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Clibbens N, Close A, Poxton J, Davies C, Geary L, Dickens G. Psychosocial Care Delivery in Intensive Home Treatment During a Mental Health Crisis: A Qualitative Thematic Analysis. Int J Ment Health Nurs 2024. [PMID: 39034435 DOI: 10.1111/inm.13394] [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: 12/22/2023] [Revised: 05/28/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024]
Abstract
Community-based intensive home treatment (IHT) is delivered as an alternative to psychiatric hospital admission as part of crisis resolution services. People receiving IHT present with complex mental health issues and are acutely distressed. Home treatment options are often preferred and there is evidence of service fidelity, although less is known about psychosocial care in this setting. Underpinned by a critical realist epistemology, this study aimed to explore psychosocial care in the context of home treatment from the perspectives of staff, service users and family carers. Data were collected using individual interviews and focus groups in two NHS organisations in England. An inductive qualitative thematic analysis resulted in five themes focused on (1) the staffing model and effective care provision, (2) the organisation of work and effective care provision, (3) skills and training and service user need, (4) opportunities for involvement and personal choice, and (5) effective communication. Findings suggest that co-production may improve congruence between IHT service design, what service users and carers want and staff ideals about optimal care. Service designs that optimise continuity of care and effective communication were advocated. Staff training in therapeutic interventions was limited by not being tailored to the home treatment context. Evidence gaps remain regarding the most effective psychosocial care and related training and supervision required. There is also a lack of clarity about how carers and family members ought to be supported given their often-crucial role in supporting the person between staff visits.
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Affiliation(s)
- Nicola Clibbens
- Northumbria University, Coach Lane Campus, Newcastle-upon-Tyne, UK
| | - Adrianne Close
- Rotherham, Doncaster and South Humber NHS Foundation Trust, Doncaster, UK
| | - Julie Poxton
- Leeds and York Partnership Foundation Trust, Leeds, UK
| | - Carly Davies
- Rotherham, Doncaster and South Humber NHS Foundation Trust, Doncaster, UK
| | - Lesley Geary
- Leeds and York Partnership Foundation Trust, Leeds, UK
| | - Geoffrey Dickens
- Northumbria University, Coach Lane Campus, Newcastle-upon-Tyne, UK
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2
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Steimle L, von Peter S, Frank F. Professional relationships during crisis interventions: A scoping review. PLoS One 2024; 19:e0298726. [PMID: 38394216 PMCID: PMC10890742 DOI: 10.1371/journal.pone.0298726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION A crisis can be described as subjective experience that threatens and overwhelms a person's ability to handle a specific situation. In dealing with crises some people are looking for support from professionals. The "professional relationship" between people experiencing a crisis and professionals plays an important role in the successful management of a crisis which has been widely researched in many contexts. However, regarding outpatient services (e. g. crisis resolution home treatment teams), yet empirical evidence remains limited. OBJECTIVE We aim to explore descriptions of supportive professional relationships during outpatient crisis interventions in empirical literature. Accordingly, a scoping review was conducted to identify types of evidence, map the key concepts, and point out research gaps. METHODS MEDLINE, PsycINFO, CINAHL and Social Science Citation Index were searched for studies reporting empirical data on the professional relationship between people experiencing a crisis (18+) and professionals (e. g. social workers, psychiatrists) during a crisis intervention, defined as a short-term, face-to-face, low threshold, time-limited, outpatient, and voluntary intervention to cope with crises. Studies were excluded if they were published before 2007, in languages other than English and German, and if they couldn't be accessed. Included studies were summarized, compared, and synthesized using qualitative content analyses. RESULTS 3.741 records were identified, of which 8 met the eligibility criteria. Only one study directly focused on the relationship; the others addressed varied aspects. Two studies explored the perspectives of service users, five focused on those of the professionals and one study examined both. The empirical literature was categorized into three main themes: strategies used to develop a supportive professional relationship, factors influencing the relationship and the nature of these relationships. DISCUSSION The results reveal a gap in understanding the nature of supportive professional relationships from the service users' perspective, as well as how professionals construct these relationships.
