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Lamb D, Milton A, Forsyth R, Lloyd-Evans B, Akther S, Fullarton K, O'Hanlon P, Johnson S, Morant N. Implementation of a crisis resolution team service improvement programme: a qualitative study of the critical ingredients for success. Int J Ment Health Syst 2024; 18:18. [PMID: 38704589 PMCID: PMC11069280 DOI: 10.1186/s13033-024-00638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Crisis Resolution Teams (CRTs) offer home-based care for people in mental health crisis, as an alternative to hospital admission. The success of CRTs in England has been variable. In response to this, the CRT Optimization and RElapse prevention (CORE) study developed and trialled a 12-month Service Improvement Programme (SIP) based on a fidelity model. This paper describes a qualitative evaluation of the perspectives of CRT staff, managers, and programme facilitators. We identify barriers and facilitators to implementation, and mechanisms by which service improvements took place. METHODS Managers and staff from six purposively sampled CRTs were interviewed, as well as six facilitators who were employed to support the implementation of service improvement plans. Semi-structured focus groups and individual interviews were conducted and analysed using thematic analysis. FINDINGS A majority of participants viewed all components of the SIP as helpful in improving practice, although online resources were under-used. Perceived barriers to implementation centred principally around lack of staff time and ownership. Support from both senior staff and facilitators was essential in enabling teams to undertake the work associated with the SIP. All participating stakeholder groups reported that using the fidelity model to benchmark their CRT work to best practice and feel part of a 'bigger whole' was valuable. CONCLUSION CRT staff, managers and programme facilitators thought that a structured service improvement programme helped to increase fidelity to a best practice model. Flexibility (from all stakeholders) was key to enable service improvement actions to be manageable within time- and resource-poor teams.
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Affiliation(s)
- Danielle Lamb
- Department of Applied Health Research, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Alyssa Milton
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Lundahl A. Suicide-preventive compulsory admission is not a proportionate measure - time for clinicians to recognise the associated risks. Monash Bioeth Rev 2024:10.1007/s40592-024-00190-6. [PMID: 38615159 DOI: 10.1007/s40592-024-00190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/15/2024]
Abstract
Suicide is considered a global public health issue and compulsory admission is a commonly used measure to prevent suicide. However, the practice has been criticised since several studies indicate that the measure lacks empirical support and may even increase suicide risk. This paper investigates whether the practice has enough empirical support to be considered proportionate. To that end, arguments supporting compulsory admission as a suicide-preventive measure for most suicidal patients are scrutinized. The ethical point of departure is that the expected benefits of compulsory admission should outweigh the potential harms of the measure to be proportionate and defensible. It is concluded that, for most suicidal patients, suicide-preventive compulsory admission cannot be presumed to be a proportionate measure. To be so, the expected medical benefits of the measure should be greater than the potential increase in suicide risk and other harms that compulsory admission could entail. Instead of using compulsory admission as a suicide-preventive measure, extra safety measures may be needed during and after compulsory admission to prevent the risk of hospitalisation-induced suicide.
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Affiliation(s)
- Antoinette Lundahl
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
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Fleury MJ, Cao Z, Grenier G. Characteristics for Low, High and Very High Emergency Department Use for Mental Health Diagnoses from Health Records and Structured Interviews. West J Emerg Med 2024; 25:144-154. [PMID: 38596910 PMCID: PMC11000562 DOI: 10.5811/westjem.18327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Patients with mental health diagnoses (MHD) are among the most frequent emergency department (ED) users, suggesting the importance of identifying additional factors associated with their ED use frequency. In this study we assessed various patient sociodemographic and clinical characteristics, and service use associated with low ED users (1-3 visits/year), compared to high (4-7) and very high (8+) ED users with MHD. Methods Our study was conducted in four large Quebec (Canada) ED networks. A total of 299 patients with MHD were randomly recruited from these ED in 2021-2022. Structured interviews complemented data from network health records, providing extensive data on participant profiles and their quality of care. We used multivariable multinomial logistic regression to compare low ED use to high and very high ED use. Results Over a 12-month period, 39% of patients were low ED users, 37% high, and 24% very high ED users. Compared with low ED users, those at greater probability for high or very high ED use exhibited more violent/disturbed behaviors or social problems, chronic physical illnesses, and barriers to unmet needs. Patients previously hospitalized 1-2 times had lower risk of high or very high ED use than those not previously hospitalized. Compared with low ED users, high and very high ED users showed higher prevalence of personality disorders and suicidal behaviors, respectively. Women had greater probability of high ED use than men. Patients living in rental housing had greater probability of being very high ED users than those living in private housing. Using at least 5+ primary care services and being recurrent ED users two years prior to the last year of ED use had increased probability of very high ED use. Conclusion Frequency of ED use was associated with complex issues and higher perceived barriers to unmet needs among patients. Very high ED users had more severe recurrent conditions, such as isolation and suicidal behaviors, despite using more primary care services. Results suggested substantial reduction of barriers to care and improvement on both access and continuity of care for these vulnerable patients, integrating crisis resolution and supported housing services. Limited hospitalizations may sometimes be indicated, protecting against ED use.
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Affiliation(s)
- Marie-Josée Fleury
- McGill University, Department of Psychiatry, Montreal, Canada
- Douglas Mental Health University Research Centre, Montreal, Canada
| | - Zhirong Cao
- Douglas Mental Health University Research Centre, Montreal, Canada
| | - Guy Grenier
- Douglas Mental Health University Research Centre, Montreal, Canada
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Wong SY, Teo YN, Wo YJ, Lim CW, Lai YF. Distilling lessons from home hospital implementation: a narrative scoping review. Singapore Med J 2024:00077293-990000000-00093. [PMID: 38363647 DOI: 10.4103/singaporemedj.smj-2020-478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/16/2022] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Multiple Cochrane Reviews have demonstrated 'hospital at home' (HaH) as a promising healthcare model to be explored, with benefits such as higher care quality, reduced readmissions, shorter lengths of stay, lower cost and greater patient satisfaction. While there have been many reviews focusing on the quantitative clinical outcomes of HaH, there is generally a lack of collation of qualitative insights from stakeholders and lessons learnt from past HaH implementation. METHODS We performed a systematic literature search on four databases and included 17 papers involving the provision of acute and/or subacute care by healthcare professionals in patients' homes. Review characteristics and relevant outcomes were extracted from the reported findings and tables in the reviews, and these included stakeholder attitudes and factors contributing to the success of HaH implementation. RESULTS Factors relating to patients and caregivers included home setup, preference for care and death settings, and support for caregiver. Factors involving the healthcare professionals and intervention included a multidisciplinary care team, accessibility to emergency care and support, training of providers and patients, adequate manpower allocation, robust eligibility and referral criteria, sufficient awareness of the HaH referral pathway, communication and medication management. CONCLUSION HaH presents a promising alternative care model, and many of the success factors identified, including the strong push for multidisciplinary single care teams, existing frameworks for data sharing and strong community network, are already present today. As such, Singapore appears to be well positioned to adopt a new care model like HaH.
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Affiliation(s)
- Shi Yin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Neng Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yu Jun Wo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cher Wee Lim
- Office for Healthcare Transformation, Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yi Feng Lai
- Office for Healthcare Transformation, Ministry of Health, Singapore
- School of Public Health, University of Illinois at Chicago, USA
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
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Ruud T, Hasselberg N, Siqveland J, Holgersen KH. Patient-reported outcome, clinician-reported outcome, and patient satisfaction with treatment by crisis resolution teams: a multicenter pre-post study of outcome and associated factors in Norway. BMC Psychiatry 2024; 24:82. [PMID: 38297302 PMCID: PMC10829386 DOI: 10.1186/s12888-024-05543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/20/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Crisis resolution teams (CRTs) have become a part of mental health services in many high-income countries. Many studies have investigated the impact of CRTs on acute admissions to inpatient units, but very few studies have investigated patient-reported and clinician-reported outcomes for CRT service users. Our aims were to study patient-reported and clinician-reported outcomes of CRT treatment, how the outcomes were associated with characteristics of the service user and the treatment, and whether outcomes were different across CRTs. METHODS The study was a pre-post observational multicenter study of 475 patients receiving treatment from 25 CRTs in urban and rural areas in Norway. There was no control group. Outcomes were change in mental health status reported by service users using CORE-10 and by clinicians using HoNOS. Patient satisfaction was measured using CSQ-8 at the end of the treatment. Components of CRT accessibility and interventions were measured by clinicians reporting details on each session with the service user. CRT model fidelity was measured using the CORE CRT Fidelity Scale version 2. We used paired t-tests to analyze outcomes and linear mixed modeling to analyze associations of the outcomes with the characteristics of service users and the treatment provided. Using independent t-tests, we analyzed differences in outcomes and patient satisfaction between two clusters of CRTs with differences in accessibility. RESULTS The patient-reported outcomes and the clinician-reported outcomes were significantly positive and with a large effect size. Both were significantly positively associated with practical support and medication management and negatively associated with collaboration with mental health inpatient units. Patient satisfaction was high at the end of the treatment. CRTs with higher accessibility had a significantly better clinician-reported outcome, but no significant differences were reported for patient-reported outcomes or patient satisfaction. CONCLUSIONS CRT treatment led to improved symptom status as reported by patients and clinicians, as well as high patient satisfaction. Practical support and medication management were the interventions most strongly associated with positive outcomes. Some of the variations in outcomes were at the team level. Patient- and clinician-reported outcomes should be used more in studies on the effect of treatment provided by crisis resolution teams.
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Affiliation(s)
- T Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - N Hasselberg
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - J Siqveland
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- National Center for Suicide Research and Prevention, University of Oslo, Oslo, Norway
| | - K H Holgersen
- Nidelv Community Mental Health Centre, Tiller, Department of Mental Health, St. Olavs Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Neumann A, Schmitt J, Seifert M, Kliemt R, March S, Häckl D, Swart E, Pfennig A, Baum F. Changes in patient care through flexible and integrated treatment programs in German psychiatric hospitals: meta-analyses based on a series of controlled claims-based cohort studies. BMC Psychiatry 2024; 24:74. [PMID: 38279112 PMCID: PMC10811876 DOI: 10.1186/s12888-024-05500-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Global treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals. METHODS We conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient's first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms group (FIT hospital vs. routine care) x time (year before vs. first or second patient year after study inclusion) in the Poisson models. RESULTS The 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals. CONCLUSIONS Global treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions. TRIAL REGISTRATION This study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713).
