Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems.
Care
Crisis
Emerging
Mental health
Models
Survey
Systems
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
29 Oct 2021
29 Oct 2021
Historique:
received:
06
07
2021
accepted:
15
10
2021
entrez:
29
10
2021
pubmed:
30
10
2021
medline:
3
11
2021
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 34711222
doi: 10.1186/s12913-021-07181-x
pii: 10.1186/s12913-021-07181-x
pmc: PMC8553397
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1174Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2021. The Author(s).
Références
Lloyd-Evans B, Johnson S. Community alternatives to inpatient admissions in psychiatry. World Psychiatry. 2019;18(1):31–2. https://doi.org/10.1002/wps.20587 .
doi: 10.1002/wps.20587
pubmed: 30600640
pmcid: 6313241
Bowers L, Chaplin R, Quirk A, Lelliott P. A conceptual model of the aims and functions of acute inpatient psychiatry. J Ment Health. 2009;18(4):316–25. https://doi.org/10.1080/09638230802053359 .
doi: 10.1080/09638230802053359
Farrelly S, Brown G, Rose D, Doherty E, Henderson RC, Birchwood M, et al. What service users with psychotic disorders want in a mental health crisis or relapse: thematic analysis of joint crisis plans. Soc Psych Psych Epid. 2014;49(10):1609–17. https://doi.org/10.1007/s00127-014-0869-1 .
doi: 10.1007/s00127-014-0869-1
Johnson S, Totman J, Hobbs L. Crisis and emergency services. In: Thornicroft G, Szmuckler G, Mueser K, Drake R, editors. Oxford textbook of community mental health. Oxford: Oxford University Press; 2011. p. 118–28. https://doi.org/10.1093/med/9780199565498.003.0068 .
doi: 10.1093/med/9780199565498.003.0068
Department of Health. The NHS Plan: a plan for investment, a plan for reform. 2000.
Johnson S. Crisis resolution and home treatment teams: an evolving model. Adv Psychiatr Treat. 2013;19(2):115–23. https://doi.org/10.1192/apt.bp.107.004192 .
doi: 10.1192/apt.bp.107.004192
Lambert M, Karow A, Gallinat J, Ludecke D, Kraft V, Rohenkohl A, et al. Study protocol for a randomised controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER). BMJ Open. 2020;10(5):e036021. https://doi.org/10.1136/bmjopen-2019-036021 .
doi: 10.1136/bmjopen-2019-036021
pubmed: 32371520
pmcid: 7223141
Murphy S, Irving CB, Adams CE, Waqar M. Crisis intervention for people with severe mental illnesses. Cochrane Database Syst Rev. 2015;12. https://doi.org/10.1002/14651858.CD001087.pub5 .
Wheeler C, Lloyd-Evans B, Churchard A, Fitzgerald C, Fullarton K, Mosse L, et al. Implementation of the crisis resolution team model in adult mental health settings: a systematic review. BMC Psychiatry. 2015;15(1):74. https://doi.org/10.1186/s12888-015-0441-x .
doi: 10.1186/s12888-015-0441-x
pubmed: 25879674
pmcid: 4405828
Marshall M, Crowther R, Sledge WH, Rathbone J, Soares-Weiser K. Day hospital versus admission for acute psychiatric disorders. Cochrane Database Syst Rev. 2011;12:CD004026. https://doi.org/10.1002/14651858.CD004026.pub2 .
doi: 10.1002/14651858.CD004026.pub2
Morant N, Davidson M, Wackett J, Lamb D, Pinfold V, Smith D, et al. Acute day units for mental health crises: a qualitative study of service user and staff views and experiences. BMC Psychiatry. 2021;21(1):1–12. https://doi.org/10.1186/s12888-021-03140-2 .
Lamb D, Steare T, Marston L, Canaway A, Johnson S, Kirkbride JB, et al. 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(2):1–8. https://doi.org/10.1192/bjo.2021.30 .
Kallert TW, Glockner M, Priebe S, Briscoe J, Rymaszewska J, Adamowski T, et al. A comparison of psychiatric day hospitals in five European countries: implications of their diversity for day hospital research. Soc Psychiatry Psychiatr Epidemiol. 2004;39(10):777–88. https://doi.org/10.1007/s00127-004-0813-x .
doi: 10.1007/s00127-004-0813-x
pubmed: 15669658
Lamb D, Davidson M, Lloyd-Evans B, Johnson S, Heinkel S, Steare T, et al. Adult mental health provision in England: a national survey of acute day units. BMC Health Serv Res. 2019;19(1):866. https://doi.org/10.1186/s12913-019-4687-8 .
doi: 10.1186/s12913-019-4687-8
pubmed: 31752861
pmcid: 6868849
Lloyd-Evans B, Slade M, Jagielska D, Johnson S. Residential alternatives to acute psychiatric hospital admission: systematic review. Br J Psychiatry. 2009;195(2):109–17. https://doi.org/10.1192/bjp.bp.108.058347 .
doi: 10.1192/bjp.bp.108.058347
pubmed: 19648539
Byford S, Sharac J, Lloyd-Evans B, Gilburt H, Osborn DP, Leese M, et al. Alternatives to standard acute in-patient care in England: readmissions, service use and cost after discharge. Br J Psychiatry Suppl. 2010;53:s20–5. https://doi.org/10.1192/bjp.bp.110.081067 .
doi: 10.1192/bjp.bp.110.081067
pubmed: 20679275
Care Quality Commission. Right here, right now – help, care and support during a mental health crisis. 2015.
