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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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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: 0] [Impact Index Per Article: 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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Soldini E, Alippi M, Zufferey MC, Lisi A, Lucchini M, Albanese E, Colombo RA, Rossa S, Bolla E, Mellacqua ZB, Larghi G, Cordasco S, Kawohl W, Crivelli L, Traber R. Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography. BMC Psychiatry 2022; 22:405. [PMID: 35715789 PMCID: PMC9204869 DOI: 10.1186/s12888-022-04020-z] [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: 11/09/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis Resolution Home Treatment (CRHT) is an alternative to inpatient treatment for acute psychiatric crises management. However, evidence on CRHT effectiveness is still limited. In the Canton of Ticino (Southern Switzerland), in 2016 the regional public psychiatric hospital replaced one acute ward with a CRHT. The current study was designed within this evaluation setting to assess the effectiveness of CRHT compared to standard inpatient treatment. METHODS CRHT was offered to patients aged 18 to 65 with an acute psychiatric crisis that would have required hospitalization. We used a natural experiment based on geography, where intervention and control groups were formed according to the place of residence. Primary endpoints were reduction of psychiatric symptoms at discharge measured using the Health of the Nation Outcome Scales, treatment duration in days, and rate and length of readmissions during a two-year follow-up period after discharge. Safety during the treatment period was measured with the number of serious adverse events (suicide/suicide attempts, major self-harm episodes, acute alcohol/drug intoxications, aggressions to caregivers or family members). We used linear, log-linear and logistic regression models with propensity scores for the main analysis. RESULTS We enrolled 321 patients; 67 were excluded because the treatment period was too short and 17 because they were transferred before the end of the treatment. Two hundred thirty-seven patients were available for data analysis, 93 in the intervention group and 144 in the control group. No serious adverse event was observed during the treatment period in both groups. Reduction of psychiatric symptoms at discharge (p-value = 0.359), readmission rates (p-value = 0.563) and length of readmissions (p-value = 0.770) during the two-year follow-up period did not differ significantly between the two groups. Treatment duration was significantly higher in the treatment group (+ 29.6% on average, p-value = 0.002). CONCLUSIONS CRHT was comparable to standard hospitalization in terms of psychiatric symptoms reduction, readmission rates and length of readmissions, but it was also characterized by a longer first treatment period. However, observational evidence following the study indicated that CRHT duration constantly lowered over time since its introduction in 2016 and became comparable to hospitalization, showing therefore to be an effective alternative also in terms of treatment length. TRIAL REGISTRATION ISRCTN38472626 (17/11/2020, retrospectively registered).
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Affiliation(s)
- Emiliano Soldini
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928, Manno, Switzerland.
| | - Maddalena Alippi
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Maria Caiata Zufferey
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Angela Lisi
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Mario Lucchini
- grid.7563.70000 0001 2174 1754Department of Sociology and Social Research, Università Degli Studi Di Milano Bicocca, piazza dell’Ateneo nuovo 1, 20126 Milan, Italy
| | - Emiliano Albanese
- grid.29078.340000 0001 2203 2861Institute of Public Health (IPH), Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via Giuseppe Buffi 13, CH-6900 Lugano, Switzerland
| | - Raffaella Ada Colombo
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Simona Rossa
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Emilio Bolla
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Zefiro Benedetto Mellacqua
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Giuseppina Larghi
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Severino Cordasco
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Wolfram Kawohl
- Clienia Schlössli, Psychiatric Hospital, Schlösslistrasse 8, 8618 Oetwil Am See, Switzerland
| | - Luca Crivelli
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Rafael Traber
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
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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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5
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Mundt AP, Delhey Langerfeldt S, Rozas Serri E, Siebenförcher M, Priebe S. Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data. Front Psychiatry 2021; 12:745247. [PMID: 35002794 PMCID: PMC8738080 DOI: 10.3389/fpsyt.2021.745247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Mental health policies have encouraged removals of psychiatric beds in many countries. It is under debate whether to continue those trends. We conducted a systematic review of expert arguments for trends of psychiatric bed numbers. Methods: We searched seven electronic databases and screened 15,479 papers to identify expert opinions, arguments and recommendations for trends of psychiatric bed numbers, published until December 2020. Data were synthesized using thematic analysis and classified into arguments to maintain or increase numbers and to reduce numbers. Results: One hundred six publications from 25 countries were included. The most common themes arguing for reductions of psychiatric bed numbers were inadequate use of inpatient care, better integration of care and better use of community care. Arguments to maintain or increase bed numbers included high demand of psychiatric beds, high occupancy rates, increasing admission rates, criminalization of mentally ill, lack of community care and inadequately short length of stay. Cost effectiveness and quality of care were used as arguments for increase or decrease. Conclusions: The expert arguments presented here may guide and focus future debate on the required psychiatric bed numbers. The recommendations may help policymakers to define targets for psychiatric bed numbers. Arguments need careful local evaluation, especially when supporting opposite directions of trends in different contexts.