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Affiliation(s)
- Anne Neumann
- Center of Evidence-Based Health Care (ZEGV), Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Jochen Schmitt
- Center of Evidence-Based Health Care (ZEGV), Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Martin Seifert
- Center of Evidence-Based Health Care (ZEGV), Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Roman Kliemt
- WIG2 Scientific Institute for Health Economics and Health System Research Leipzig, Leipzig, Germany
| | - Stefanie March
- Institute of Social Medicine and Health Services Research, Medical Faculty, Otto-Von-Guericke-University, Magdeburg, Germany
- Department of Social Work, Health and Media, Hochschule Magdeburg-Stendal, Magdeburg, Germany
| | - Dennis Häckl
- WIG2 Scientific Institute for Health Economics and Health System Research Leipzig, Leipzig, Germany
| | - Enno Swart
- Institute of Social Medicine and Health Services Research, Medical Faculty, Otto-Von-Guericke-University, Magdeburg, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Fabian Baum
- Center of Evidence-Based Health Care (ZEGV), Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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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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Rojas-García A, Dalton-Locke C, Sheridan Rains L, Dare C, Ginestet C, Foye U, Kelly K, Landau S, Lynch C, McCrone P, Nairi S, Newbigging K, Nyikavaranda P, Osborn D, Persaud K, Sevdalis N, Stefan M, Stuart R, Simpson A, Johnson S, Lloyd-Evans B. Investigating the association between characteristics of local crisis care systems and service use in an English national survey. BJPsych Open 2023; 9:e209. [PMID: 37920101 PMCID: PMC10753954 DOI: 10.1192/bjo.2023.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND In England, a range of mental health crisis care models and approaches to organising crisis care systems have been implemented, but characteristics associated with their effectiveness are poorly understood. AIMS To (a) develop a typology of catchment area mental health crisis care systems and (b) investigate how crisis care service models and system characteristics relate to psychiatric hospital admissions and detentions. METHOD Crisis systems data were obtained from a 2019 English national survey. Latent class analyses were conducted to identify discernible typologies, and mixed-effects negative binomial regression models were fitted to explore associations between crisis care models and admissions and detention rates, obtained from nationally reported data. RESULTS No clear typology of catchment area crisis care systems emerged. Regression models suggested that provision of a crisis telephone service within the local crisis system was associated with a 11.6% lower admissions rate and 15.3% lower detention rate. Provision of a crisis cafe was associated with a 7.8% lower admission rates. The provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with a 12.8% higher admission rate. CONCLUSIONS The configuration of crisis care systems varies considerably in England, but we could not derive a typology that convincingly categorised crisis care systems. Our results suggest that a crisis phone line and a crisis cafe may be associated with lower admission rates. However, our findings suggest crisis assessment teams, separate from home treatment teams, may not be associated with reductions in admission and detentions.
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Affiliation(s)
- Antonio Rojas-García
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK; and Department of Psychiatry, University of Granada, Spain
| | | | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Ceri Dare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Cedric Ginestet
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Una Foye
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | | | - Sabine Landau
- NIHR Mental Health Policy Research Unit, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Chris Lynch
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Paul McCrone
- NIHR Mental Health Policy Research Unit, Institute for Lifecourse Development, University of Greenwich, UK
| | - Shilpa Nairi
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK; and Department of Primary Care and Public Health, Brighton & Sussex Medical School, University of Sussex, UK
| | - David Osborn
- Department of Psychiatry, University of Granada, Spain; and Camden and Islington NHS Foundation Trust, London, UK
| | - Karen Persaud
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; and NUS Centre for Behavioural & Implementation Science Interventions, Singapore
| | - Martin Stefan
- Mental Health Addictions and Intellectual Disability Directorate, Te Whatu Ora (Southern), Dunedin, New Zealand
| | - Ruth Stuart
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
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Castillo BA, Shterenberg R, Bolton JM, Dewa CS, Pullia K, Hensel JM. Virtual Acute Psychiatric Ward: Evaluation of Outcomes and Cost Savings. Psychiatr Serv 2023; 74:1045-1051. [PMID: 37016824 DOI: 10.1176/appi.ps.20220332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE The COVID-19 pandemic motivated rapid expansion of virtual care. In Winnipeg, Canada, the authors launched a virtual psychiatric acute care ward (vWARD) to divert patients from hospitalization through daily remote treatment by a psychiatry team using telephone or videoconferencing. This study examined vWARD patient characteristics, predictors of transfer to a hospital, use of acute care postdischarge, and costs of the vWARD compared with in-person hospitalization. METHODS Data for all vWARD admissions from March 23, 2020, to April 30, 2021, were retrieved from program documents and electronic records. Emergency department visits and hospitalizations in the 6 months before admission and the 30 days after discharge were documented. Logistic regression identified factors associated with transfer to a hospital. Thirty-day acute care use after discharge was modeled with Kaplan-Meier curves. A break-even cost analysis was generated with data for usual hospital-based care. RESULTS The 132 vWARD admissions represented a diverse demographic and clinical population. Overall, 57% involved suicidal behavior, and 29% involved psychosis or mania. Seventeen admissions (13%) were transferred to a hospital. Only presence of psychosis or mania significantly predicted transfer (OR=34.2, 95% CI=3.3-354.6). Eight individuals were hospitalized in the 30 days postdischarge (cumulative survival=0.93). vWARD costs were lower than usual care across several scenarios. CONCLUSIONS A virtual ward is a feasible, effective, and potentially cost-saving intervention to manage acute psychiatric crises in the community and avoid hospitalization. It has benefits for both the health system and the individual who prefers to receive care at home.
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Affiliation(s)
- Bon A Castillo
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Ravit Shterenberg
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Carolyn S Dewa
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Katrina Pullia
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Jennifer M Hensel
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
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10
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Moreno-Alonso I, Nieves-Carnicer M, Noguero-Alegre A, Alvarez-Mon MA, Rodriguez-Quiroga A, Dorado JF, Mora F, Quintero J. Patient satisfaction and outcomes of crisis resolution home treatment for the management of acute psychiatric crises: a study during the COVID-19 pandemic in Madrid. Front Psychiatry 2023; 14:1197833. [PMID: 37732079 PMCID: PMC10507704 DOI: 10.3389/fpsyt.2023.1197833] [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: 03/31/2023] [Accepted: 07/27/2023] [Indexed: 09/22/2023] Open
Abstract
Background Crisis Resolution Home Treatment (CRHT) seem to offer comparable results to the traditional hospitalization model, at a lower cost and offering greater flexibility and scope. However, in Madrid, its implementation in Mental Health did not occur until the midst of the COVID-19 pandemic. In this work we analysed the effectiveness of a mental health CRHT unit promoted during the COVID-19 pandemic, as well as the degree of satisfaction of patients and their families. Methods 90 patients were treated by the CRHT unit in the period between October 2020 and June 2022. All patients met the inclusion criteria: (1) Acute psychopathological decompensation in patients suffering from psychotic disorders, major affective disorder, obsessive compulsive disorder, personality disorder and other severe mental disorders causing functional disability, according to ICD-10 diagnostic criteria; (2) Ages between 18-90 years old; (3) Living in the urban area of Vallecas, Madrid; and (4) Counting with sufficient social and family support. The effectiveness of the intervention was evaluated with the SF-36 health questionnaire, the caregiver burden with the Zarit questionnaire, and patient satisfaction with a survey specifically designed for this work. Results 55 (61.1%) patients completed the SF-36 at baseline and at the end of hospitalization. Statistically significant improvements were observed in the 8 dimensions of the SF-36 (p < 0.05). However, CRHT did not achieve a statistically significant decrease in caregiver burden. Regarding the satisfaction of the patients with the attention and care received, an average score of 47.72/50 was obtained. Conclusion The Crisis Resolution Home Treatment intervention resulted in significant improvement in patients' quality of life with high satisfaction scores. However, it did not effectively reduce caregiver burden. Future research should focus on randomized controlled trials with long-term follow-up to assess the effectiveness of CRHT compared to traditional hospitalization and utilize specific assessment scales for different mental disorders.
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Affiliation(s)
- Irene Moreno-Alonso
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Manuel Nieves-Carnicer
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Alexandra Noguero-Alegre
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Miguel Angel Alvarez-Mon
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Medicine and Medical Specialities, University of Alcala, Alcala de Henares, Madrid, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Alberto Rodriguez-Quiroga
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- PeRTICA Análisis Estadísticos, Madrid, Spain
| | - Juan F. Dorado
- Department of Legal and Psychiatry, Complutense University, Madrid, Spain
| | - Fernando Mora
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- PeRTICA Análisis Estadísticos, Madrid, Spain
| | - Javier Quintero
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- PeRTICA Análisis Estadísticos, Madrid, Spain
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11
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Adam N, Neumann M, Edelhäuser F. Patient satisfaction in inpatient psychiatric treatment compared with inpatient equivalent home treatment in Germany: an in-depth qualitative study. FRONTIERS IN HEALTH SERVICES 2023; 3:1195614. [PMID: 37457238 PMCID: PMC10344693 DOI: 10.3389/frhs.2023.1195614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
Background Inpatient treatment (IT) is the predominant form of psychiatric care in Germany and worldwide, whereby forms of psychiatric treatment have mainly evolved in the direction of home services. Inpatient equivalent home treatment (IEHT) is a new and additional pillar of psychiatric acute care provision legally embedded since 2018 in Germany. Objective The aim of this study was to conduct an in-depth exploration as little qualitative research has been performed so far in Germany to examine possible differences in patient satisfaction with IT compared with IEHT. Methods In the current qualitative study, N = 9 patients of a German hospital providing IT and IEHT were interviewed with the problem-centered interview. Inclusion criteria were IT or IT with subsequent IEHT. The theoretical sampling method was applied to select test persons in the research process. The experiences of the participants during their psychiatric treatment were analyzed using a qualitative content analysis. Results The results of both types of psychiatric treatment refer to different satisfaction factors during the treatment period. The function of fellow patients, the setting of the treatment, the conditions in place, and the relationship to relatives turn out to be pivotal for patient satisfaction. In addition, the quality of the therapy and relationship to caregivers itself can have an impact on patient satisfaction, particularly by shared decision making. During the IEHT, patient satisfaction can be strengthened by the possibility to handle daily tasks, to be close to relatives, while not so close to fellow patients, whereas IT patients are mostly satisfied because of the distance to their everyday life and the closeness to fellow patients. The choice of the form of psychiatric treatment according to the individual needs of the patients seems to be one key driver that can in turn increase patient satisfaction. In addition, a clean and hygienic environment seems to be critical for our respondents as a lack of it is one of the reasons to drop out of treatment. Conclusions Despite its limitations, this hypothesis-generating study is one of the first investigating German IEHT in comparison with IT in an in-depth qualitative approach contributing to a patient-oriented and cost-effective psychiatric treatment. Although hospitals are highly complex organizations and therefore not directly comparable, other German and international providers of IEHT may derive several generic success factors from this study for the development and improvement of patient satisfaction.