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Affiliation(s)
- Larissa Steimle
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Faculty of Health and Social Work, Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Fabian Frank
- Department of Social Work, Protestant University of Applied Sciences Freiburg, Freiburg, Germany
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3
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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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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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6
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Robins JE, Morley KI, Hayes RD, Pritchard M, Kornblum D, Kalk NJ. Outcomes following suicidal crisis among hazardous and harmful alcohol users in the Crisis Resolution Team. Int J Ment Health Nurs 2023; 32:590-602. [PMID: 36594457 DOI: 10.1111/inm.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 01/04/2023]
Abstract
Despite associations between alcohol use and suicidal acts, little research measures prognoses of alcohol-using patients treated by Crisis Resolution Teams (CRTs), an intensive community-based intervention. We estimated the association of alcohol use amongst patients accepted following suicidal acts or ideation in four London-based Crisis Resolution Teams, with death-by-any-cause or recontact with crisis care. We analysed the electronic health records of 1615 CRT patients accepted following suicidal acts or ideation over 38 months, following STROBE guidelines. Using logistic regression we estimated the association of alcohol use (indicated by risk-assessment, AUDIT, or ICD-10 diagnosis) with death-or-recontact at (i) 30-days and (ii) 1-year after treatment start, adjusted for age, sex, ethnicity, psychiatric diagnosis, and severity of need. Hazardous, harmful, or dependent drinking was identified in 270 cases at baseline (16.7%); 73 (4.5%) were alcohol dependent. By 1-year, 622 patients (38.5%) had recontacted crisis care or died. After adjustment, alcohol use at a hazardous, harmful, or dependent level was not associated with increased odds of death-or-recontact at 30-days (AOR 1.17, 95%CI 0.73, 1.88) or 1-year (AOR 1.17, 95%CI 0.85, 1.60). Patients with hazardous, harmful, and dependent alcohol use are a small proportion of CRT patients, despite being more commonly encountered in emergency settings from which patients may be referred to CRTs, indicating a potential gap in provision. Those who are included in CRTs are not at increased risk of death-or-recontact within 1 year of treatment, suggesting that their inclusion can work, at least in a sample with predominantly hazardous or harmful alcohol use.
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Affiliation(s)
- John E Robins
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IOPPN) King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Katherine I Morley
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IOPPN) King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,Innovation, Health, and Science, RAND Europe, Cambridge, UK.,Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard D Hayes
- South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine and NIHR Maudsley Biomedical Research Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Megan Pritchard
- South London and Maudsley NHS Foundation Trust, London, UK.,NIHR Maudsley Biomedical Research Centre (BRC), King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Daisy Kornblum
- South London and Maudsley NHS Foundation Trust, London, UK.,NIHR Maudsley Biomedical Research Centre (BRC), King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Nicola J Kalk
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IOPPN) King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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7
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Goldsmith LP, Anderson K, Clarke G, Crowe C, Jarman H, Johnson S, Lomani J, McDaid D, Park AL, Smith JG, Gillard S. Service use preceding and following first referral for psychiatric emergency care at a short-stay crisis unit: A cohort study across three cities and one rural area in England. Int J Soc Psychiatry 2022:207640221142530. [PMID: 36527189 DOI: 10.1177/00207640221142530] [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: 12/23/2022]
Abstract
BACKGROUND Internationally, hospital-based short-stay crisis units have been introduced to provide a safe space for stabilisation and further assessment for those in psychiatric crisis. The units typically aim to reduce inpatient admissions and psychiatric presentations to emergency departments. AIMS To assess changes to service use following a service user's first visit to a unit, characterise the population accessing these units and examine equality of access to the units. METHODS A prospective cohort study design (ISCTRN registered; 53431343) compared service use for the 9 months preceding and following a first visit to a short-stay crisis unit at three cities and one rural area in England. Included individuals first visited a unit in the 6 months between 01/September/2020 and 28/February/2021. RESULTS The prospective cohort included 1189 individuals aged 36 years on average, significantly younger (by 5-13 years) than the population of local service users (<.001). Seventy percent were White British and most were without a psychiatric diagnosis (55%-82% across sites). The emergency department provided the largest single source of referrals to the unit (42%), followed by the Crisis and Home Treatment Team (20%). The use of most mental health services, including all types of admission and community mental health services was increased post discharge. Social-distancing measures due to the COVID-19 pandemic were in place for slightly over 50% of the follow-up period. Comparison to a pre-COVID cohort of 934 individuals suggested that the pandemic had no effect on the majority of service use variables. CONCLUSIONS Short-stay crisis units are typically accessed by a young population, including those who previously were unknown to mental health services, who proceed to access a broader range of mental health services following discharge.