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Affiliation(s)
- Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Santiago, Chile.,Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | - Enzo Rozas Serri
- Medical Faculty, Universidad Diego Portales, Santiago, Chile.,Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Mathias Siebenförcher
- Department of Psychiatry and Psychotherapy Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
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Nelson D, Walcott G, Walters C, Hickling FW. Community Engagement Mental Health Model for Home Treatment of Psychosis in Jamaica. Psychiatr Serv 2020; 71:522-524. [PMID: 32114944 DOI: 10.1176/appi.ps.201900063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Economic constraints in low- and middle-income countries like Jamaica challenge health care services to identify efficient methods of mental health care. This column describes the community engagement mental health (CEMH) model in Kingston, Jamaica, for patients with mental disorders, including psychosis. The CEMH uses a task sharing methodology to deliver acute psychiatric treatment within a community setting. Preliminary results suggest high service user and provider satisfaction and good clinical outcomes. The authors discuss challenges and benefits of the CEMH in terms of its potential as a cost-effective service innovation.
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Affiliation(s)
- Danielle Nelson
- South East Regional Health Authority, Ministry of Health of the Government of Jamaica, Kingston (Nelson); Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica (Walcott, Walters, Hickling); Caribbean Institute of Mental Health and Substance Abuse, Kingston (Walcott, Hickling). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - Geoffrey Walcott
- South East Regional Health Authority, Ministry of Health of the Government of Jamaica, Kingston (Nelson); Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica (Walcott, Walters, Hickling); Caribbean Institute of Mental Health and Substance Abuse, Kingston (Walcott, Hickling). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - Christine Walters
- South East Regional Health Authority, Ministry of Health of the Government of Jamaica, Kingston (Nelson); Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica (Walcott, Walters, Hickling); Caribbean Institute of Mental Health and Substance Abuse, Kingston (Walcott, Hickling). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - Frederick W Hickling
- South East Regional Health Authority, Ministry of Health of the Government of Jamaica, Kingston (Nelson); Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica (Walcott, Walters, Hickling); Caribbean Institute of Mental Health and Substance Abuse, Kingston (Walcott, Hickling). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
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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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8
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Schöttle D, Ruppelt F, Schimmelmann BG, Karow A, Bussopulos A, Gallinat J, Wiedemann K, Luedecke D, Rohenkohl AC, Huber CG, Bock T, Lambert M. Reduction of Involuntary Admissions in Patients With Severe Psychotic Disorders Treated in the ACCESS Integrated Care Model Including Therapeutic Assertive Community Treatment. Front Psychiatry 2019; 10:736. [PMID: 31708810 PMCID: PMC6822062 DOI: 10.3389/fpsyt.2019.00736] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/13/2019] [Indexed: 01/12/2023] Open
Abstract
Objective: The ACCESS treatment model offers assertive community treatment (ACT) embedded in an integrated care program to patients with severe psychotic disorders. Compared to standard care, it proved to be more effective in terms of service disengagement and other outcomes in patients with psychotic disorders over 12, 24, and 48 months. Many patients with severe mental disorders experience involuntary admissions which can be potentially traumatic. In this study, we assessed the effect of ACT on reducing involuntary admissions over an observation period of 4 years. Method: One hundred seventy-one patients treated in ACCESS were included in this study. The primary outcome was rate of involuntary admissions during 48 months. Secondary outcomes were differences between those with and without involuntary admissions in the 2 years prior to ACCESS regarding change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication non-adherence, and service-disengagement. Results: Of 171 patients, 58 patients (33.9%) were involuntarily admitted to hospital in the past 2 years before entry. During the 4 years of treatment, 16 patients (9.4%) were involuntarily admitted to hospital which was a significantly lower rate compared to the 2 years before inclusion in ACCESS (p < .001). Comparing the two groups, larger improvements in severity of illness (p = .004) and functional status (p = .043) were detected in the group with no history of involuntary admissions. At 4-year follow-up, of the remaining patients, 69.2% (n = 81) were full adherent (p < .001), compared to 18.9% (n = 31) at baseline with no differences between the two groups over the study period (p = .25). Over 4 years, only 13 patients (13.2%) were service-disengaged due to non-practical reasons. Conclusions: In this long-term study, we were able to demonstrate a reduction in involuntary admissions in four treatment years compared to the 2 years prior to admission to the ACCESS model in patients with severe and mostly multiphase schizophrenia spectrum disorders and affective disorders with psychotic features. This may help prevent patients from suffering from a potentially traumatic experience during treatment in the psychiatric system. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT01888627.
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Affiliation(s)
- Daniel Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Bussopulos
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken Basel (UPK), University of Basel, Basel, Switzerland
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Christine Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian G Huber
- Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken Basel (UPK), University of Basel, Basel, Switzerland
| | - Thomas Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
SummaryCrisis resolution and home treatment teams have been introduced throughout England as part of a transformation of the community mental healthcare system. They aim to assess all patients being considered for acute hospital admission, to offer intensive home treatment rather than hospital admission if feasible, and to facilitate early discharge from hospital. Key features include 24-hour availability and intensive contact in the community, with visits twice daily if needed. This article describes the main characteristics and core interventions of these teams, and reviews the impact of their nationwide introduction. The model has evolved as a pragmatic response to difficulties in the acute care system, and its adaptation continues. Key challenges include achieving close integration with the rest of the mental health system and delivering continuity of care and effective therapeutic relationships despite the involvement of multiple workers in each crisis.