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Affiliation(s)
- Nele Adam
- Faculty of Health, Department of Psychology/Psychotherapy, University of Witten/Herdecke, Witten, Germany
| | - Melanie Neumann
- Faculty of Health, Department of Medicine, Institute of Integrative Medicine and Integrated Curriculum for Anthroposophic Medicine (ICURAM), University of Witten/Herdecke, Witten, Germany
- Faculty of Health, Department of Medicine, Chair on Psychosomatic Medicine and Psychotherapy, University of Witten/Herdecke, Witten, Germany
| | - Friedrich Edelhäuser
- Faculty of Health, Department of Medicine, Institute of Integrative Medicine and Integrated Curriculum for Anthroposophic Medicine (ICURAM), University of Witten/Herdecke, Witten, Germany
- Gemeinschaftskrankenhaus, Department of Early Rehabilitation, Herdecke, Germany
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12
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Le Novere M, Johnson S, Lloyd-Evans B, Marston L, Ambler G, Clarke CS, Osborn D, Lamb D, Hunter RM. Cost-effectiveness of peer-supported self-management for people discharged from a mental health crisis team: methodological challenges and recommendations. Front Psychiatry 2023; 14:1031159. [PMID: 37333912 PMCID: PMC10272352 DOI: 10.3389/fpsyt.2023.1031159] [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: 08/29/2022] [Accepted: 04/27/2023] [Indexed: 06/20/2023] Open
Abstract
Background Mental health acute crisis episodes are associated with high inpatient costs. Self-management interventions may reduce readmission by enabling individuals to manage their condition. Delivery of such interventions by Peer Support Workers (PSWs) may be cost-effective. CORE, a randomized control trial of a PSW self-management intervention compared to usual care, found a significant reduction in admissions to acute mental healthcare for participants receiving the intervention. This paper aims to evaluate the cost-effectiveness of the intervention over 12 months from a mental health service perspective. Analysis methods of increasing complexity were used to account for data missingness and distribution. Methods Participants were recruited from six crisis resolution teams in England from 12 March 2014 to 3 July 2015 (trial registration ISRCTN: 01027104). Resource use was collected from patient records at baseline and 12 months. The EQ-5D-3L was collected at baseline and 4 and 18 months, and linear interpolation was used to calculate 12-month values for quality-adjusted life-years (QALYs). The primary analysis of adjusted mean incremental costs and QALYs for complete cases are calculated separately using OLS regression. Secondly, a complete-case non-parametric two-stage bootstrap (TSB) was performed. The impacts of missing data and skewed cost data were explored using multiple imputation using chained equations and general linear models, respectively. Results Four hundred and forty-one participants were recruited to CORE; 221 randomized to the PSW intervention and 220 to usual care plus workbook. The probability that the PSW intervention was cost-effective compared with the workbook plus usual care control at 12 months varied with the method used, and ranged from 57% to 96% at a cost-effectiveness threshold of £20,000 per QALY gained. Discussion There was a minimum 57% chance that the intervention was cost-effective compared to the control using 12-month costs and QALYs. The probability varied by 40% when methods were employed to account for the relationship between costs and QALYs, but which restricted the sample to those who provided both complete cost and utility data. Caution should therefore be applied when selecting methods for the evaluation of healthcare interventions that aim to increase precision but may introduce bias if missing data are heavily unbalanced between costs and outcomes.
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Affiliation(s)
- Marie Le Novere
- Research Department of Primary Care and Population Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Sonia Johnson
- Divison of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Brynmor Lloyd-Evans
- Divison of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Louise Marston
- Research Department of Primary Care and Population Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Gareth Ambler
- Department of Statistical Science, Faculty of Mathematical & Physical Sciences, University College London, London, United Kingdom
| | - Caroline S. Clarke
- Research Department of Primary Care and Population Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - David Osborn
- Divison of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Danielle Lamb
- Department of Applied Health Research, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Rachael Maree Hunter
- Department of Applied Health Research, Faculty of Population Health Sciences, University College London, London, United Kingdom
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13
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Kadra-Scalzo G, Kornblum D, Stewart R, Howard LM. Adverse outcomes associated with recorded victimization in mental health electronic records during the first UK COVID-19 lockdown. Soc Psychiatry Psychiatr Epidemiol 2023; 58:431-440. [PMID: 36434299 PMCID: PMC9702612 DOI: 10.1007/s00127-022-02393-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The impact of COVID-19 pandemic policies on vulnerable groups such as people with mental health problems who experience violence remains unknown. This study aimed to investigate the prevalence of victimization recorded in mental healthcare records during the first UK lockdown, and associations with subsequent adverse outcomes. METHODS Using a large mental healthcare database, we identified all adult patients receiving services between 16.12.2019 and 15.06.2020 and extracted records of victimisation between 16.03.2020 and 15.06.2020 (first UK COVID-19 lockdown). We investigated adverse outcomes including acute care, emergency department referrals and all-cause mortality in the year following the lockdown (16.06.2020- 01.11.2021). Multivariable Cox regressions models were constructed, adjusting for socio-demographic, socioeconomic, clinical, and service use factors. RESULTS Of 21,037 adults receiving mental healthcare over the observation period, 3,610 (17.2%) had victimisation mentioned between 16.03.2020 and 15.06.2020 (first UK COVID-19 lockdown). Service users with mentions of victimisation in their records had an elevated risk for all outcomes: acute care (adjusted HR: 2.1; 95%CI 1.9-2.3, p < 0.001), emergency department referrals (aHR: 2.0; 95%CI 1.8-2.2; p < 0.001), and all-cause mortality (aHR: 1.5; 95%CI 1.1-1.9; p = 0.003), when compared to service users with no recorded victimisation. We did not observe a statistically significant interaction with gender; however, after adjusting for possible confounders, men had slightly higher hazard ratios for all-cause mortality and emergency department referrals than women. CONCLUSION Patients with documented victimisation during the first UK lockdown were at increased risk for acute care, emergency department referrals and all-cause mortality. Further research is needed into mediating mechanisms.
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Affiliation(s)
- Giouliana Kadra-Scalzo
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, BRC Nucleus, IOPPN, Mapother House, De Crespigny Park, London, UK.
| | - Daisy Kornblum
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, BRC Nucleus, IOPPN, Mapother House, De Crespigny Park, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, BRC Nucleus, IOPPN, Mapother House, De Crespigny Park, London, UK
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14
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Atmore KH, Taylor BL, Potts LC, Trevillion K, Howard LM. Caregiving and mental health needs in the significant others of women receiving inpatient and home treatment for acute severe postpartum mental illness. Arch Womens Ment Health 2023; 26:49-56. [PMID: 36565312 PMCID: PMC9908709 DOI: 10.1007/s00737-022-01286-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/09/2022] [Indexed: 01/01/2023]
Abstract
To examine the mental health and caregiving needs of significant others (including partners, parents, friends) to women who received acute psychiatric care either as inpatients or at home during the perinatal period. Cross-sectional survey of 98 significant others of 279 women who participated in a quasi-experimental cohort study of services for mothers with acute severe postpartum mental health diagnoses. Significant others completed an adapted General Health Questionnaire-12 (GHQ) and Involvement Evaluation Questionnaire (IEQ) to indicate their mental health needs and service use as well as caregiving activities. The mean age of significant others was 38.9 years (range 24-69). 81.6% were male and 81.6% were intimate partners to the women. High levels of unmet mental health needs were detected in significant others, with a majority (51.0%) having a score > 2 on the GHQ-12 indicating caseness for a psychiatric disorder. In those with GHQ-12 caseness indicated, few were receiving help for their difficulties: 22.5% received support from their general practitioner, and 14.3% received help from a social worker, psychologist, psychiatrist or outpatient department. 18.4% received medication for GHQ-12 symptoms. The median sumscore of IEQ surveying caregiving activities in significant others was 18/108. We did not find evidence of differences in GHQ-12 or IEQ scores for significant others to women who received inpatient care versus care at home. Significant others to women with acute severe postpartum psychiatric illness have high levels of unmet mental health needs during the weeks after women are discharged from acute care. Services need to address these needs to optimise outcomes for the whole family.
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Affiliation(s)
- Katie H. Atmore
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Billie Lever Taylor
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Laura C. Potts
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kylee Trevillion
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Louise M. Howard
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
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Jones R, Jackson D, Woods C, Usher K. Social issues, crisis, and care coordination: First responders experience responding to people affected by methamphetamines. Int J Ment Health Nurs 2023; 32:755-766. [PMID: 36695412 DOI: 10.1111/inm.13119] [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] [Received: 03/08/2022] [Revised: 11/21/2022] [Accepted: 12/30/2022] [Indexed: 01/26/2023]
Abstract
Methamphetamines remain a public health problem due to the extensive burden of illicit drug use on society. Callout events in the pre-hospital environment related to methamphetamine use is increasing. In addition, there has been an increase in reported mental health side effects and breakdown in relationships and social networks. Descriptive phenomenology research design was undertaken and data analysed using thematic analysis. Semi-structured interviews were utilized to collect data exploring the experience of first responders attending callouts to people affected by methamphetamines in the pre-hospital environment. Interviews included paramedics (8) and police officers (10) from across Australia. Overall, participants reported responding to people affected by methamphetamines was complex in nature. Complexity was affected by extensive social circumstances, people presenting in states of crisis, lack of coordinated approach, and unsuitable care environments. The social impact of methamphetamine addiction is extensive. Staff working as first responders have an opportunity to help reduce the social impact and crises, referring people to follow-up care and drug and alcohol support services. Further research is needed to determine if a standardized approach, between first responders and EDs, should be developed to help streamlines services and improve how the individual services respond as a group to people affected by substances.
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Affiliation(s)
- Rikki Jones
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Debra Jackson
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Cindy Woods
- University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Kim Usher
- School of Health, University of New England, Armidale, New South Wales, Australia
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16
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Lotmore M, Ziedonis D, Alvarez Monjaras M, Hopfenbeck M, Razzaque R, Wilson E, Pilling S. Development and refinement of the open dialog adherence protocol in complex mental health care. Front Psychol 2023; 13:1041375. [PMID: 36687823 PMCID: PMC9853976 DOI: 10.3389/fpsyg.2022.1041375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Open dialog (OD) is a both a therapeutic practice and a service delivery model that offers an integrated response to mental health care through mobilizing resources within the service user's family and community networks through joint network meetings. Therapist adherence is a crucial to the effective delivery of interventions. A key way to measure this is through structured observation tools. Aims The aim of this research project is to develop and refine the Dialogic Practice Adherence Scale, for use in OD research trials in the United Kingdom. Methods This study was a mixed methods approach to the development of an OD practitioner adherence measure. Initial steps involved meetings and discussions with experts and a review of the literature. Content validation studies were completed using a modified Delphi technique. To assess reliability of the measure, OD network meetings were audio-recorded, and tapes were rated by two independent researchers. Inter-rater reliability and internal consistency were assessed through quantitative approaches assessing variance. Results Results provide a description of how the OD Adherence Manual was developed in collaboration. Validation surveys showed high levels on consensus among experts in the field on the key elements of OD network meetings. Inter-rater reliability for the total score was excellent and internal consistency analyses suggest the scale is highly reliable. Discussion The scale presented here is an initial attempt at rating practitioner adherence in OD network meetings. It provides encouraging evidence that this can be done with strong validity and reliability and can be completed by a range of raters with varying levels of clinical experience.
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Affiliation(s)
- Melissa Lotmore
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom,*Correspondence: Melissa Lotmore,
| | - Douglas Ziedonis
- Department of Health Sciences, The University of New Mexico, Albuquerque, NM, United States
| | - Mauricio Alvarez Monjaras
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Mark Hopfenbeck
- Department of Health Sciences, Norwegian University of Science and Technology, Trondheim, Sør-Trøndelag, Norway
| | | | - Emily Wilson
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Stephen Pilling
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom,Camden and Islington NHS Foundation Trust, London, United Kingdom
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17
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Reinhardt I, Heinz J, Zielasek J, Engemann S, Gouzoulis-Mayfrank E. [Person-Centered Psychosocial Complex Care for People with Severe Mental Illness: Implementation and Evaluation of a Cross-Sectoral Care Model at a Psychiatric Hospital]. PSYCHIATRISCHE PRAXIS 2023; 50:10-19. [PMID: 35081631 DOI: 10.1055/a-1706-0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM OF THE STUDY Implementation and evaluation of a cross-sectoral complex care model for persons with severe mental illness (SMI). METHODS The care model was implemented at a psychiatric-psychotherapeutic specialized clinic. Within this patient-centered and needs-oriented complex care model, intensive case management was applied to transition persons with SMI between inpatient and outpatient mental health care. Evaluation was conducted using a matched control group design (n = 46/21). RESULTS According to clinical assessment, two thirds of the patients benefited from the care model. In the course of treatment, the patients showed a significant reduction in the use of inpatient psychiatric care structures and an improvement in clinical symptoms. CONCLUSION For people with SMI, there is a care gap in the in the transition from inpatient to outpatient care, which could be partially closed.