Jacobs R, Barrenho E. Impact of crisis resolution and home treatment teams on psychiatric admissions in England. Br J Psychiatry. 2011;199(1):71–6. https://doi.org/10.1192/bjp.bp.110.079830 .
doi: 10.1192/bjp.bp.110.079830
pubmed: 21292926
Lamb D, Lloyd-Evans B, Fullarton K, Kelly K, Goater N, Mason O, et al. 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(2):187–201. https://doi.org/10.1111/inm.12658 .
doi: 10.1111/inm.12658
pubmed: 31566846
Paton F, Wright K, Ayre N, Dare C, Johnson S, Lloyd-Evans B, et al. Improving outcomes for people in mental health crisis: a rapid synthesis of the evidence for available models of care. Health Technol Assess. 2016;20(3):1–162. https://doi.org/10.3310/hta20030 .
doi: 10.3310/hta20030
pubmed: 27094189
pmcid: 4860560
HM Government. Mental health crisis care concordat improving outcomes for people experiencing mental health crisis. 2014.
Newbigging K, Rees J, Ince R, Mohan J, Joseph D, Ashman M, et al. The contribution of the voluntary sector to mental health crisis care: a mixed-methods study. Health Serv Deliv Res. 2020;8(29):1–199. https://doi.org/10.3310/hsdr08290 .
Lloyd-Evans B, Lamb D, Barnby J, Eskinazi M, Turner A, Johnson S. Mental health crisis resolution teams and crisis care systems in England: a national survey. BJPsych Bull. 2018;42(4):146–51. https://doi.org/10.1192/bjb.2018.19 .
doi: 10.1192/bjb.2018.19
pubmed: 29792390
pmcid: 6436049
Mind. Listening to experience: An independent inquiry into acute and crisis mental health care. 2011.
Wood C. Listen and you might learn. Pure Potential Scotland; 2016. https://www.slideshare.net/CarolynWood2/listen-and-you-might-learn-report-2016-public . Accessed 10/05/2021.
Wood C. Proposal for an out of hours crisis Café for north East Glasgow. Pure Potential Scotland; 2017. https://purepotentialscotland.co.uk/wp-content/uploads/2017/10/Proposal-for-an-Out-of-Hours-Crisis-Cafe-NE-Glasgow-1ST.pdf . Accessed 10/05/2021.
Surrey and Borders Partnership NHS Foundation Trust. ‘The Safe Haven’ Aldershot: Evaluation Report. 2014.
Reveruzzi B, Pilling S. Street Triage: Report on the evaluation of nine pilot schemes in England. London: UCL; 2016. https://www.ucl.ac.uk/pals/sites/pals/files/street_triage_evaluation_final_report.pdf . Accessed 10/05/2021.
Goldsmith LP, Anderson K, Clarke G, Crowe C, Jarman H, Johnson S, et al. The psychiatric decision unit as an emerging model in mental health crisis care: a national survey in England. Int J Ment Health Nurs. 2021;30(4):955–62. https://doi.org/10.1111/inm.12849 .
doi: 10.1111/inm.12849
pubmed: 33630402
Medical Research Council. Developing and evaluating complex interventions: New guidance. 2019.
Johnson S, Gilburt H, Lloyd-Evans B, Osborn DP, Boardman J, Leese M, et al. In-patient and residential alternatives to standard acute psychiatric wards in England. Br J Psychiatry. 2009;194(5):456–63. https://doi.org/10.1192/bjp.bp.108.051698 .
doi: 10.1192/bjp.bp.108.051698
pubmed: 19407278
Lloyd-Evans B, Paterson B, Onyett S, Brown E, Istead H, Gray R, et al. National implementation of a mental health service model: a survey of crisis resolution teams in England. Int J Ment Health Nurs. 2018;27(1):214–26. https://doi.org/10.1111/inm.12311 .
doi: 10.1111/inm.12311
pubmed: 28075067
UK Parliament. Freedom of information act 2000. 2000.
Medical Research Council Regulatory Support Centre. Is my study research? 2017 [cited 2021 18/05/2021]. Available from: http://www.hra-decisiontools.org.uk/research/ .