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Affiliation(s)
| | | | | | - Chloe Crowe
- North East London NHS Foundation Trust, Goodmayes Hospital, Ilford, UK
| | - Heather Jarman
- Population Health Research Institute, St George's, University of London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London - Bloomsbury, UK
| | - Jo Lomani
- NHS England and NHS Improvement, London, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK
| | - Jared G Smith
- Population Health Research Institute, St George's, University of London, UK
| | - Steven Gillard
- School of Health and Psychological Sciences, City, University of London, London, UK
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8
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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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9
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Henderson C. Intensive home treatment in different settings. Lancet Psychiatry 2022; 9:603-604. [PMID: 35779531 DOI: 10.1016/s2215-0366(22)00199-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Claire Henderson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley National Health Service Foundation Trust, London, UK.
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10
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Hartveit M, Hovlid E, Øvretveit J, Assmus J, Bond G, Joa I, Heiervang K, Stensrud B, Høifødt TS, Biringer E, Ruud T. Can systematic implementation support improve programme fidelity by improving care providers' perceptions of implementation factors? A cluster randomized trial. BMC Health Serv Res 2022; 22:808. [PMID: 35733211 PMCID: PMC9215018 DOI: 10.1186/s12913-022-08168-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: 02/08/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Investigations of implementation factors (e.g., collegial support and sense of coherence) are recommended to better understand and address inadequate implementation outcomes. Little is known about the relationship between implementation factors and outcomes, especially in later phases of an implementation effort. The aims of this study were to assess the association between implementation success (measured by programme fidelity) and care providers' perceptions of implementation factors during an implementation process and to investigate whether these perceptions are affected by systematic implementation support. METHODS Using a cluster-randomized design, mental health clinics were drawn to receive implementation support for one (intervention) and not for another (control) of four evidence-based practices. Programme fidelity and care providers' perceptions (Implementation Process Assessment Tool questionnaire) were scored for both intervention and control groups at baseline, 6-, 12- and 18-months. Associations and group differences were tested by means of descriptive statistics (mean, standard deviation and confidence interval) and linear mixed effect analysis. RESULTS Including 33 mental health centres or wards, we found care providers' perceptions of a set of implementation factors to be associated with fidelity but not at baseline. After 18 months of implementation effort, fidelity and care providers' perceptions were strongly correlated (B (95% CI) = .7 (.2, 1.1), p = .004). Care providers perceived implementation factors more positively when implementation support was provided than when it was not (t (140) = 2.22, p = .028). CONCLUSIONS Implementation support can facilitate positive perceptions among care providers, which is associated with higher programme fidelity. To improve implementation success, we should pay more attention to how care providers constantly perceive implementation factors during all phases of the implementation effort. Further research is needed to investigate the validity of our findings in other settings and to improve our understanding of ongoing decision-making among care providers, i.e., the mechanisms of sustaining the high fidelity of recommended practices. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03271242 (registration date: 05.09.2017).