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Affiliation(s)
- Isabelle Reinhardt
- LVR-Institut für Forschung und Bildung, LVR-Institut für Versorgungsforschung
| | - Josephine Heinz
- LVR-Institut für Forschung und Bildung, LVR-Institut für Versorgungsforschung
| | - Jürgen Zielasek
- LVR-Institut für Forschung und Bildung, LVR-Institut für Versorgungsforschung
| | - Sandra Engemann
- LVR-Institut für Forschung und Bildung, LVR-Institut für Versorgungsforschung
| | - Euphrosyne Gouzoulis-Mayfrank
- LVR-Institut für Forschung und Bildung, LVR-Institut für Versorgungsforschung.,LVR-Klinik Köln, Akademisches Lehrkrankenhaus der Universität zu Köln
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18
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Alvarez-Monjaras M, Lotmore M, Razzaque R, Hopfenbeck MS, Pilling S. The community mental health team fidelity scale: A measure of program fidelity of social networks interventions for severe mental illness. Front Psychol 2023; 14:1076791. [PMID: 36910782 PMCID: PMC9992884 DOI: 10.3389/fpsyg.2023.1076791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023] Open
Abstract
Open dialogue (OD) is a multi-component therapeutic and organizational intervention for crisis and continuing community mental health care with a therapeutic focus on clients' social networks. The development and implementation of this model of care in the United Kingdom requires considerable contextual adaptations which need to be assessed to support effective implementation. Program fidelity-the extent to which core components of an intervention are delivered as intended by an intervention protocol at all levels-is crucial for these adaptations. Aims To develop, pilot, and implement a program fidelity measure for community mental health services providing OD and 'treatment as usual' (TAU) or standard NHS crisis and community care. Methods Measure structure, content, and scoring were developed and refined through an iterative process of discussion between the research team and OD experts. Measure was piloted in the 6 OD and 6 TAU services participating in a large-scale research program. Results Initial data suggests that the Community Mental Health Team Fidelity Scale (COM-FIDE) is a potentially reliable and feasible measure of the fidelity of community mental health services and specific OD components of such services.
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Affiliation(s)
- Mauricio Alvarez-Monjaras
- Department of Clinical Educational and Health Psychology, University College London, London, United Kingdom
| | - Melissa Lotmore
- Department of Clinical Educational and Health Psychology, University College London, London, United Kingdom
| | | | - Mark Steven Hopfenbeck
- Department of Health Sciences, Norwegian University of Science and Technology, Trondheim, Sør-Trøndelag, Norway
| | - Stephen Pilling
- Department of Clinical Educational and Health Psychology, University College London, London, United Kingdom
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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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Abstract
In this paper, we examine a number of approaches that propose new models for psychiatric theory and practices: in the way that they incorporate 'social' dimensions, in the way they involve 'communities' in treatment, in the ways that they engage mental health service users, and in the ways that they try to shift the power relations within the psychiatric encounter. We examine the extent to which 'alternatives' - including 'Postpsychiatry', 'Open Dialogue', the 'Power, Threat and Meaning Framework' and Service User Involvement in Research - really do depart from mainstream models in terms of theory, practice and empirical research and identify some shortcomings in each. We propose an approach which seeks more firmly to ground mental distress within the lifeworld of those who experience it, with a particular focus on the biopsychosocial niches within which we make our lives, and the impact of systematic disadvantage, structural violence and other toxic exposures within the spaces and places that constitute and constrain many everyday lives. Further, we argue that a truly alternative psychiatry requires psychiatric professionals to go beyond simply listening to the voices of service users: to overcome epistemic injustice requires professionals to recognise that those who have experience of mental health services have their own expertise in accounting for their distress and in evaluating alternative forms of treatment. Finally we suggest that, if 'another psychiatry' is possible, this requires a radical reimagination of the role and responsibilities of the medically trained psychiatrist within and outside the clinical encounter.
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Affiliation(s)
- Diana Rose
- Australian National University, Canberra, Australia
| | - Nikolas Rose
- Australian National University, Canberra, Australia
- Institute of Advanced Studies, University College London, London, UK
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21
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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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Lee K, Bolton SL, Shterenberg R, Bolton JM, Hensel JM. Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study. JMIR Form Res 2022; 6:e39861. [PMID: 36252139 PMCID: PMC9640197 DOI: 10.2196/39861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/26/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic was accompanied by the accelerated uptake of virtual care, leading to a proliferation of virtual ward models as alternatives to facility-based care. Early in the pandemic, our program implemented a virtual mental health crisis ward (vWard) to provide options for individuals requiring intense psychiatric and/or crisis support but who preferred to remain in the community and were deemed safe to do so. Objective The aim of this study was to identify early learnings from the vWard, which was implemented rapidly in a resource-constrained environment, to inform the future state should it be sustained beyond the pandemic. Methods Mixed methods of data collection were used to evaluate provider perspectives on the vWard, develop archetypes for individuals who are a good fit for the vWard model, and create a driver diagram. Data sources included an anonymous survey of clinical and managerial staff involved in the vWard, a service planning workshop, and program discharge forms for all individuals admitted between March 2020 and April 2021. Survey responses were coded for themes under categories of “benefits” and “challenges.” Discharge forms where the team indicated that the vWard was a good fit for an individual were examined for characteristics common to these admissions. These findings were reviewed in the service planning workshop and refined with input from the participants into patient archetypes. A driver diagram was created for the future state. Results Survey respondents (N=60) represented diverse roles in crisis services and the vWard team. Ten providers took part in the service planning workshop. A total of 467 discharge forms were reviewed. The vWard was felt to be a model that worked by 39 survey respondents, one respondent felt it did not work, and the remaining participants had no response. Several benefits for the individual and the system were identified alongside challenges, including certain processes and materials related to the nature of rapid implementation during the pandemic, and others due to lack of fit for certain individuals. The model was felt to be a good fit for 67.5% of admissions. Four patient archetypes representing a good fit with the model were developed. The driver diagram connected the program aim with primary drivers of (1) reduce barriers to care; (2) improve outcomes; and (3) provide collaborative, patient- and family-centered care to secondary drivers and interventions that leveraged virtual technology among other crisis care interventions. Conclusions Despite some challenges, the vWard demonstrated high levels of provider acceptance and a range of mechanisms by which the model works for a variety of patient archetypes. These early learnings provide a foundation for growth, sustainability, and spread of this model going forward beyond the pandemic.
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Affiliation(s)
- Katherine Lee
- Max Rady School of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Shay-Lee Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Ravit Shterenberg
- Max Rady School of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
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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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Martin-Iñigo L, Ortiz S, Urbano D, Teba Pérez S, Contaldo SF, Alvarós J, Baladon L, Parody-Rúa E, Rubio-Valera M. Assessment of the efficacy of a Crisis Intervention Team (CIT): experience in the Esplugues Mental Health Center (Barcelona). Soc Psychiatry Psychiatr Epidemiol 2022; 57:2109-2117. [PMID: 35246708 DOI: 10.1007/s00127-022-02250-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
AIM Crisis Resolution Teams (CRT) have shown positive clinical and service-use results in various countries but evidence in the south of Europe is scarce. The aim is to assess the impact of the Crisis Intervention Team (CIT) in Spain with respect to the course of symptomatology and mental health services use in patients served. METHODS Prospective observational cohort study. Assessment of the psychopathological severity (HoNOS scale) of the clinical course (CGI scale) and use of medical services. RESULTS A positive clinical course was observed following the intervention. The mean difference in HoNOS (Health of the Nation Outcome Scales) scores between baseline and discharge was 7 points (p < 0.05). On discharge, more than 60% of patients had improved their symptomatology according to the CGI scale (Clinical Global Impression) and most were discharged due to improvement or goal achievement. A tendency to reduction in the number of admissions to acute units and day hospital was observed, along with fewer emergency room visits. In contrast, an increase in the number of admissions to subacute units was seen. During the intervention, the median number of visits to the center was 15 and the median duration of care provision by the CIT was 39 days. CONCLUSIONS The CIT intervention promotes patients' clinical improvement and has a positive impact in terms of reducing acute hospitalizations and emergency room visits.
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Affiliation(s)
- Laia Martin-Iñigo
- Parc Sanitari Sant Joan de Déu (Esplugues MHC), Esplugues de Llobregat, Spain
| | - Sonia Ortiz
- Parc Sanitari Sant Joan de Déu (Esplugues MHC), Esplugues de Llobregat, Spain
| | - David Urbano
- Parc Sanitari Sant Joan de Déu (Cerdanyola MHC), Ripollet, Cerdanyola del Vallès, Spain
| | - Silvia Teba Pérez
- Parc Sanitari Sant Joan de Déu (Esplugues MHC), Esplugues de Llobregat, Spain
| | | | - Joan Alvarós
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Luisa Baladon
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Maria Rubio-Valera
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain. .,Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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25
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Reinke B, Mahlke C, Botros C, Kläring A, Lambert M, Karow A, Gallinat J, Zapf A, Ozga AK, Höller A, Bustami N, Reimer J, Lüdtke J, Schaper O, Lison M, Bechdolf A, Baumgardt J, Spiegel J, Hardt O, Rout S, Memarzadeh S, von Peter S, Schwarz J, Langer C, Glotz S, Frasch K, Rüsch N, Künstler U, Bock T, Becker T. Study protocol of a randomized controlled trial evaluating home treatment with peer support for acute mental health crises (HoPe). BMC Psychiatry 2022; 22:619. [PMID: 36123649 PMCID: PMC9483879 DOI: 10.1186/s12888-022-04247-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Home treatment (HT) is a treatment modality for patients with severe mental illness (SMI) in acute mental crises. It is frequently considered equivalent to psychiatric inpatient treatment in terms of treatment outcome. Peer Support (PS) means that people with lived experience of a mental illness are trained to support others on their way towards recovery. While PS is growing in international importance and despite a growing number of studies supporting its benefits, it is still not comprehensively implemented into routine care. The HoPe (Home Treatment with Peer Support) study investigates a combination of both - HT and PS - to provide further evidence for a recovery-oriented treatment of psychiatric patients. METHODS In our randomized controlled trial (RCT), HT with PS is compared with HT without PS within a network of eight psychiatric clinical centers from the North, South and East of Germany. We investigate the effects of a combination of both approaches with respect to the prevention of relapse/recurrence defined as first hospitalization after randomization (primary outcome), disease severity, general functioning, self-efficacy, psychosocial health, stigma resistance, recovery support, and service satisfaction (secondary outcomes). A sample of 286 patients will be assessed at baseline after admission to HT care (data point t0) and randomized into the intervention (HT + PS) and control arm (HT). Follow-Up assessments will be conducted 2, 6 and 12 months after admission (resulting in three further data points, t1 to t3) and will be analyzed via intention-to-treat approach. DISCUSSION This study may determine the positive effects of PS added to HT, prove additional evidence for the efficacy of PS and thereby facilitate its further implementation into psychiatric settings. The aim is to improve quality of mental health care and patients' recovery as well as to reduce the risk of relapses and hospitalizations for patients with SMI. TRIAL REGISTRATION The trial is registered with ClinicalTrials.gov: NCT04336527 , April 7, 2020.