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Carpenter RA, Falkenburg J, White TP, Tracy DK. Crisis teams: systematic review of their effectiveness in practice. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.112.039933] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodCrisis resolution and home treatment teams (variously abbreviated to CRTs, CRHTTs, HTTs) were introduced to reduce the number and duration of in-patient admissions and better manage individuals in crisis. Despite their ubiquity, their evidence base is challengeable. This systematic review explored whether CRTs: (a) affected voluntary and compulsory admissions; (b) treat particular patient groups; (c) are cost-effective; and (d) provide care patients value.ResultsCrisis resolution teams appear effective in reducing admissions, although data are mixed and other factors have also influenced this. Compulsory admissions may have increased, but evidence that CRTs are causally related is inconclusive. There are few clinical differences between ‘gate-kept’ patients admitted and those not. Crisis resolution teams are cheaper than in-patient care and, overall, patients are satisfied with CRT care.Clinical implicationsHigh-quality evidence for CRTs is scarce, although they appear to contribute to reducing admissions. Patient-relevant psychosocial and longitudinal outcomes are under-explored.
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Forbes NF, Cash HT, Lawrie SM. Intensive home treatment, admission rates and use of mental health legislation. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.109.027417] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodWe examined the local impact of introducing a home treatment team on the use of in-patient psychiatric resources and rates of detention under the Mental Health (Care and Treatment) (Scotland) Act 2003.ResultsRates of admission to hospital and duration of hospital stay were unchanged. However, there was an increase in episodes of detention in the year following the team's introduction.Clinical implicationsOffering home treatment as an alternative to in-patient care may be associated with an increase in compulsory treatment. If true, this is incompatible with the ‘least restrictive alternative’ principle of the recently revised mental health legislation.
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12
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Tyrer P, Gordon F, Nourmand S, Lawrence M, Curran C, Southgate D, Oruganti B, Tyler M, Tottle S, North B, Kulinskaya E, Kaleekal JT, Morgan J. Controlled comparison of two crisis resolution and home treatment teams. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.108.023077] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Aims and methodTo compare an existing crisis resolution service with a new crisis resolution team (CRT) in Wales. The impact of the new team was measured by changes in bed days and admissions. A random sample of patients from each service was assessed for service satisfaction, social functioning and quality of life after first presentation.ResultsThe total number of bed days was reduced following the introduction of the new CRT (27.3%). The frequency and duration of compulsory admissions increased by 31% in the CRT between the first and second years and by 7% in the control service, offset by a greater reduction in informal admissions in the CRT (23.5%) compared with the control group (13.3%); overall bed usage was unchanged. Service satisfaction, social functioning and quality of life showed no important differences between the services.Clinical implicationsCrisis resolution teams may reduce informal admissions in the short term but at the cost of more compulsory admissions later.
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13
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Wullschleger A, Berg J, Bermpohl F, Montag C. Can "Model Projects of Need-Adapted Care" Reduce Involuntary Hospital Treatment and the Use of Coercive Measures? Front Psychiatry 2018; 9:168. [PMID: 29765339 PMCID: PMC5939233 DOI: 10.3389/fpsyt.2018.00168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 04/12/2018] [Indexed: 11/13/2022] Open
Abstract
Intensive outpatient models of need-adapted psychiatric care have been shown to reduce the length of hospital stays and to improve retention in care for people with severe mental illnesses. In contrast, evidence regarding the impact of such models on involuntary hospital treatment and other coercive measures in inpatient settings is still sparse, although these represent important indicators of the patients' wellbeing. In Germany, intensive models of care still have not been routinely implemented, and their effectiveness within the German psychiatric system is only studied in a few pioneering regions. An innovative model of flexible, assertive, need-adapted care established in Berlin, Germany, in 2014, treating unselected 14% of the catchment area's patients, was evaluated on the basis of routine clinical data. Records of n = 302 patients diagnosed with severe mental disorders, who had been hospitalized at least once during a 4-year-observational period, were analyzed in a retrospective individual mirror-image design, comparing the 2 years before and after inclusion in the model project regarding the time spent in hospital, the number and duration of involuntary hospital treatments and the use of direct coercive interventions like restraint or isolation. After inclusion to the project, patients spent significantly less time in hospital. Among patients treated on acute wards and patients with a diagnosis of psychosis, the number of patients subjected to provisional detention due to acute endangerment of self or others decreased significantly, as did the time spent under involuntary hospital treatment. The number of patients subjected to mechanical restraint, but not to isolation, on the ward decreased significantly, while the total number of coercive interventions remained unchanged. Findings suggest some potential of intensive models of need-adapted care to reduce coercive interventions in psychiatry. However, results must be substantiated by evidence from randomized-controlled trials and longer observation periods.