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Affiliation(s)
- Miriam Hartveit
- Valen Hospital Helse Fonna HF, 5451, Valen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Box 7804, 5020, Bergen, Norway.
| | - Einar Hovlid
- Department of Social Science, Western Norway University of Applied Sciences, Røyrgata 6, 6856, Sogndal, Norway
| | - John Øvretveit
- Stockholm Health Care Services, Region Stockholm (SLSO) and LIME/MMC, Tomtebodavägen 18A, Karolinska Institutet, Stockholm, Sweden
| | - Jørg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Box 1400, 5021, Bergen, Norway
| | - Gary Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Lebanon, NH, USA
| | - Inge Joa
- Network for Clinical Research in Psychosis, Stavanger University Hospital, Box 8100, 4068, Stavanger, Norway.,Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Kristin Heiervang
- Division of Mental Health Services, Akershus University Hospital, Box 1000, 1478, Lørenskog, Norway
| | - Bjørn Stensrud
- Division of Mental Health, Innlandet Hospital Trust, Box 104, 2381, Brumunddal, Norway
| | | | - Eva Biringer
- Valen Hospital Helse Fonna HF, 5451, Valen, Norway.,Department of Research and Innovation, Helse Fonna HF, 5416, Stord, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Box 1171 Blindern, 0318, Oslo, Norway
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11
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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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12
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Troup J, Lever Taylor B, Sheridan Rains L, Broeckelmann E, Russell J, Jeynes T, Cooper C, Steare T, Dedat Z, McNicholas S, Oram S, Dale O, Johnson S. Clinician perspectives on what constitutes good practice in community services for people with complex emotional needs: A qualitative thematic meta-synthesis. PLoS One 2022; 17:e0267787. [PMID: 35511900 PMCID: PMC9070883 DOI: 10.1371/journal.pone.0267787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/15/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The need to improve the quality of community mental health services for people with Complex Emotional Needs (CEN) (who may have a diagnosis of 'personality disorder') is recognised internationally and has become a renewed policy priority in England. Such improvement requires positive engagement from clinicians across the service system, and their perspectives on achieving good practice need to be understood. AIM To synthesise qualitative evidence on clinician perspectives on what constitutes good practice, and what helps or prevents it being achieved, in community mental health services for people with CEN. METHODS Six bibliographic databases were searched for studies published since 2003 and supplementary citation tracking was conducted. Studies that used any recognised qualitative method and reported clinician experiences and perspectives on community-based mental health services for adults with CEN were eligible for this review, including generic and specialist settings. Meta-synthesis was used to generate and synthesise over-arching themes across included studies. RESULTS Twenty-nine papers were eligible for inclusion, most with samples given a 'personality disorder' diagnosis. Six over-arching themes were identified: 1. The use and misuse of diagnosis; 2. The patient journey into services: nowhere to go; 3. Therapeutic relationships: connection and distance; 4. The nature of treatment: not doing too much or too little; 5. Managing safety issues and crises: being measured and proactive; 6. Clinician and wider service needs: whose needs are they anyway? The overall quality of the evidence was moderate. DISCUSSION Through summarising the literature on clinician perspectives on good practice for people with CEN, over-arching priorities were identified on which there appears to be substantial consensus. In their focus on needs such as for a long-term perspective on treatment journeys, high quality and consistent therapeutic relationships, and a balanced approach to safety, clinician priorities are mainly congruent with those found in studies on service user views. They also identify clinician needs that should be met for good care to be provided, including for supervision, joint working and organisational support.
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Affiliation(s)
- Jordan Troup
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, England
| | | | - Luke Sheridan Rains
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, England
- * E-mail:
| | - Eva Broeckelmann
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, England
| | - Jessica Russell
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, England
| | - Tamar Jeynes
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, England
| | - Chris Cooper
- Department of Clinical, Educational and Health Psychology, University College London, London, England
| | - Thomas Steare
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, England
| | - Zainab Dedat
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, England
| | | | - Sian Oram
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, England
| | - Oliver Dale
- West London Mental Health Trust, London, England
| | - Sonia Johnson
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, England
- Camden and Islington NHS Foundation Trust, London, England
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13
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Pilling S, Clarke K, Parker G, James K, Landau S, Weaver T, Razzaque R, Craig T. Open Dialogue compared to treatment as usual for adults experiencing a mental health crisis: Protocol for the ODDESSI multi-site cluster randomised controlled trial. Contemp Clin Trials 2021; 113:106664. [PMID: 34958932 PMCID: PMC8844585 DOI: 10.1016/j.cct.2021.106664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022]
Abstract
Background ‘Open Dialogue’ is a social network model of crisis and continuing mental healthcare which involves elements of service delivery such as immediate response and a style of therapeutic meeting called network meetings. Although there are indications from non-randomised studies that it may help people in their recovery from severe mental health crises and improve long-term outcomes, this has yet to be tested in a randomised controlled trial. Methods This paper outlines the protocol for a multi-site cluster-randomised control trial assessing the clinical and cost-effectiveness of Open Dialogue compared to treatment as usual (TAU) for individuals presenting in crisis to six mental health services in England. The primary outcome is time to relapse, with secondary outcomes including measures of recovery and service use. Participants will be followed-up for two years, with data collected from electronic medical records and researcher-led interviews. The analysis will compare outcomes between treatment groups as well as investigating potential mediators of effect: shared decision-making and social network quality and size. Carers of a subsample of participants will be asked about their experiences of shared decision-making, carer burden, and satisfaction. Discussion This trial will provide evidence of whether Open Dialogue services implemented in the English mental health system is an effective alternative to current care and may have important implications for the organization of community mental health services. Trial registration: retrospectively registered (108 participants recruited of 570 target) on 20/12/2019, ISRCTN52653325.