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Affiliation(s)
- Britta Reinke
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christina Botros
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexa Kläring
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- grid.13648.380000 0001 2180 3484Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- grid.13648.380000 0001 2180 3484Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Höller
- grid.13648.380000 0001 2180 3484Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadia Bustami
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital Lüneburg, Lüneburg, Germany
| | - Jens Reimer
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Jenny Lüdtke
- Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Oliver Schaper
- Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Martin Lison
- Department of Psychiatry and Psychotherapy, Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
| | - Andreas Bechdolf
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban Und Vivantes Hospital Im Friedrichshain, Charité – Universitätsmedizin Berlin, Berlin, Germany ,grid.415085.dDepartment of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Friedrichshain Hospital, Berlin, Germany ,grid.411097.a0000 0000 8852 305XDepartment of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Johanna Baumgardt
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban Und Vivantes Hospital Im Friedrichshain, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jennifer Spiegel
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban Und Vivantes Hospital Im Friedrichshain, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Olaf Hardt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Neukölln Hospital, Berlin, Germany
| | - Sandeep Rout
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Neukölln Hospital, Berlin, Germany
| | - Sonja Memarzadeh
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Neukölln Hospital, Berlin, Germany
| | - Sebastian von Peter
- grid.473452.3Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Julian Schwarz
- grid.473452.3Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Claudia Langer
- grid.473452.3Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Sabine Glotz
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany
| | - Karel Frasch
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany ,Donauwörth Regional Hospital, Donauwörth, Germany
| | - Nicolas Rüsch
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany
| | - Ulf Künstler
- Department of Psychiatry and Psychotherapy, Asklepios Western Hospital Hamburg, Rissen, Germany
| | - Thomas Bock
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Becker
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, Ulm University, Günzburg Regional Hospital, Günzburg, Germany
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Baum F, Schmitt J, Seifert M, Kliemt R, Kubat D, March S, Häckl D, Pfennig A, Swart E, Neumann A. Lengths of inpatient stay and sick leave of patients with mental diseases: disorder-specific effects of flexible and integrated treatment programs in Germany. Transl Psychiatry 2022; 12:370. [PMID: 36071050 PMCID: PMC9452681 DOI: 10.1038/s41398-022-02131-5] [Citation(s) in RCA: 2] [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: 11/23/2021] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
Mental disorders pose a worldwide growing public health burden. One of the major challenges for healthcare systems remains to respond to the need of patients with mental disorders for continuous and flexible treatment. The EVA64 study evaluates novel programs of flexible and integrative treatment (FIT) in hospitals. This manuscript presents results from the evaluation of FIT hospitals in comparison to hospitals from regular routine care. In addition to data from adult patients, we also present data from affiliated child and adolescent psychiatric wards employing FIT programs. Using comprehensive claims data, primary outcomes are the utilization of inpatient care and sick leave for a priori defined clusters of mental disorders. We stratify between patients already under treatment (ongoing treatment) and patients with incident treatment cases (initial treatment) at the point of inclusion in the study. In the initial treatment group, we found a significant reduction in the length of inpatient stay of 4.1 days in FIT hospitals compared to routine care. While patients with mood affective disorders (-1.8 days) and patients with neurotic, stress-related, and somatoform disorders (-3.6 days) showed an even stronger effect of the reduction of inpatient lengths of stay, the effect was significantly weaker in patients with mental and behavioral disorders due to use of alcohol (+3.3 days). Regarding the duration of sick leave, we found no significant treatment effect of FIT programs compared to routine care. In the ongoing treatment group of adult patients, we found a significantly lower utilization of inpatient treatment by 1.3 days as well as a shorter duration of sick leave by 4.3 days in FIT hospitals compared to routine care. In the cohort of children and adolescent patients, we also did not observe a significant treatment effect in either the initial treatment group or the ongoing treatment group. Registration: this study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713).
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Affiliation(s)
- Fabian Baum
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Jochen Schmitt
- grid.4488.00000 0001 2111 7257Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Seifert
- grid.4488.00000 0001 2111 7257Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Roman Kliemt
- WIG2 Scientific Institute for Health Economics and Health System Research Leipzig, Leipzig, Germany
| | - Denise Kubat
- grid.5807.a0000 0001 1018 4307Institute of Social Medicine and and Health Systems Research, Medical Faculty, Otto-von-Guericke- University Magdeburg, Magdeburg, Germany
| | - Stefanie March
- grid.5807.a0000 0001 1018 4307Institute of Social Medicine and and Health Systems Research, Medical Faculty, Otto-von-Guericke- University Magdeburg, Magdeburg, Germany ,grid.440962.d0000 0001 2218 3870Hochschule Magdeburg-Stendal, Department of Social Work, Health and Media, Magdeburg, Germany
| | - Dennis Häckl
- WIG2 Scientific Institute for Health Economics and Health System Research Leipzig, Leipzig, Germany ,grid.9647.c0000 0004 7669 9786Health Economics and Management, Faculty of Economics and Management Science, Leipzig University, Leipzig, Germany
| | - Andrea Pfennig
- grid.4488.00000 0001 2111 7257Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Enno Swart
- grid.5807.a0000 0001 1018 4307Institute of Social Medicine and and Health Systems Research, Medical Faculty, Otto-von-Guericke- University Magdeburg, Magdeburg, Germany
| | - Anne Neumann
- grid.4488.00000 0001 2111 7257Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Cornelis J, Barakat A, Blankers M, Peen J, Lommerse N, Eikelenboom M, Zoeteman J, Van H, Beekman ATF, Dekker J. The effectiveness of intensive home treatment as a substitute for hospital admission in acute psychiatric crisis resolution in the Netherlands: a two-centre Zelen double-consent randomised controlled trial. Lancet Psychiatry 2022; 9:625-635. [PMID: 35779532 DOI: 10.1016/s2215-0366(22)00187-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/24/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although de-institutionalisation has been underway for decades, admission to hospital followed by low-intensity outpatient care remains the usual treatment for patients with an acute psychiatric crisis. Intensive home treatment has been developed for patients in a severe psychiatric crisis as an alternative to inpatient care. This study aimed to evaluate the potential of intensive home treatment to reduce bed-days and its clinical effectiveness compared with treatment as usual. METHODS We did a two-armed, two-centre, open-label, Zelen, double-consent, pragmatic randomised controlled trial. Patients aged 18-65 years were recruited at the psychiatric emergency service and psychiatric emergency wards of the two major mental health institutions (Arkin and GGZ inGeest) in Amsterdam, the Netherlands. Patients diagnosed with at least one DSM-IV-TR or DSM-5 disorder and in a psychiatric crisis and for whom psychiatrists had indicated or completed a clinical admission could be included. Trained psychiatric emergency service and hospital professionals did the automated web-based pre-randomisation procedure upon first contact with the patient. A seeded pseudo-random number generator allocated patients (2:1) to intensive home treatment or treatment as usual. Informed consent was obtained after randomisation as soon as the patient was mentally capable within 14 days. Due to the nature of this study, patients and professionals were not masked to treatment. Intensive home treatment was tailored to the nature of the crisis and goals of patients and relatives, and developed in collaboration with them and a multidisciplinary professional team. All main analyses were intention-to-treat, and the primary outcome was the total number of admission days 12 months after randomisation. To investigate the effect of treatment conditions on the outcome measures, linear mixed modelling analyses using restricted maximum likelihood estimation were done. This trial was prospectively registered with Trialregister.nl, NL-6020 (NTR-6151). FINDINGS Between Nov 15, 2016, and Oct 15, 2018, 246 patients were included in the study (183 patients with intensive home treatment vs 63 patients with treatment as usual). 135 women (55%) and 111 men (45%) were included, with a mean age of 41·01 years (range 18-65; SD 12·68). 114 participants (46%) were born in the Netherlands and 85 (35%) elsewhere (missing data on 47 [19%] participants). Ethnicity data were not available. After 12 months, the mean number of admission days in the intensive home treatment condition was 42·47 (SD 53·92) versus 67·02 (SD 79·03) for treatment as usual, a reduction of 24·55 days (SD 10·73) or 36·6% (p=0·033). 26 adverse events were registered, 23 (89%) of which were suicide attempts. The number of patients with a reported adverse event did not differ significantly between the groups (15 [8%] in the intensive home treatment group vs five [8%] in the treatment as usual group; p=0·950). Five patients died by suicide (three [2%] in the intensive home treatment group vs two [3%] in the treatment as usual group; p=0·610). No treatment-related deaths occurred. INTERPRETATION Intensive home treatment is a safe and effective partial substitute for conventional psychiatric crisis care that led to a reduction in admission days, causing patients to stay longer in their social environment, with similar clinical effects, patient satisfaction and adverse events. FUNDING De Stichting tot Steun Vereniging voor Christelijke Verzorging van Geestes-en Zenuwzieken.
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Affiliation(s)
- Jurgen Cornelis
- Department of Research, Arkin, Amsterdam, Netherlands; Psychiatric Emergency Service, Arkin, Amsterdam, Netherlands; Psychiatric Residence Training Program, Arkin, Amsterdam, Netherlands.
| | - Ansam Barakat
- Department of Research, Arkin, Amsterdam, Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Amsterdam, Netherlands; Trimbos Institute: The Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Jaap Peen
- Department of Research, Arkin, Amsterdam, Netherlands
| | - Nick Lommerse
- Department of Research, Arkin, Amsterdam, Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Psychiatry Amsterdam University Medical Centre/Vrije Universiteit Medisch Centrum and Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
| | - Jeroen Zoeteman
- Department of Research, Arkin, Amsterdam, Netherlands; Psychiatric Emergency Service, Arkin, Amsterdam, Netherlands
| | - Henricus Van
- Department of Research, Arkin, Amsterdam, Netherlands; Psychiatric Residence Training Program, Arkin, Amsterdam, Netherlands; NPI, Arkin, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Psychiatry Amsterdam University Medical Centre/Vrije Universiteit Medisch Centrum and Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
| | - Jack Dekker
- Department of Research, Arkin, Amsterdam, Netherlands; Vrije Universiteit Department Clinical Psychology, Amsterdam, The Netherlands
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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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Abstract
BACKGROUND Stigmatized attitudes towards people with mental illness may influence treatment choice for oneself and others. AIM To gauge the attitudes of the UK general public towards treatment at home for mental illness and to assess the extent to which non-acceptability was related to stigmatized attitudes. METHODS Two hundred and two (101 female) people living in the UK completed an online (vignette) questionnaire in which we asked demographic details and personal experience of mental illness. To measure stigma, we used an adapted version of the Attitudes to Mental Illness Questionnaire (AMIQ) with vignettes asking about treatment at home and using scales for social distance and poor expectations; participants also filled in the Mental Health Knowledge Schedule (MAKS). RESULTS Participants did not evidence overall agreement with treatment at home for mental illness (i.e. >0; range = -16-to-+16, Mean (M) = 0.86, 95% confidence interval (CI) = -0.08, 1.80, p = .073), although they showed significant agreement with treatment at home should they experience mental illness themselves (range = -8-to-+8, M = 1.36, CI = 0.82, 1.89, p < .001). Acceptability for treatment at home differed according to specific mental illness considered (range = -4-to-+4); depression (M = 0.47, CI = 0.13, 0.81, p = .006) and alcohol abuse (M = 1.46, CI = 1.14,1.77, p < .001) were considered suitable for being treated at home but schizophrenia was not (M = -0.78, CI = -1.13,-0.43, p < .001). Multivariate analyses revealed that older age and attitudes indicating comfort with less social distance from people with mental illness were independently associated with treatment at home agreeability. CONCLUSIONS Public acceptability of home treatment for mental illness remains ambivalent in the UK, most obviously when considering treatment approaches for individuals other than themselves and for people with schizophrenia. Disagreement with home treatment is particularly evident in younger people and those who prefer less social contact with people with mental illness.