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Affiliation(s)
- Alexandre Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jürgen Berg
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Lloyd-Evans B, Fullarton K, Lamb D, Johnston E, Onyett S, Osborn D, Ambler G, Marston L, Hunter R, Mason O, Henderson C, Goater N, Sullivan SA, Kelly K, Gray R, Nolan F, Pilling S, Bond G, Johnson S. The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial. Trials 2016; 17:158. [PMID: 27004517 PMCID: PMC4804533 DOI: 10.1186/s13063-016-1283-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users' experiences of care, service use, staff well-being, and team model fidelity. METHODS/DESIGN Twenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services' electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study's primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline differences and participant characteristics using linear random effects modelling. Qualitative investigations with participating CRT managers and staff and programme facilitators will explore the experiences of the service improvement programme. DISCUSSION Our trial will show whether a theoretically underpinned and clearly defined package of resources are effective in supporting service improvement and improving outcomes for mental health crisis resolution teams. TRIAL REGISTRATION Current Controlled Trials ISRCTN47185233.
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Affiliation(s)
| | - Kate Fullarton
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Danielle Lamb
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Elaine Johnston
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Steve Onyett
- />Onyett Entero Ltd, Care of University of the West of England, Health and Life Sciences Coldharbour Ln, Bristol, BS16 1QY UK
| | - David Osborn
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Gareth Ambler
- />Department of Statistical Science, UCL, Gower Street, London, WC1E 6BT UK
| | - Louise Marston
- />Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF UK
| | - Rachael Hunter
- />Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF UK
| | - Oliver Mason
- />Department of Clinical Education and Health Psychology, UCL, Gower Street, London, WC1E 6BT UK
| | - Claire Henderson
- />Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Nicky Goater
- />West London Mental Health NHS Trust, Uxbridge Road, Southall, London, UB1 3EU UK
| | - Sarah A. Sullivan
- />Epidemiology and Health Services Research, CLAHRC West, Lewins Mead, Bristol, BS1 2NT UK
| | - Kathleen Kelly
- />Oxfordshire Healthcare NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Richard Gray
- />Mental Health Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Fiona Nolan
- />Centre for Outcomes Research and Effectiveness, Division of Psychology and language Sciences, UCL, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Stephen Pilling
- />Centre for Outcomes Research and Effectiveness, Division of Psychology and language Sciences, UCL, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Gary Bond
- />Department of Psychiatry, Dartmouth Psychiatric Research Centre, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756 USA
| | - Sonia Johnson
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
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15
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Begum R, Riordan S. Nurses experiences of working in Crisis Resolution Home Treatment Teams with its additional gatekeeping responsibilities. J Psychiatr Ment Health Nurs 2016; 23:45-53. [PMID: 26799055 DOI: 10.1111/jpm.12276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Through their gatekeeping role, CRHTT aim to reduce inappropriate admissions, facilitate early discharge from hospital and maximize the ability of service users to live independently within their own communities. It is evident that there is a vast array of literature on CRHTT internationally, however, little evidence on nurses experiences of working within CRHTT and gatekeeping. Therefore, in the light of limited research, this study aims to expand the current evidence base by exploring nurse's experiences of working in CRHTT with its additional gatekeeping responsibilities. METHODOLOGY Six nurses working across two CRHTT's were interviewed using semi-structured interviews. Data were analysed through the use of thematic analysis. RESULTS Four key themes emerged which were, 'CRHTT as a specialist role', 'core principles of the gatekeeping role', 'redefining risk management for gatekeepers in CRHTT' and 'the future of gatekeeping'. DISCUSSION It is evident through nurse's experiences of working within CRHTT and gatekeeping that their roles were very dynamic and challenging. A positive risk-taking approach contributed towards the success of CRHTT as gatekeepers. Family members played a significant role in ensuring gatekeeping remained a priority consistent with Government targets. Clinical Implications and recommendations for future research are discussed.
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Affiliation(s)
- R Begum
- Clinical and Corporate Nursing, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - S Riordan
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
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Wheeler C, Lloyd-Evans B, Churchard A, Fitzgerald C, Fullarton K, Mosse L, Paterson B, Zugaro CG, Johnson S. Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review. BMC Psychiatry 2015; 15:74. [PMID: 25879674 PMCID: PMC4405828 DOI: 10.1186/s12888-015-0441-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/16/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users' satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs. METHODS A systematic review was conducted. MEDLINE, Embase, PsycINFO, CINAHL and Web of Science were searched to November 2013. A further web-based search was conducted for government and expert guidelines on CRTs. We analysed studies separately as: comparing CRTs to Treatment as Usual; comparing two or more CRT models; national or regional surveys of CRT services; qualitative studies of stakeholders' views regarding best practice in CRTs; and guidelines from government and expert organisations regarding CRT service delivery. Quality assessment and narrative synthesis were conducted. Statistical meta-analysis was not feasible due to the variety of design of retrieved studies. RESULTS Sixty-nine studies were included. Studies varied in quality and in the composition and activities of the clinical services studied. Quantitative studies suggested that longer opening hours and the presence of a psychiatrist in the team may increase CRTs' ability to prevent hospital admissions. Stakeholders emphasised communication and integration with other local mental health services; provision of treatment at home; and limiting the number of different staff members visiting a service user. Existing guidelines prioritised 24-hour, seven-day-a-week CRT service provision (including psychiatrist and medical prescriber); and high quality of staff training. CONCLUSIONS We cannot draw confident conclusions about the critical components of CRTs from available quantitative evidence. Clearer definition of the CRT model is required, informed by stakeholders' views and guidelines. Future studies examining the relationship of overall CRT model fidelity to outcomes, or evaluating the impact of key aspects of the CRT model, are desirable. TRIAL REGISTRATION Prospero CRD42013006415 .