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Affiliation(s)
- Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Department of Clinical, Health and Educational Psychology, University College London, 1-19 Torrington Pl, London WC1E 7HB, UK.
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness, Department of Clinical, Health and Educational Psychology, University College London, 1-19 Torrington Pl, London WC1E 7HB, UK
| | - Georgie Parker
- Centre for Outcomes Research and Effectiveness, Department of Clinical, Health and Educational Psychology, University College London, 1-19 Torrington Pl, London WC1E 7HB, UK
| | - Kirsty James
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London SE5 8AB, UK
| | - Sabine Landau
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London SE5 8AB, UK
| | - Timothy Weaver
- Middlesex University, Department of Mental Health & Social Work, Room TG70, Ground Floor Town Hall, School of Health and Education, The Burroughs, London NW4 4BT, UK
| | - Russell Razzaque
- North East London Foundation Trust, Research and Development Department, 1st Floor Maggie Lilley Suite, Goodmayes Hospital, Barley Lane Ilford, IG3 8XJ London, UK
| | - Thomas Craig
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London SE5 8AB, UK
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14
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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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15
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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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16
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Hasselberg N, Holgersen KH, Uverud GM, Siqveland J, Lloyd-Evans B, Johnson S, Ruud T. Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway. BMC Psychiatry 2021; 21:231. [PMID: 33947362 PMCID: PMC8094557 DOI: 10.1186/s12888-021-03237-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/16/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown. METHODS We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT. RESULTS The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users' choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support. CONCLUSIONS The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.
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Affiliation(s)
- N Hasselberg
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - K H Holgersen
- Tiller Community Mental Health Centre, Department of Mental Health, St. Olavs Hospital, Trondheim, Norway
| | - G M Uverud
- University of South-Eastern Norway, Vestfold, Norway
| | - J Siqveland
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- National Center for Suicide Research and Prevention, University of Oslo, Oslo, Norway
| | - B Lloyd-Evans
- Division of Psychiatry, University College London, London, UK
| | - S Johnson
- Division of Psychiatry, University College London, London, UK
| | - T Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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17
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Lamb D, Steare T, Marston L, Canaway A, Johnson S, Kirkbride JB, Lloyd-Evans B, Morant N, Pinfold V, Smith D, Weich S, Osborn DP. A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England. BJPsych Open 2021; 7:e68. [PMID: 33736743 PMCID: PMC8058818 DOI: 10.1192/bjo.2021.30] [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] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND For people in mental health crisis, acute day units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to crisis resolution teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly compared with those receiving CRT care alone. AIMS We aimed to investigate readmission rates, satisfaction and well-being outcomes for people using ADUs and CRTs. METHOD We conducted a cohort study comparing readmission to acute mental healthcare during a 6-month period for ADU and CRT participants. Secondary outcomes included satisfaction (Client Satisfaction Questionnaire), well-being (Short Warwick-Edinburgh Mental Well-being Scale) and depression (Center for Epidemiologic Studies Depression Scale). RESULTS We recruited 744 participants (ADU: n = 431, 58%; CRT: n = 312, 42%) across four National Health Service trusts/health regions. There was no statistically significant overall difference in readmissions: 21% of ADU participants and 23% of CRT participants were readmitted over 6 months (adjusted hazard ratio 0.78, 95% CI 0.54-1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire scores (2.5, 95% CI 1.4-3.5, P < 0.001) and well-being scores (1.3, 95% CI 0.4-2.1, P = 0.004), and lower depression scores (-1.7, 95% CI -2.7 to -0.8, P < 0.001), than CRT participants. CONCLUSIONS Patients who accessed ADUs demonstrated better outcomes for satisfaction, well-being and depression, and no significant differences in risk of readmission, compared with those who only used CRTs. Given the positive outcomes for patients, and the fact that ADUs are inconsistently provided in the National Health Service, their value and place in the acute care pathway needs further consideration and research.
