time. Common interventions were advice from a nurse, laboratory testing, prescriptions and minor surgical treatment. A third of patients in contact with doctors were referred to in-patient treatment, mostly non-psychiatric wards. Many patients were not given diagnoses signalling mental problems. When police was involved, they often presented the patient for examination. CONCLUSIONS Most mental illness related contacts are managed in Norwegian casualty clinics without referral to in-patient care. The patients benefit from a wide range of interventions, of which psychiatric admission is only one.
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Affiliation(s)
- Ingrid H Johansen
- National Centre for Emergency Primary Health Care, Uni Health, Uni Research, Kalfarveien 31, 5018, Bergen, Norway.
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32
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Hasselberg N, Gråwe RW, Johnson S, Ruud T. Treatment and outcomes of crisis resolution teams: a prospective multicentre study. BMC Psychiatry 2011; 11:183. [PMID: 22108030 PMCID: PMC3258194 DOI: 10.1186/1471-244x-11-183] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 11/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis resolution teams (CRTs) aim to help patients in acute mental health crises without admitting them to hospital. The aims of this study were to investigate content of treatment, service practice, and outcomes of crises of CRTs in Norway. METHODS The study had a multicentre prospective design, examining routine data for 680 patients and 62 staff members of eight CRTs. The clinical staff collected data on the demographic, clinical, and content of treatment variables. The service practices of the staff were assessed on the Community Program Practice Scale. Information on each CRT was recorded by the team leaders. The outcomes of crises were measured by the changes in Global Assessment of Functioning scale scores and the total scores on the Health of the Nation Outcome Scales between admission and discharge. Regression analysis was used to predict favourable outcomes. RESULTS The mean length of treatment was 19 days for the total sample (N = 680) and 29 days for the 455 patients with more than one consultation; 7.4% of the patients had had more than twice-weekly consultations with any member of the clinical staff of the CRTs. A doctor or psychologist participated in 55.5% of the treatment episodes. The CRTs collaborated with other mental health services in 71.5% of cases and with families/networks in 51.5% of cases. The overall outcomes of the crises were positive, with a small to medium effect size. Patients with depression received the longest treatments and showed most improvement of crisis. Patients with psychotic symptoms and substance abuse problems received the shortest treatments, showed least improvement, and were most often referred to other parts of the mental health services. Length of treatment, being male and single, and a team focus on out-of-office contact were predictors of favourable outcomes of crises in the adjusted model. CONCLUSIONS Our study indicates that, compared with the UK, the Norwegian CRTs provided less intensive and less out-of-office care. The Norwegian CRTs worked more with depression and suicidal crises than with psychoses. To be an alternative to hospital admission, the Norwegian CRTs need to intensify their treatment and meet more patients outside the office.
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Affiliation(s)
- Nina Hasselberg
- Department of Research and Development at the Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
| | - Rolf W Gråwe
- Department of Research and Development at the Alcohol and Drug Treatment Health Trust in Central Norway, Trondheim, Norway,Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sonia Johnson
- Department of Mental Health Sciences, University College London, London, UK
| | - Torleif Ruud
- Department of Research and Development at the Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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