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Affiliation(s)
- Claire Wheeler
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Alasdair Churchard
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Caroline Fitzgerald
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Kate Fullarton
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Liberty Mosse
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Bethan Paterson
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Clementina Galli Zugaro
- Department of Psychology, University of Bath, Claverton Down, Bath, North East Somerset, BA2 7AY, UK.
| | - Sonia Johnson
- Division of Psychiatry, UCL, London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK.
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Hunt IM, Rahman MS, While D, Windfuhr K, Shaw J, Appleby L, Kapur N. Safety of patients under the care of crisis resolution home treatment services in England: a retrospective analysis of suicide trends from 2003 to 2011. Lancet Psychiatry 2014; 1:135-41. [PMID: 26360577 DOI: 10.1016/s2215-0366(14)70250-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Community care provided by crisis resolution home treatment teams is used increasingly as an alternative to admission to psychiatric wards. No systematic analysis has been done of the safety of these teams in terms of rates of suicide. We aimed to compare the rate and number of suicides among patients under the care of crisis resolution home treatment teams with those of psychiatric inpatients. We also assessed the clinical features of individuals who died by suicide in both home and hospital settings. METHODS We did a retrospective longitudinal analysis between 2003 and 2011 of all adults (aged 18 years or older) treated by the National Health Service in England who died by suicide while under the care of crisis resolution home treatment services or as a psychiatric inpatient. We obtained data from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness and from the Mental Health Minimum Dataset. FINDINGS 1256 deaths by suicide (12% of all patient suicides) were recorded among patients cared for under crisis resolution home treatment teams, an average of 140 deaths per year. Different denominators meant that direct comparison between groups was difficult, but the average rate of suicide under crisis resolution home treatment services (14·6 per 10 000 episodes under crisis care) seemed higher than the average rate of suicide among psychiatric inpatients (8·8 per 10 000 admissions). The number of suicides in patients under the care of crisis resolution home treatment teams increased from an average of 80 per year (in 2003 and 2004) to 163 per year (in 2010 and 2011) and were twice as frequent as inpatient suicides in the last few years of the study. However, because of the growing number of patients under the care of crisis resolution home treatment teams, the average rate of suicide fell by 18% between the first and last 2 years of the study. 548 (44%) patients who died by suicide under the care of crisis resolution home treatment teams lived alone and 594 (49%) had had a recent adverse life event. In a third of patients (n=428) under the care of crisis resolution home treatment teams, suicide happened within 3 months of discharge from psychiatric inpatient care. INTERPRETATION Although the number of suicides under the care of crisis resolution home treatment teams has risen since 2003, the rate has fallen. However, suicide rates remain high compared with the inpatient setting, and safety of individuals cared for by crisis resolution home treatment teams should be a priority for mental health services. For some vulnerable people who live alone or have adverse life circumstances, crisis resolution home treatment might not be the most appropriate care setting. Use of crisis resolution home treatment teams to facilitate early discharge could present a risk to some patients, which should be investigated further. FUNDING Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Isabelle M Hunt
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK.
| | - Mohammad Shaiyan Rahman
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - David While
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Jenny Shaw
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Homicide, Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester, UK
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Loader K. Resolving the psychiatric bed crisis: a critical analysis of policy. ACTA ACUST UNITED AC 2014; 23:150-2, 154-5. [PMID: 24526022 DOI: 10.12968/bjon.2014.23.3.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The National Service Framework (NSF) for Mental Health in 1999 was central to the modernisation of mental health services under the New Labour government of 1997. It placed an emphasis on universal clinical standards and set out a vision for service developments over the next 10 years. One such proposal was the development of crisis resolution teams, aimed at reducing the psychiatric admissions rate by providing care at home. This article provides a critical analysis of policies relating to the provision of 24-hour access to mental health services, focusing on the specifications for creating crisis resolution teams, as laid out in the NSF for Mental Health and the NHS Plan. First, it looks at the historical context surrounding the policy, examining the content of the NSF and NHS plan and how policy was disseminated and implemented nationally and locally. Then it examines the effects and changes this policy brought about and, specifically, whether it has achieved its aims of reducing the nationwide acute psychiatric inpatient admission rate.