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Affiliation(s)
- Allerdiena A Hubbeling
- Wandsworth Home Treatment Team, South West London and St George's Mental Health NHS Trust, Springfield University Hospital, London, UK
| | - Jared G Smith
- Population Health Research Institute, St George's, University of London, UK
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Johnson S, Dalton‐Locke C, Baker J, Hanlon C, Salisbury TT, Fossey M, Newbigging K, Carr SE, Hensel J, Carrà G, Hepp U, Caneo C, Needle JJ, Lloyd‐Evans B. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. World Psychiatry 2022; 21:220-236. [PMID: 35524608 PMCID: PMC9077627 DOI: 10.1002/wps.20962] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best ap-proaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision-making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low- and middle-income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low-resource settings may lead to wider learning from locally embedded strategies.
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Affiliation(s)
- Sonia Johnson
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | | | - John Baker
- School of Healthcare, University of LeedsLeedsUK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK,Department of PsychiatrySchool of Medicine, and Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa UniversityAddis AbabaEthiopia
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Matt Fossey
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordUK
| | - Karen Newbigging
- Department of PsychiatryUniversity of OxfordOxfordUK,Institute for Mental Health, University of BirminghamBirminghamUK
| | - Sarah E. Carr
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Jennifer Hensel
- Department of PsychiatryUniversity of ManitobaWinnipegMBCanada
| | - Giuseppe Carrà
- Department of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur, Zürcher UnterlandWinterthurSwitzerland
| | - Constanza Caneo
- Departamento de Psiquiatría, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
| | - Justin J. Needle
- Centre for Health Services Research, School of Health Sciences, City, University of LondonLondonUK
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Ruud T, Holgersen KH, Hasselberg N, Siqveland J. Accessibility and interventions of crisis resolution teams: a multicenter study of team practices and team differences in Norway. BMC Psychiatry 2022; 22:350. [PMID: 35597926 PMCID: PMC9123690 DOI: 10.1186/s12888-022-03992-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/09/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Components of crisis resolution teams' (CRTs) practices have been defined in recommendations and a fidelity scale, and surveys have reported how team leaders describe CRT practices. However, studies on CRTs have not measured and reported details of the crisis intervention provided to individual service users. The present study aimed to measure how various components of CRT practice were provided to individual service users and differences in practice between CRTs. METHODS The study was exploratory and part of a prospective multicenter pre-post project on outcome of CRT treatment in Norway. Accessibility and intervention components of 25 CRTs were measured for 959 service users at the first contact after referral and in 3,244 sessions with service users. The data on CRT practice components were analyzed with descriptive statistics and factor analyses, and differences between teams were analyzed using ANOVA and calculating the proportion (intraclass correlation coefficient) of total variance that was due to differences between teams. RESULTS One-third of the service users had their first session with the CRT the day of referral and another third the following day. Treatment intensity was mean 1.8 sessions the first week, gradually decreasing over subsequent weeks. Three of ten sessions were conducted in the service user's home and six of ten in the team's location. Eight of ten sessions took place during office hours and two of ten in the evening. The CRT provided assessment and psychological interventions to all service users. Family involvement, practical support, and medication were provided to two of ten service users. Between CRTs, significant differences were identified for a substantial proportion of practice components and especially for several aspects of accessibility. Cluster analysis identified two clusters of CRTs with significant differences in accessibility but no significant differences in the use of intervention components. CONCLUSIONS Measurements of accessibility and interventions provided to individual service users gave a detailed description of CRT practices and differences between teams. Such measurements may be helpful as feedback on clinical practice, for studying and comparing crisis resolution team practices, and in future studies on the association between different outcomes and potential critical elements of crisis interventions.
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Affiliation(s)
- Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Katrine Høyer Holgersen
- grid.52522.320000 0004 0627 3560Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olavs Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina Hasselberg
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Johan Siqveland
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway ,grid.5510.10000 0004 1936 8921National Center for Suicide Research and Prevention, University of Oslo, Oslo, Norway
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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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Is Home Treatment for Everyone? Characteristics of Patients Receiving Intensive Mental Health Care at Home. Community Ment Health J 2022; 58:231-239. [PMID: 33735397 DOI: 10.1007/s10597-021-00814-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
We aimed at determining differential characteristics of patients treated by a home treatment (HT) team compared to patients treated on hospital wards. Of 412 consecutively admitted patients, 194 (47.1%) were at least partially treated at home, whereas 218 (52.9%) received inpatient treatment only during an episode of acute illness. A multivariate logistic regression model identified current employment to increase the odds of HT (p < 0.001). A primary diagnosis of anxiety or stress-related disorder (p < 0.001), other rare primary diagnoses such as personality disorders (p < 0.001), and more pronounced clinician-rated social problems (p = 0.041) decreased the odds of HT. Overall, it remained difficult to clearly specify suitability for HT based on available sociodemographic and clinical characteristics. This might indicate that responsible clinicians consider HT to be a viable alternative to hospital care and hence initiate HT for a relatively broad spectrum of patients.
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Achieving Quality and Effectiveness in Dementia Using Crisis Teams (AQUEDUCT): a study protocol for a randomised controlled trial of a Resource Kit. Trials 2022; 23:54. [PMID: 35042544 PMCID: PMC8764492 DOI: 10.1186/s13063-021-05995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving care at home for people with dementia is a core policy goal in the dementia strategies of many European countries. A challenge to effective home support is the occurrence of crises in the care of people with dementia which arise from changes in their health and social circumstances. Improving the management of these crises may prevent hospital admissions and facilitate better and longer care at home. This trial is part of a National Institute for Health Research funded programme, AQUEDUCT, which aims to improve the quality and effectiveness of teams working to manage crises in dementia. METHODS/DESIGN It is a pragmatic randomised controlled trial of an online Resource Kit to enhance practice in teams managing crises in dementia care. Thirty teams managing mental health crises in dementia in community settings will be randomised between the Resource Kit intervention and treatment as usual. The primary outcome measure is psychiatric admissions to hospital for people with dementia in the teams' catchment area recorded 6 months after randomisation. Other outcomes include quality of life measures for people with dementia and their carers, practitioner impact measures, acute hospital admissions and costs. To enhance understanding of the Resource Kit intervention, qualitative work will explore staff, patient and carers' experience. DISCUSSION The Resource Kit intervention reflects current policy to enable home-based care for people with dementia by addressing the management of crises which threaten the viability of care at home. It is based upon a model of best practice for managing crises in dementia designed to enhance the quality of care, developed in partnership with people with dementia, carers and practitioners. If the Resource Kit is shown to be clinically and cost-effective in this study, this will enhance the probability of its incorporation into mainstream practice. TRIAL REGISTRATION ISRCTN 42855694 ; Registered on 04/03/2021; Protocol number: 127686/2020v9; Research Ethics Committee, 09/03/2021, Ref 21/WM/0004; IRAS ID: 289982.
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35
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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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Towicz M, Yang WX, Moylan S, Tindall R, Berk M. Hospital-in-the-Home as a Model for Mental Health Care Delivery: A Narrative Review. Psychiatr Serv 2021; 72:1415-1427. [PMID: 34106743 DOI: 10.1176/appi.ps.202000763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: Hospital-in-the-home (HITH) is a service model widely adopted in medical specialties to help alleviate pressure on the availability of inpatient beds and allow patients to receive acute care in familiar surroundings. To date, such models are not widely utilized in mental health care. The authors review existing HITH-type mental health services, focusing on the domains of design, implementation, and outcomes.Methods: An electronic database search was conducted of MEDLINE, PsycINFO, CINAHL, Embase, Scopus, Web of Science, and Google Scholar. Fifty-six studies were eligible for inclusion in this review. Because of heterogeneous methods and outcome reporting in the available research, a narrative approach was used to highlight key themes in the literature.Results: Mental health HITH services exist under a wide range of names with differing theoretical origins and governance structures. Common characteristics and functions are summarized. The authors found moderate evidence for a reduced number and length of hospital admissions as a result of mental health HITH programs. HITH is likely to be cost-effective because of these effects. Limited evidence exists for clinical measures, consumer satisfaction, and effects on caregivers and staff.Conclusions: Mental health HITH services are an effective alternative to inpatient admission for certain consumers. The authors propose a definition of HITH as any service intended to provide inpatient-comparable mental health care in the home instead of the hospital. Standardized studies are needed for systematic analysis of key HITH outcomes.