Cambridge and Peterborough NHS Foundation Trust. First Response Service (FRS) 2021 [Available from: https://www.cpft.nhs.uk/service-detail/service/first-response-service-frs-21/ .
Central and North West London NHS Trust. Single Point of Access service 2021 [cited 2021 10/05/2021]. Available from: https://www.cnwl.nhs.uk/services/mental-health-services/adult-and-older-adult/single-point-access .
Richmond Fellowship. Lowther Street Crisis House in Cumbria 2021 [cited 2021 10/05/2021]. Available from: https://www.recoveryfocus.org.uk/find-services/crisis-support-service/lowther-street-crisis/?view=map-view .
Camden and Islington NHS Foundation Trust. Drayton Park Women's Crisis House 2021 [cited 2021 10/05/2021]. Available from: https://www.candi.nhs.uk/services/drayton-park-womens-crisis-house-and-resource-centre .
Mind. Bexley Crisis Café 2021 [cited 2021 10/05/2021]. Available from: https://mindinbexley.org.uk/crisis-cafe .
Leeds Survvior-Led Crisis Service. Dial House 2021 [cited 2021 18/05/2021]. Available from: https://www.lslcs.org.uk/about-us/ .
Coventry and Warwickshire Partnership NHS Trust. Fennell Acute Day Treatment Service in Coventry 2021 [cited 2021 10/05/2021]. Available from: https://www.covwarkpt.nhs.uk/service-detail/health-service/fennell-acute-day-treatment-service-756/ .
Tees Esk, and Wear Valley NHS Foundation Trust. Teeside Street Triage 2021 [cited 2021 10/05/2021]. Available from: https://www.tewv.nhs.uk/services/street-triage/ .
Sheffield Health and Social Care NHS Foundation Trust. Sheffield Decision Unit 2021 [cited 2021 10/05/2021]. Available from: https://www.shsc.nhs.uk/services/decisions-unit
Greater Manchester Mental Health NHS Foundation Trust. Swift Assessment for the Immediate Resolution of Emergencies (SAFIRE) Unit in Manchester 2021 [cited 2021 10/05/2021]. Available from: https://www.gmmh.nhs.uk/safire-unit .
Hertfordshire Partnership University NHS Foundation Trust. Hertfordshire Host Families Scheme 2021 [cited 2021 10/05/2021]. Available from: https://www.hpft.nhs.uk/services/acute-and-rehabilitation-services/alternative-services-to-an-inpatient-stay/host-families-scheme/ .
Morant N, Lloyd-Evans B, Lamb D, Fullarton K, Brown E, Paterson B, et al. Crisis resolution and home treatment: stakeholders’ views on critical ingredients and implementation in England. BMC Psychiatry. 2017;17(1):254. https://doi.org/10.1186/s12888-017-1421-0 .
doi: 10.1186/s12888-017-1421-0
pubmed: 28716022
pmcid: 5512942
Hussain D. Mental health patient slept in a CHAIR for a week while waiting for a bed. Birmingham: Birmingham Live; 2017. https://www.birminghammail.co.uk/news/midlands-news/mental-health-patient-slept-chair-13906129 . Accessed 02/07/2021.
Health Innovation Network. SIM London end of year report. London: Health Innovation Network; 2020. https://healthinnovationnetwork.com/wp-content/uploads/2020/10/SIM-London-End-of-Year-Report-2020FINAL.pdf . Accessed 06/09/2021.
StopSIM: Mental illness is not a crime. https://stopsim.co.uk/ . Accessed 5 Nov 2021.
Royal College of Nursing. RCN position on the national rollout of Serenity Integrated Mentoring (SIM) and other similar models in England. 2021.
Centre for Mental Health. Updated: Centre for Mental Health responds to the Serenity Integrated Mentoring (SIM) model. 2021.
Johnson S, Dalton-Locke C, Vera San Juan N, Foye U, Oram S, Papamichail A, et al. Impact on mental health care and on mental health service users of the COVID-19 pandemic: a mixed methods survey of UK mental health care staff. Soc Psychiatry Psychiatr Epidemiol. 2021;56(1):25–37. https://doi.org/10.1007/s00127-020-01927-4 .
doi: 10.1007/s00127-020-01927-4
pubmed: 32857218
Royal College of Psychiatrists. Alternatives to emergency departments for mental health assessments during the COVID-19 pandemic. 2020.
National Suicide Prevention Alliance. Beachy Head Chaplaincy Team 2021 [cited 2021 18/05/2021]. Available from: https://nspa.org.uk/member/beachy-head-chaplaincy-team/ .
Lloyd-Evans B, Osborn D, Marston L, Lamb D, Ambler G, Hunter R, et al. The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial. Br J Psychiatry. 2020;216(6):314–22. https://doi.org/10.1192/bjp.2019.21 .
doi: 10.1192/bjp.2019.21
pubmed: 30761976
pmcid: 7511901