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Affiliation(s)
- Katie Loader
- Community Mental Health Nurse at Gordon Hospital, Bloomburg Street, London
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Hasselberg N, Gråwe RW, Johnson S, Šaltytė-Benth J, Ruud T. Psychiatric admissions from crisis resolution teams in Norway: a prospective multicentre study. BMC Psychiatry 2013; 13:117. [PMID: 23594922 PMCID: PMC3637541 DOI: 10.1186/1471-244x-13-117] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 04/08/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Crisis resolution teams (CRTs) provide intensive alternative care to hospital admission for patients with mental health crises. The aims of this study were to describe the proportions and characteristics of patients admitted to in-patient wards from CRTs, to identify any differences in admission practices between CRTs, and to identify predictors of admissions from CRTs. METHODS A naturalistic prospective multicentre design was used to study 680 consecutive patients under the care of eight CRTs in Norway over a 3-month period in 2005/2006. Socio-demographic and clinical data were collected on the patients, and on the organization and operation of the CRTs. Logistic regression analysis for hierarchical data was used to test potential predictors of admission at team and patient level. RESULTS One hundred and forty-six patients (21.5%) were admitted to in-patient wards. There were significant differences in admission rates between the CRTs. The likelihood of being admitted to an in-patient ward was significantly lower for patients treated by CRTs that operated during extended opening hours than CRTs that operated during office hours only. Those most likely to be admitted were patients with psychotic symptoms, suicidal risk, and a prior history of admissions. CONCLUSIONS Extended opening hours may help CRTs to prevent more admissions for patients with moderately severe and relapsing mental illnesses. Patients with severe psychosis seem to be difficult to treat in the community by Norwegian CRTs even with extended opening hours.
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Affiliation(s)
- Nina Hasselberg
- Department of Research and Development, Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
| | - Rolf W Gråwe
- Department of Research and Development, Alcohol and Drug Treatment Health Trust in Central Norway, Trondheim, Norway,Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sonia Johnson
- Department of Mental Health Sciences, University College London, London, UK
| | - Jūratė Šaltytė-Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Torleif Ruud
- Department of Research and Development, Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abstract
BACKGROUND For too long there have been heated debates between those who believe that mental health care should be largely or solely provided from hospitals and those who adhere to the view that community care should fully replace hospitals. The aim of this study was to propose a conceptual model relevant for mental health service development in low-, medium- and high-resource settings worldwide. Method We conducted a review of the relevant peer-reviewed evidence and a series of surveys including more than 170 individual experts with direct experience of mental health system change worldwide. We integrated data from these multiple sources to develop the balanced care model (BCM), framed in three sequential steps relevant to different resource settings. RESULTS Low-resource settings need to focus on improving the recognition and treatment of people with mental illnesses in primary care. Medium-resource settings in addition can develop 'general adult mental health services', namely (i) out-patient clinics, (ii) community mental health teams (CMHTs), (iii) acute in-patient services, (iv) community residential care and (v) work/occupation. High-resource settings, in addition to primary care and general adult mental health services, can also provide specialized services in these same five categories. CONCLUSIONS The BCM refers both to a balance between hospital and community care and to a balance between all of the service components (e.g. clinical teams) that are present in any system, whether this is in low-, medium- or high-resource settings. The BCM therefore indicates that a comprehensive mental health system includes both community- and hospital-based components of care.
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Affiliation(s)
- G Thornicroft
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK.
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21
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Abstract
BACKGROUND Crisis resolution and home treatment teams (CRTs) and home treatment teams have been established nationwide in the UK to reduce admissions to psychiatric hospitals. However, the evidence for CRTs was limited at the time of their introduction. AIMS Review of the literature accumulated since the national rollout of CRTs in 2000. METHOD Systematic narrative literature review utilising British Nursing Index, Cinahl, Embase, Medline and PsyINFO. RESULTS The search revealed one randomised controlled trial and a number of naturalistic studies. The balance of evidence suggests that CRTs can reduce hospital beds and costs with similar symptomatic outcome and service user satisfaction, but there is no evidence that CRTs are the only way to do so. There is no conclusive evidence that CRTs cause an increase in serious and untoward incidents (SUIs) or compulsory admissions. CONCLUSIONS Currently, there is no compelling evidence for the widespread implementation of CRTs. In the future, the incidence of compulsory admissions and SUIs needs to be studied at a national level, CRTs have to be compared with other methods to reduce hospital admissions and studies need to specify sample and treatment characteristics with greater detail.
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Affiliation(s)
- Dieneke Hubbeling
- Wandsworth Crisis and Home Treatment Team, Springfield Hospital, London SW17 7DJ, UK.