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Levati S, Mellacqua Z, Caiata-Zufferey M, Soldini E, Albanese E, Alippi M, Bolla E, Colombo RA, Cordasco S, Kawohl W, Larghi G, Lisi A, Lucchini M, Rossa S, Traber R, Crivelli L. Home Treatment for Acute Mental Health Care: Protocol for the Financial Outputs, Risks, Efficacy, Satisfaction Index and Gatekeeping of Home Treatment (FORESIGHT) Study. JMIR Res Protoc 2021; 10:e28191. [PMID: 34751660 PMCID: PMC8663595 DOI: 10.2196/28191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Crisis Resolution and Home Treatment (CRHT) teams represent a community-based mental health service offering a valid alternative to hospitalization. CRHT teams have been widely implemented in various mental health systems worldwide, and their goal is to provide care for people with severe acute mental disorders who would be considered for admission to acute psychiatric wards. The evaluation of several home-treatment experiences shows promising results; however, it remains unclear which specific elements and characteristics of CRHT are more effective and acceptable. Objective This study aims to assess the acceptability, effectiveness, and cost-effectiveness of a new CRHT intervention in Ticino, Southern Switzerland. Methods This study includes an interventional, nonrandomized, quasi-experimental study combined with a qualitative study and an economic evaluation to be conducted over a 48-month period. The quasi-experimental evaluation involves two groups: patients in the northern area of the region who were offered the CRHT service (ie, intervention group) and patients in the southern area of the region who received care as usual (ie, control group). Individual interviews will be conducted with patients receiving the home treatment intervention and their family members. CRHT members will also be asked to participate in a focus group. The economic evaluation will include a cost-effectiveness analysis. Results The project is funded by the Swiss National Science Foundation as part of the National Research Program NRP74 for a period of 48 months starting from January 2017. As of October 2021, data for the nonrandomized, quasi-experimental study and the qualitative study have been collected, and the results are expected to be published by the end of the year. Data are currently being collected for the economic evaluation. Conclusions Compared to other Swiss CRHT experiences, the CRHT intervention in Ticino represents a unique case, as the introduction of the service is backed by the closing of one of its acute wards. The proposed study will address several areas where there are evidence gaps or contradictory findings relating to the home treatment of acute mental crisis. Findings from this study will allow local services to improve their effectiveness in a challenging domain of public health and contribute to improving access to more effective care for people with severe mental disorders. Trial Registration ISRCTN registry ISRCTN38472626; https://www.isrctn.com/ISRCTN38472626 International Registered Report Identifier (IRRID) DERR1-10.2196/28191
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Affiliation(s)
- Sara Levati
- Competence Centre for Healthcare Practices and Policies, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Zefiro Mellacqua
- Organizzazione sociopsichiatrica cantonale, Mendrisio, Switzerland
| | - Maria Caiata-Zufferey
- Competence Centre for Healthcare Practices and Policies, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Emiliano Soldini
- Research Methodology Competence Centre, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Maddalena Alippi
- Organizzazione sociopsichiatrica cantonale, Mendrisio, Switzerland
| | - Emilio Bolla
- Organizzazione sociopsichiatrica cantonale, Mendrisio, Switzerland
| | | | | | | | | | - Angela Lisi
- Research Methodology Competence Centre, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Mario Lucchini
- Department of Sociology and Social Research, University of Milan Bicocca, Milan, Italy
| | - Simona Rossa
- Organizzazione sociopsichiatrica cantonale, Mendrisio, Switzerland
| | - Rafael Traber
- Organizzazione sociopsichiatrica cantonale, Mendrisio, Switzerland
| | - Luca Crivelli
- Competence Centre for Healthcare Practices and Policies, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
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Paradis-Gagné E, Holmes D. Gilles Deleuze's societies of control: Implications for mental health nursing and coercive community care. Nurs Philos 2021; 23:e12375. [PMID: 34724314 DOI: 10.1111/nup.12375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/14/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
Since the era of deinstitutionalisation, many clinical approaches have emerged to enable the care and treatment of people suffering from mental illness. In recent years, the use of coercive approaches in the community (e.g., outpatient commitment or community treatment orders) has also increased internationally. Although nurses' role regarding these coercive approaches is central and significant, few empirical and theoretical writings have tackled this controversial nursing practice. The purpose of this paper is to analyse coercive nursing care through the lens of French philosopher Gilles Deleuze's concept of 'societies of control'. Taking up Michel Foucault's work on disciplinary power, Deleuze explores how the move from the striated spaces of closed institutions to the smooth spaces of societies of control took place since the middle of the 20th century. According to Deleuze, the overall objective of 'societies of control' is no longer simply to govern deviant behaviour in closed environments (e.g., psychiatric hospitals and prisons) but to ensure a regime of unrelentless surveillance in the open spaces of our communities.
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Affiliation(s)
| | - Dave Holmes
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Dalton-Locke C, Johnson S, Harju-Seppänen J, Lyons N, Sheridan Rains L, Stuart R, Campbell A, Clark J, Clifford A, Courtney L, Dare C, Kelly K, Lynch C, McCrone P, Nairi S, Newbigging K, Nyikavaranda P, Osborn D, Persaud K, Stefan M, Lloyd-Evans B. Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems. BMC Health Serv Res 2021; 21:1174. [PMID: 34711222 PMCID: PMC8553397 DOI: 10.1186/s12913-021-07181-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Inpatient psychiatric care is unpopular and expensive, and development and evaluation of alternatives is a long-standing policy and research priority around the world. In England, the three main models documented over the past fifty years (teams offering crisis assessment and treatment at home; acute day units; and residential crisis services in the community) have recently been augmented by several new service models. These are intended to enhance choice and flexibility within catchment area acute care systems, but remain largely undocumented in the research literature. We therefore aimed to describe the types and distribution of crisis care models across England through a national survey. Methods We carried out comprehensive mapping of crisis resolution teams (CRTs) using previous surveys, websites and multiple official data sources. Managers of CRTs were invited to participate as key informants who were familiar with the provision and organisation of crisis care services within their catchment area. The survey could be completed online or via telephone interview with a researcher, and elicited details about types of crisis care delivered in the local catchment area. Results We mapped a total of 200 adult CRTs and completed the survey with 184 (92%). Of the 200 mapped adult CRTs, there was a local (i.e., within the adult CRT catchment area) children and young persons CRT for 84 (42%), and an older adults CRT for 73 (37%). While all but one health region in England provided CRTs for working age adults, there was high variability regarding provision of all other community crisis service models and system configurations. Crisis cafes, street triage teams and separate crisis assessment services have all proliferated since a similar survey in 2016, while provision of acute day units has reduced. Conclusions The composition of catchment area crisis systems varies greatly across England and popularity of models seems unrelated to strength of evidence. A group of emerging crisis care models with varying functions within service systems are increasingly prevalent: they have potential to offer greater choice and flexibility in managing crises, but an evidence base regarding impact on service user experiences and outcomes is yet to be established. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07181-x.
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Affiliation(s)
- Christian Dalton-Locke
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Jasmine Harju-Seppänen
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Natasha Lyons
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ruth Stuart
- NIHR Mental Health Policy Research Unit, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Amelia Campbell
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK
| | - Jeremy Clark
- Mental Health Policy Branch, Department of Health and Social Care, London, UK
| | | | - Laura Courtney
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ceri Dare
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK
| | | | - Chris Lynch
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK
| | - Paul McCrone
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - Shilpa Nairi
- Camden and Islington NHS Foundation Trust, London, UK
| | - Karen Newbigging
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK
| | - David Osborn
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Karen Persaud
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK
| | - Martin Stefan
- Southern District Health Board, Southern Health, Dunedin, New Zealand
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
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Ma R, Wang J, Lloyd-Evans B, Marston L, Johnson S. Trajectories of loneliness and objective social isolation and associations between persistent loneliness and self-reported personal recovery in a cohort of secondary mental health service users in the UK. BMC Psychiatry 2021; 21:421. [PMID: 34425767 PMCID: PMC8381487 DOI: 10.1186/s12888-021-03430-9] [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: 04/04/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Loneliness is a frequent and distressing experience among people with mental health problems. However, few longitudinal studies have so far investigated the trajectories of loneliness and objective social isolation, and the extent to which both issues may impact mental health outcomes among mental health service users. Therefore, this study aims to describe the trajectories of loneliness and objective social isolation and their associations with self-rated personal recovery among people leaving crisis resolution teams (CRTs). METHODS A total of 224 participants receiving care from CRTs (recruited for a large multi-site randomised controlled trial) were included in this longitudinal cohort study. They completed the eight-item University of California at Los Angeles Loneliness Scale (ULS-8), Lubben-Social Network Scale (LNSN-6), and the Questionnaire about the Process of Recovery (QPR) (primary outcome) at baseline, 4- and 18-month follow-up, as well as baseline sociodemographic and clinical variables. RESULTS We compared groups who were persistently lonely (at all time points), intermittently lonely (at one or two time points) and never lonely. After adjusting for all potential confounders and baseline predictive variables, persistent severe loneliness was associated with worse personal recovery at 18-month follow-up compared with the never lonely (reference group) (coef. = - 12.8, 95% CI -11.8, - 3.8, p < .001), as was being intermittently lonely (coef. = - 7.8, 95% CI -18.8, - 6.8, p < .001). The persistently objectively social isolated group (coef. = - 9.8, 95% CI -15.7, - 3.8, p = .001) also had poorer self-rated recovery at 18-month follow-up than those who were not socially isolated at any timepoint (i.e., reference category). CONCLUSION Results suggest that both persistent loneliness and objective social isolation are associated with poorer self-rated recovery following a crisis, compatible with a causal relationship. These findings suggest a potential role for interventions aimed at alleviating loneliness and objective social isolation in improving recovery outcomes for people with mental health symptoms. Increased awareness of both issues among health practitioners is also warranted.
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Affiliation(s)
- Ruimin Ma
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF England ,grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK SE5 8AB
| | - Jingyi Wang
- grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Brynmor Lloyd-Evans
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF England
| | - Louise Marston
- grid.83440.3b0000000121901201Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, England. .,Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, England.
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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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Chilman N, Morant N, Lloyd-Evans B, Wackett J, Johnson S. Twitter Users' Views on Mental Health Crisis Resolution Team Care Compared With Stakeholder Interviews and Focus Groups: Qualitative Analysis. JMIR Ment Health 2021; 8:e25742. [PMID: 34185017 PMCID: PMC8278295 DOI: 10.2196/25742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Analyzing Twitter posts enables rapid access to how issues and experiences are socially shared and constructed among communities of health service users and providers, in ways that traditional qualitative methods may not. OBJECTIVE To enrich the understanding of mental health crisis care in the United Kingdom, this study explores views on crisis resolution teams (CRTs) expressed on Twitter. We aim to identify the similarities and differences among views expressed on Twitter compared with interviews and focus groups. METHODS We used Twitter's advanced search function to retrieve public tweets on CRTs. A thematic analysis was conducted on 500 randomly selected tweets. The principles of refutational synthesis were applied to compare themes with those identified in a multicenter qualitative interview study. RESULTS The most popular hashtag identified was #CrisisTeamFail, where posts were principally related to poor quality of care and access, particularly for people given a personality disorder diagnosis. Posts about CRTs giving unhelpful self-management advice were common, as were tweets about resource strains on mental health services. This was not identified in the research interviews. Although each source yielded unique themes, there were some overlaps with themes identified via interviews and focus groups, including the importance of rapid access to care. Views expressed on Twitter were generally more critical than those obtained via face-to-face methods. CONCLUSIONS Traditional qualitative studies may underrepresent the views of more critical stakeholders by collecting data from participants accessed via mental health services. Research on social media content can complement traditional or face-to-face methods and ensure that a broad spectrum of viewpoints can inform service development and policy.
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Affiliation(s)
- Natasha Chilman
- Division of Psychiatry, University College London, London, United Kingdom.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Nicola Morant
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Jane Wackett
- Division of Psychiatry, University College London, London, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
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Lefort H, Tazarourte K. [Not Available]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2021; 66:69-70. [PMID: 34187661 DOI: 10.1016/s0038-0814(21)00170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Hugues Lefort
- Hôpital d'instruction des armées Legouest, 27 avenue de Plantières, BP 90001, 57077 Metz cedex, France.
| | - Karim Tazarourte
- Hôpital Édouard-Herriot, Structure des urgences, Samu 69, 5 place d'Arsonval, 69003 Lyon, France
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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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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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Hassiotis A, Kouroupa A, Jones R, Morant N, Courtenay K, Hall I, Crossey V, Romeo R, Taggart L, Langdon P, Ratti V, Kirchner V, Lloyd-Evans B. Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour: a comparative cohort study protocol. BMJ Open 2021; 11:e043358. [PMID: 33785489 PMCID: PMC8011791 DOI: 10.1136/bmjopen-2020-043358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Approximately 17% of adults with intellectual disabilities (ID) living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy inpatient stays in England. We have identified two models of ISTs (model 1: enhanced provision and model 2: independent provision). This study aims to investigate the clinical and cost-effectiveness of the two models of ISTs. METHODS AND ANALYSIS A cohort of 226 adults with ID displaying behaviour that challenges who receive support from ISTs from each model will be recruited and assessed at baseline and 9 months later to compare the clinical and cost-effectiveness between models. The primary outcome is reduction in challenging behaviour measured by the Aberrant Behaviour Checklist-Community (ABC-C). The mean difference in change in ABC score between the two IST models will be estimated from a multilevel linear regression model. Secondary outcomes include mental health status, clinical risk, quality of life, health-related quality of life, level of functioning and service use. We will undertake a cost-effectiveness analysis taking both a health and social care and wider societal perspective. Semistructured interviews will be conducted with multiple stakeholders (ie, service users, paid/family carers, IST managers/staff) to investigate the experience of IST care as well as an online survey of referrers to capture their contact with the teams. ETHICS AND DISSEMINATION The study was approved by the London-Bromley Research Ethics Committee (REC reference: 18/LO/0890). Informed consent will be obtained from the person with ID, or a family/nominated consultee for those lacking capacity and from his/her caregivers. The findings of the study will be disseminated to academic audiences, professionals, experts by experience and arm's-length bodies and policymakers via publications, seminars and digital platforms. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03586375).