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Affiliation(s)
- Danielle Lamb
- NIHR ARC North Thames, Department of Applied Health Research, University College London, UK
| | - Thomas Steare
- Division of Psychiatry, University College London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, UK
| | | | - Sonia Johnson
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UK
| | | | | | - Nicola Morant
- Division of Psychiatry, University College London, UK
| | | | | | - Scott Weich
- School of Health and Related Research, University of Sheffield, UK
| | - David P Osborn
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UK
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18
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Sheridan Rains L, Weich S, Maddock C, Smith S, Keown P, Crepaz-Keay D, Singh SP, Jones R, Kirkbride J, Millett L, Lyons N, Branthonne-Foster S, Johnson S, Lloyd-Evans B. Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model. BJPsych Open 2020; 6:e88. [PMID: 32792034 PMCID: PMC7453796 DOI: 10.1192/bjo.2020.64] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The steep rise in the rate of psychiatric hospital detentions in England is poorly understood. AIMS To identify explanations for the rise in detentions in England since 1983; to test their plausibility and support from evidence; to develop an explanatory model for the rise in detentions. METHOD Hypotheses to explain the rise in detentions were identified from previous literature and stakeholder consultation. We explored associations between national indicators for potential explanatory variables and detention rates in an ecological study. Relevant research was scoped and the plausibility of each hypothesis was rated. Finally, a logic model was developed to illustrate likely contributory factors and pathways to the increase in detentions. RESULTS Seventeen hypotheses related to social, service, legal and data-quality factors. Hypotheses supported by available evidence were: changes in legal approaches to patients without decision-making capacity but not actively objecting to admission; demographic changes; increasing psychiatric morbidity. Reductions in the availability or quality of community mental health services and changes in police practice may have contributed to the rise in detentions. Hypothesised factors not supported by evidence were: changes in community crisis care, compulsory community treatment and prescribing practice. Evidence was ambiguous or lacking for other explanations, including the impact of austerity measures and reductions in National Health Service in-patient bed numbers. CONCLUSIONS Better data are needed about the characteristics and service contexts of those detained. Our logic model highlights likely contributory factors to the rise in detentions in England, priorities for future research and potential policy targets for reducing detentions.