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22
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Suicide on the Isle of Wight: A Case-study of 35 Suicides among Mental Health Service Users Between 2006 and 2008. Ir J Psychol Med 2012; 29:80-84. [PMID: 30199952 DOI: 10.1017/s0790966700017341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS To identify the sociodemographic, clinical and service delivery risk factors for suicide in psychiatric patients in a limited geographic area. METHOD A retrospective case study of 35 patients who died as a result of suicide between January 2006 and December 2008. RESULTS Male gender, unemployment, living alone, basic education and significant life events were identified as sociodemographic factors. A history of previous psychiatric admission, previous suicide attempt, suffering from depression, co-morbidity of another psychiatric disorder (mainly stress-related symptoms and alcoholism), and contacting the services prior to suicide were found as typical clinical factors. Hanging was the most common method of suicide in both men and women. Most men died in spring and summer, while the majority of females died in autumn. CLINICAL IMPLICATIONS As in similar studies, mental disorders could be identified as the strongest risk factor for suicide. Almost 70% of suicides were conducted by people suffering from a mental disorder. Treating mental disorders and identifying certain sociodemographic and clinical characteristics of people suffering from mental disorders and addressing them is the key in suicide prevention strategies.
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Hasselberg N, Gråwe RW, Johnson S, Ruud T. Treatment and outcomes of crisis resolution teams: a prospective multicentre study. BMC Psychiatry 2011; 11:183. [PMID: 22108030 PMCID: PMC3258194 DOI: 10.1186/1471-244x-11-183] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 11/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis resolution teams (CRTs) aim to help patients in acute mental health crises without admitting them to hospital. The aims of this study were to investigate content of treatment, service practice, and outcomes of crises of CRTs in Norway. METHODS The study had a multicentre prospective design, examining routine data for 680 patients and 62 staff members of eight CRTs. The clinical staff collected data on the demographic, clinical, and content of treatment variables. The service practices of the staff were assessed on the Community Program Practice Scale. Information on each CRT was recorded by the team leaders. The outcomes of crises were measured by the changes in Global Assessment of Functioning scale scores and the total scores on the Health of the Nation Outcome Scales between admission and discharge. Regression analysis was used to predict favourable outcomes. RESULTS The mean length of treatment was 19 days for the total sample (N = 680) and 29 days for the 455 patients with more than one consultation; 7.4% of the patients had had more than twice-weekly consultations with any member of the clinical staff of the CRTs. A doctor or psychologist participated in 55.5% of the treatment episodes. The CRTs collaborated with other mental health services in 71.5% of cases and with families/networks in 51.5% of cases. The overall outcomes of the crises were positive, with a small to medium effect size. Patients with depression received the longest treatments and showed most improvement of crisis. Patients with psychotic symptoms and substance abuse problems received the shortest treatments, showed least improvement, and were most often referred to other parts of the mental health services. Length of treatment, being male and single, and a team focus on out-of-office contact were predictors of favourable outcomes of crises in the adjusted model. CONCLUSIONS Our study indicates that, compared with the UK, the Norwegian CRTs provided less intensive and less out-of-office care. The Norwegian CRTs worked more with depression and suicidal crises than with psychoses. To be an alternative to hospital admission, the Norwegian CRTs need to intensify their treatment and meet more patients outside the office.
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Affiliation(s)
- Nina Hasselberg
- Department of Research and Development at the Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
| | - Rolf W Gråwe
- Department of Research and Development at the Alcohol and Drug Treatment Health Trust in Central Norway, Trondheim, Norway,Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sonia Johnson
- Department of Mental Health Sciences, University College London, London, UK
| | - Torleif Ruud
- Department of Research and Development at the Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Hasselberg N, Gråwe RW, Johnson S, Ruud T. An implementation study of the crisis resolution team model in Norway: are the crisis resolution teams fulfilling their role? BMC Health Serv Res 2011; 11:96. [PMID: 21569226 PMCID: PMC3116476 DOI: 10.1186/1472-6963-11-96] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 05/10/2011] [Indexed: 11/27/2022] Open
Abstract
Background The establishment of crisis resolution teams (CRTs) is part of the national mental health policy in several Western countries. The purpose of the present study is to describe characteristics of CRTs and their patients, explore the differences between CRTs, and examine whether the CRTs in Norway are organized according to the international CRT model. Methods The study was a naturalistic study of eight CRTs and 680 patients referred to these teams in Norway. Mental health problems were assessed using the Health of the Nation Outcome Scales (HoNOS), Global Assessment of Functioning Scales (GAF) and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Results None of the CRTs operated 24 hours a day, seven days a week (24/7 availability) or had gate-keeping functions for acute wards. The CRTs also treated patients who were not considered for hospital admission. Forty per cent of patients waited more than 24 hours for treatment. Fourteen per cent had psychotic symptoms, and 69% had affective symptoms. There were significant variations between teams in patients' total severity of symptoms and social problems, but no variations between teams with respect to patients' aggressive behaviour, non-accidental self-injury, substance abuse or psychotic symptoms. There was a tendency for teams operating extended hours to treat patients with more severe mental illnesses. Conclusions The CRT model has been implemented in Norway without a rapid response, gate-keeping function and 24/7 availability. These findings indicate that the CRTs do not completely fulfil their intended role in the mental health system.
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Affiliation(s)
- Nina Hasselberg
- R&D Department, Mental Health Services, Akershus University Hospital and Institute of Clinical Medicine, University Oslo, Norway.