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Affiliation(s)
| | | | - Rebecca Jones
- Division of Psychiatry, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Ken Courtenay
- Assessment and Intervention Team, Barnet Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Ian Hall
- Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK
| | - Vicky Crossey
- South West Community Learning Disability Team & Mental Health Intensive Support and Treatment Team, NHS Lothian, Edinburgh, UK
| | - Renee Romeo
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Laurence Taggart
- Institute of Nursing and Health Research, University of Ulster, Antrim, UK
| | - Peter Langdon
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - Victoria Ratti
- Division of Psychiatry, University College London, London, UK
| | - Vincent Kirchner
- Medical Director, Camden and Islington NHS Foundation Trust, London, UK
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Baumgardt J, Schwarz J, Bechdolf A, Nikolaidis K, Heinze M, Hamann J, Holzke M, Längle G, Richter J, Brieger P, Kilian R, Timm J, Hirschmeier C, Von Peter S, Weinmann S. Implementation, efficacy, costs and processes of inpatient equivalent home-treatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial. BMC Psychiatry 2021; 21:173. [PMID: 33781237 PMCID: PMC8008509 DOI: 10.1186/s12888-021-03163-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Over the last decades, many high-income countries have successfully implemented assertive outreach mental health services for acute care. Despite evidence that these services entail several benefits for service users, Germany has lagged behind and has been slow in implementing outreach services. In 2018, a new law enabled national mental health care providers to implement team-based crisis intervention services on a regular basis, allowing for different forms of Inpatient Equivalent Home Treatment (IEHT). IEHT is similar to the internationally known Home Treatment or Crisis Resolution Teams. It provides acute psychiatric treatment at the user's home, similar to inpatient hospital treatment in terms of content, flexibility, and complexity. METHODS/DESIGN The presented naturalistic, quasi-experimental cohort study will evaluate IEHT in ten hospitals running IEHT services in different German regions. Within a multi-method research approach, it will evaluate stakeholders' experiences of care, service use, efficacy, costs, treatment processes and implementation processes of IEHT from different perspectives. Quantitative surveys will be used to recruit 360 service users. Subsequently, 180 service users receiving IEHT will be compared with 180 matched statistical 'twins' receiving standard inpatient treatment. Assessments will take place at baseline as well as after 6 and 12 months. The primary outcome is the hospital re-admission rate within 12 months. Secondary outcomes include the combined readmission rate, total number of inpatient hospital days, treatment discontinuation rate, quality of life, psycho-social functioning, job integration, recovery, satisfaction with care, shared decision-making, and treatment costs. Additionally, the study will assess the burden of care and satisfaction with care among relatives or informal caregivers. A collaborative research team made up of researchers with and without lived experience of mental distress will conduct qualitative investigations with service users, caregivers and IEHT staff teams to explore critical ingredients and interactions between implementation processes, treatment processes, and outcomes from a stakeholder perspective. DISCUSSION By integrating outcome, process and implementation research as well as different stakeholder perspectives and experiences in one study, this trial captures the various facets of IEHT as a special form of home treatment. Therefore, it allows for an adequate, comprehensive evaluation on different levels of this complex intervention. TRIAL REGISTRATION Trial registrations: 1) German Clinical Trials Register (DRKS), DRKS000224769. Registered December 3rd 2020, https://www.drks.de/drks_web/setLocale_EN.do ; 2) ClinicalTrials.gov, Identifier: NCT0474550 . Registered February 9th 2021.
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Affiliation(s)
- Johanna Baumgardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany.
| | - Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany
- ORYGEN, National Center of Excellence of Youth Mental Health, University of Melbourne, Melbourne, Australia
- Department for Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Konstantinos Nikolaidis
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Johannes Hamann
- kbo-Isar Amper Klinikum, Region München, Munich, Germany
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Martin Holzke
- Center for Psychiatry Suedwuerttemberg, Department of Psychiatry I, Ulm University, Ravensburg, Weissenau, Germany
| | - Gerhard Längle
- Center for Psychiatry Suedwuerttemberg, Zwiefalten, Germany
- Gemeinnützige GmbH für Psychiatrie Reutlingen (PP.rt), Academic Hospital of Tuebingen University, Reutlingen, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Department of Medicine of the Tuebingen University, Tuebingen, Germany
| | - Janina Richter
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Department of Medicine of the Tuebingen University, Tuebingen, Germany
| | - Peter Brieger
- kbo-Isar Amper Klinikum, Region München, Munich, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | | | - Constance Hirschmeier
- Department for Psychiatry and Psychotherapy, Charité University Hospital Berlin, Berlin, Germany
| | - Sebastian Von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Stefan Weinmann
- Psychiatric Hospital and Rehabilitation Unit, Rudolf-Sophien-Stift, Stuttgart, Germany
- University Psychiatric Hospital Basel, Basel, Switzerland
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Budnick A, Kuhnert R, Schmidt H, Wienprecht L, Kuhlmey A, Blüher S. Sekundärdatenanalyse initial vollstationär behandelter Patienten mit Schizophrenie in einem Berliner Modellprojekt (nach § 64b SGB V). DAS GESUNDHEITSWESEN 2021; 83:936-945. [DOI: 10.1055/a-1305-9991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Ziel der Studie Schizophrenie zählt zu den schwersten psychiatrischen Erkrankungen. Das deutsche Versorgungssystem weist jedoch für diese und andere chronisch psychisch Erkrankte mit einem intensiven Behandlungsbedarf nach wie vor Lücken auf. Der vorliegende Beitrag fokussiert die Veränderung der Versorgung von initial vollstationär behandelten Patienten mit Schizophrenie, die an den St. Hedwig Kliniken in Berlin in einem Modellprojekt nach § 64b SGB V versorgt werden, im Vergleich zu Patienten in der Regelversorgung.
Methodik Die Zielgrößen wurden mittels Routinedaten erfasst. Dabei wurden 3 Patientenkohorten analysiert. Mittels Propensity Score Matching wurde je Kohorte eine Vergleichsgruppe gebildet.
Ergebnisse Es zeigt sich, dass im Modellprojekt die Anzahl der Krankenhausaufenthalte reduziert wurde, die Gesamtverweildauer gesenkt und Gesamtkosten teilweise gesenkt wurden. Zudem verlängerte sich die Dauer bis zur nächsten Rehospitalisierung, während sich die Gesamtzahl der Kontakte zum ambulanten Sektor erhöhte.
Schlussfolgerung Die angestrebte Verlagerung der Versorgung in den ambulanten Bereich wurde für Patienten mit Schizophrenie in diesem Modellprojekt erreicht.
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Affiliation(s)
- Andrea Budnick
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft,Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ronny Kuhnert
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft,Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Helen Schmidt
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft,Charité Universitätsmedizin Berlin, Berlin, Deutschland
- Translational Neuromodeling Unit, Institut für Biomedizinische Technik, Universität und ETH Zürich, Zürich, Schweiz
| | - Lars Wienprecht
- Stationäre Versorgung / Rehabilitation / Regress, BARMER, Berlin, Deutschland
| | - Adelheid Kuhlmey
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft,Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Stefan Blüher
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft,Charité Universitätsmedizin Berlin, Berlin, Deutschland
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Fulone I, Barreto JOM, Barberato-Filho S, Bergamaschi CDC, Silva MT, Lopes LC. Improving Care for Deinstitutionalized People With Mental Disorders: Experiences of the Use of Knowledge Translation Tools. Front Psychiatry 2021; 12:575108. [PMID: 33981256 PMCID: PMC8109270 DOI: 10.3389/fpsyt.2021.575108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/29/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The deinstitutionalization process is complex, long-term and many countries fail to achieve progress and consolidation. Informing decision-makers about appropriate strategies and changes in mental health policies can be a key factor for it. This study aimed to develop an evidence brief to summarize the best available evidence to improve care for deinstitutionalized patients with severe mental disorders in the community. Methods: We used the SUPPORT (Supporting Policy Relevant Reviews and Trials) tools to elaborate the evidence brief and to organize a policy dialogue with 24 stakeholders. A systematic search was performed in 10 electronic databases and the methodological quality of systematic reviews (SRs) was assessed by AMSTAR 2. Results: Fifteen SRs were included (comprising 378 studies and 69,736 participants), of varying methodological quality (3 high-quality SRs, 2 moderate-quality SRs, 7 low-quality SRs, 3 critically low SRs). Six strategies were identified: (i). Psychoeducation; (ii). Anti-stigma programs, (iii). Intensive case management; (iv). Community mental health teams; (v). Assisted living; and (vi). Interventions for acute psychiatric episodes. They were associated with improvements on a global status, satisfaction with the service, reduction on relapse, and hospitalization. Challenges to implementation of any of them included: stigma, the shortage of specialized human resources, limited political and budgetary support. Conclusions: These strategies could guide future actions and policymaking to improve mental health outcomes.
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Affiliation(s)
- Izabela Fulone
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, Brazil
| | | | | | | | | | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, Brazil
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Odejimi O, Bagchi D, Tadros G. Typology of psychiatric emergency services in the United Kingdom: a narrative literature review. BMC Psychiatry 2020; 20:587. [PMID: 33302905 PMCID: PMC7727184 DOI: 10.1186/s12888-020-02983-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mental health crisis requiring emergency access to psychiatric service can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 h. Presently, several types of PESs are available in the United Kingdom (UK) with the aim of providing prompt and effective assessment and management of patients. Therefore, this study aims to provide a detailed narrative literature review of the various types of Psychiatric Emergency Service (PES) currently available in the UK. METHOD Electronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was conducted. Studies were included if it described a mental health service in the UK that provides immediate response in mental health crisis within the first 24 h. Excluded studies did not describe a PES, non-English, and were not conducted in UK. RESULTS Nine types of PESs were found. Amongst the 9 services, more papers described crisis resolution home treatment. Majority of the papers reported services within England than other countries within the UK. CONCLUSION All types of PESs were described as beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of the various types of PESs. This may help inform researchers, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PESs meet the needs as well as aid recovery during crisis.
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Affiliation(s)
- Opeyemi Odejimi
- Urgent Care Pathway, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Dhruba Bagchi
- Urgent Care Pathway, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - George Tadros
- Aston Medical School, Aston University, Birmingham, UK
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