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Affiliation(s)
| | - Scott Weich
- Professor, School of Health and Related Research, University of Sheffield, UK
| | | | - Shubulade Smith
- Behavioural and Developmental Disorders Directorate, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London; and Department of Forensic and Neurodevelopmental Disorders, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | - Patrick Keown
- Northumberland Tyne and Wear NHS Foundation Trust, UK
| | | | - Swaran P Singh
- Professor, Department of Mental Health and Wellbeing, University of Warwick, UK
| | - Rebecca Jones
- Division of Psychiatry, University College London, UK
| | | | | | - Natasha Lyons
- Division of Psychiatry, University College London, UK
| | | | - Sonia Johnson
- Professor, Division of Psychiatry, University College London; and Camden and Islington NHS Foundation Trust, London, UK
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19
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Lamb D, Lloyd-Evans B, Fullarton K, Kelly K, Goater N, Mason O, Gray R, Osborn D, Nolan F, Pilling S, Sullivan SA, Henderson C, Milton A, Burgess E, Churchard A, Davidson M, Frerichs J, Hindle D, Paterson B, Brown E, Piotrowski J, Wheeler C, Johnson S. Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology. Int J Ment Health Nurs 2020; 29:187-201. [PMID: 31566846 DOI: 10.1111/inm.12658] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2019] [Indexed: 11/27/2022]
Abstract
Crisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. Previous UK research, based on self-report surveys, suggests that a loosely specified model has resulted in wide variations in CRTs' service delivery, organization and outcomes. A fidelity scale (developed through evidence review and stakeholder consensus) provided a means of objectively measuring adherence to a model of good practice for CRTs, via one-day fidelity reviews of UK crisis teams. Reviews included interviews with service users, carers, staff and managers, and examination of data, policies, protocols and anonymized case notes. Of the 75 teams reviewed, 49 (65%) were assessed as being moderate fidelity and the rest as low fidelity, with no team achieving high fidelity. The median score was 122 (range: 73-151; inter-quartile range: 111-132). Teams achieved higher scores on items about structure and organization, for example ease of referral, medication and safety systems, but scored poorly on items about the content of care and interventions. Despite a national mandate to implement the CRT model, there are wide variations in implementation in the UK and no teams in our sample achieved overall high fidelity. This suggests that a mandatory national policy is not in itself sufficient to achieve good quality implementation of a service model. The CRT Fidelity Scale provides a feasible and acceptable means to objectively assess model fidelity in CRTs. There is a need for development and testing of interventions to enhance model fidelity and facilitate improvements to these services.
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Affiliation(s)
| | - Brynmor Lloyd-Evans
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | | | - Kathleen Kelly
- Northamptonshire Healthcare NHS Foundation Trust, London, UK
| | | | - Oliver Mason
- North East London NHS Foundation Trust, London, UK
| | | | - David Osborn
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Fiona Nolan
- Camden and Islington NHS Foundation Trust, London, UK
| | - Steve Pilling
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sonia Johnson
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
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20
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Bond GR, Drake RE. Assessing the Fidelity of Evidence-Based Practices: History and Current Status of a Standardized Measurement Methodology. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:874-884. [PMID: 31691055 DOI: 10.1007/s10488-019-00991-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence-based practices are effective only when implemented faithfully. This paper explicates the history, standardization, and methods for developing and validating measures of fidelity. We overviewed the past 20 years of developing fidelity measures, summarized standardization of the development procedures, and described needed psychometric assessments. Fidelity assessment has become the sine qua non of implementation, technical assistance, and research on evidence-based practices. Researchers have established standardized procedures for scale development and psychometric testing. Widescale use of fidelity measurement remains challenging. The implementation of evidence-based practice and the development and validation of fidelity measures are interdependent. International improvements of mental health care will require attention to both.
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Affiliation(s)
- Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA.
| | - Robert E Drake
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA
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21
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Lloyd-Evans B, Christoforou M, Osborn D, Ambler G, Marston L, Lamb D, Mason O, Morant N, Sullivan S, Henderson C, Hunter R, Pilling S, Nolan F, Gray R, Weaver T, Kelly K, Goater N, Milton A, Johnston E, Fullarton K, Lean M, Paterson B, Piotrowski J, Davidson M, Forsyth R, Mosse L, Leverton M, O’Hanlon P, Mundy E, Mundy T, Brown E, Fahmy S, Burgess E, Churchard A, Wheeler C, Istead H, Hindle D, Johnson S. Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background
Crisis resolution teams (CRTs) seek to avert hospital admissions by providing intensive home treatment for people experiencing a mental health crisis. The CRT model has not been highly specified. CRT care is often experienced as ending abruptly and relapse rates following CRT discharge are high.
Aims
The aims of CORE (Crisis resolution team Optimisation and RElapse prevention) workstream 1 were to specify a model of best practice for CRTs, develop a measure to assess adherence to this model and evaluate service improvement resources to help CRTs implement the model with high fidelity. The aim of CORE workstream 2 was to evaluate a peer-provided self-management programme aimed at reducing relapse following CRT support.