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Cleary M, Hunt GE, Horsfall J, Deacon M. Ethnographic research into nursing in acute adult mental health units: a review. Issues Ment Health Nurs 2011; 32:424-35. [PMID: 21736465 DOI: 10.3109/01612840.2011.563339] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute inpatient mental health units are busy and sometimes chaotic settings, with high bed occupancy rates. These settings include acutely unwell patients, busy staff, and a milieu characterised by unpredictable interactions and events. This paper is a report of a literature review conducted to identify, analyse, and synthesize ethnographic research in adult acute inpatient mental health units. Several electronic databases were searched using relevant keywords to identify studies published from 1990-present. Additional searches were conducted using reference lists. Ethnographic studies published in English were included if they investigated acute inpatient care in adult settings. Papers were excluded if the unit under study was not exclusively for patients in the acute phase of their mental illness, or where the original study was not fully ethnographic. Ten research studies meeting our criteria were found (21 papers). Findings were grouped into the following overarching categories: (1) Micro-skills; (2) Collectivity; (3) Pragmatism; and (4) Reframing of nursing activities. The results of this ethnographic review reveal the complexity, patient-orientation, and productivity of some nursing interventions that may not have been observed or understood without the use of this research method. Additional quality research should focus on redefining clinical priorities and philosophies to ensure everyday care is aligned constructively with the expectations of stakeholders and is consistent with policy and the realities of the organisational setting. We have more to learn from each other with regard to the effective nursing care of inpatients who are acutely disturbed.
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Affiliation(s)
- Michelle Cleary
- University of Western Sydney, School of Nursing and Midwifery, Family and Community Health Research Group (FaCH), Sydney, New South Wales, Australia.
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Sjølie H, Karlsson B, Kim HS. Crisis resolution and home treatment: structure, process, and outcome - a literature review. J Psychiatr Ment Health Nurs 2010; 17:881-92. [PMID: 21078003 DOI: 10.1111/j.1365-2850.2010.01621.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ACCESSIBLE SUMMARY • During the last ten years there has been a major change in developing mental health services generally, and crisis resolution and home treatment (CRHT) services especially. Many Western countries have made a shift in perspective from in-hospital care to home treatment. The new approach is based on treating people who experience mental health crises in their homes instead of through hospitalization. • Most of the published articles on CRHT focus on structural issues pertaining to the development of home treatment services, and on macro-level outcomes such as cost-effectiveness and admission rates. These have political, economic, and practical implications. Few articles describe clinical intervention methods used in home treatment. • This paper explores how home treatment is described as an essential intervention method in crisis resolution at home in relation to three key characteristics of CRHT, which are being mobile, working in the service user's home, and working together with the person's family and network. • There remains a need for further research describing specific characteristics of home treatment, different clinical interventions that are used by CRHT teams, and the directions with which clinical interventions need to be developed further. It is critical to investigate what makes the interventions of the CRHT teams different from the hospital care, and how this affects the service users, the family and the networks, and the professionals. ABSTRACT The objective of this paper is to explore and systematize the existing knowledge regarding the structure, process, and outcome of crisis resolution and home treatment (CRHT) as a form of community mental health service. Data sources are published peer-reviewed articles. Our study selection is systematic search for peer-reviewed articles written in English and Norwegian published between January 2000 and December 2008. Data are extracted from review of published articles on the subject of CRHT team and home treatment. We identified 35 articles including 6 reviews, consisting of quantitative and qualitative studies. The knowledge regarding CRHT focuses on three areas: (1) structure in terms of the standards, organization, and development; (2) process in terms of clinical interventions; and (3) outcome in relation to cost-effectiveness and admission rates. While the structural issues were presented and discussed a great deal, there is a paucity of articles on clinical intervention methods in home treatment as well as a limited attention on outcomes at the micro-level. There is a need for further studies regarding the clinical work of CRHT teams from the home treatment perspective.
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Affiliation(s)
- H Sjølie
- Department of Health Sciences, The University College of Buskerud, Drammen, Norway.
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Horsfall J, Cleary M, Hunt GE. Acute inpatient units in a comprehensive (integrated) mental health system: a review of the literature. Issues Ment Health Nurs 2010; 31:273-8. [PMID: 20218771 DOI: 10.3109/01612840903295944] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute inpatient mental health units can be seen as one important link in the chain of complementary mental health specific and generic community support services that need to address the real needs of people in the area from which clients are drawn. This article reviews the reasons for admission to these units and research initiatives to evaluate alternative models of care within the community. Assertive community treatment and other alternative programs are discussed within a continuum of community-psychiatric support intervention models. An argument is then developed for mental health systems to be conceived within a continuous care framework for all service users, and with recovery in the forefront of service design and delivery. Further research is required to define nursing clinical priorities and philosophies to ensure a recovery focus in which care is aligned with that of consumer expectations and is consistent with other service providers.
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Affiliation(s)
- Jan Horsfall
- Sydney South West Area Mental Health Service, Concord Hospital, Sydney, Australia
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