Methods
Workstream 1 was based on a systematic review, national CRT manager survey and stakeholder qualitative interviews to develop a CRT fidelity scale through a concept mapping process with stakeholders (n = 68). This was piloted in CRTs nationwide (n = 75). A CRT service improvement programme (SIP) was then developed and evaluated in a cluster randomised trial: 15 CRTs received the SIP over 1 year; 10 teams acted as controls. The primary outcome was service user satisfaction. Secondary outcomes included CRT model fidelity, catchment area inpatient admission rates and staff well-being. Workstream 2 was a peer-provided self-management programme that was developed through an iterative process of systematic literature reviewing, stakeholder consultation and preliminary testing. This intervention was evaluated in a randomised controlled trial: 221 participants recruited from CRTs received the intervention and 220 did not. The primary outcome was re-admission to acute care at 1 year of follow-up. Secondary outcomes included time to re-admission and number of days in acute care over 1 year of follow-up and symptoms and personal recovery measured at 4 and 18 months’ follow-up.
Results
Workstream 1 – a 39-item CRT fidelity scale demonstrated acceptability, face validity and promising inter-rater reliability. CRT implementation in England was highly variable. The SIP trial did not produce a positive result for patient satisfaction [median Client Satisfaction Questionnaire score of 28 in both groups at follow-up; coefficient 0.97, 95% confidence interval (CI) –1.02 to 2.97]. The programme achieved modest increases in model fidelity. Intervention teams achieved lower inpatient admission rates and less inpatient bed use. Qualitative evaluation suggested that the programme was generally well received. Workstream 2 – the trial yielded a statistically significant result for the primary outcome, in which rates of re-admission to acute care over 1 year of follow-up were lower in the intervention group than in the control group (odds ratio 0.66, 95% CI 0.43 to 0.99; p = 0.044). Time to re-admission was lower and satisfaction with care was greater in the intervention group at 4 months’ follow-up. There were no other significant differences between groups in the secondary outcomes.
Limitations
Limitations in workstream 1 included uncertainty regarding the representativeness of the sample for the primary outcome and lack of blinding for assessment. In workstream 2, the limitations included the complexity of the intervention, preventing clarity about which were effective elements.
Conclusions
The CRT SIP did not achieve all its aims but showed potential promise as a means to increase CRT model fidelity and reduce inpatient service use. The peer-provided self-management intervention is an effective means to reduce relapse rates for people leaving CRT care.
Study registration
The randomised controlled trials were registered as Current Controlled Trials ISRCTN47185233 and ISRCTN01027104. The systematic reviews were registered as PROSPERO CRD42013006415 and CRD42017043048.
Funding
The National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
| | | | - David Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Danielle Lamb
- Division of Psychiatry, University College London, London, UK
| | - Oliver Mason
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Sarah Sullivan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Claire Henderson
- Health Service and Population Research, King’s College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Stephen Pilling
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Fiona Nolan
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Richard Gray
- Department of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Tim Weaver
- Mental Health Social Work and Interprofessional Learning, Middlesex University London, London, UK
| | | | | | - Alyssa Milton
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Elaine Johnston
- Division of Psychiatry, University College London, London, UK
| | - Kate Fullarton
- Division of Psychiatry, University College London, London, UK
| | - Melanie Lean
- Division of Psychiatry, University College London, London, UK
| | - Beth Paterson
- Division of Psychiatry, University College London, London, UK
| | | | | | - Rebecca Forsyth
- Division of Psychiatry, University College London, London, UK
| | - Liberty Mosse
- Division of Psychiatry, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | - Puffin O’Hanlon
- Division of Psychiatry, University College London, London, UK
| | - Edward Mundy
- Division of Psychiatry, University College London, London, UK
| | - Tom Mundy
- Division of Psychiatry, University College London, London, UK
| | - Ellie Brown
- Psychiatric Health Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Sarah Fahmy
- Division of Psychiatry, University College London, London, UK
| | - Emma Burgess
- Division of Psychiatry, University College London, London, UK
| | | | - Claire Wheeler
- Division of Psychiatry, University College London, London, UK
| | - Hannah Istead
- Division of Psychiatry, University College London, London, UK
| | - David Hindle
- Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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