Article

Assessing the Impact of Community-Based Mobile Crisis Services on Preventing Hospitalization

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Abstract

This study evaluated the impact of a community-based mobile crisis intervention program on the rate and timing of hospitalization. It also explored major consumer characteristics related to the likelihood of hospitalization. A quasi-experimental design with an ex post matched control group was used. A community-based mobile crisis intervention cohort (N=1,696) was matched with a hospital-based intervention cohort (N=4,106) on seven variables: gender, race, age at the time of crisis service, primary diagnosis, recency of prior use of services, indication of substance abuse, and severe mental disability certification status. The matching process resulted in a treatment group and a comparison group, each consisting of 1,100 subjects. Differences in hospitalization rate and timing between the two groups were assessed with a Cox proportional hazards model. The community-based crisis intervention reduced the hospitalization rate by 8 percentage points. A consumer using a hospital-based intervention was 51 percent more likely than one using community-based mobile crisis services to be hospitalized within the 30 days after the crisis (p<.001). Treating a greater proportion of clients in the community rather than hospitalizing them did not increase the risk of subsequent hospitalization. Those most likely to be hospitalized were young, homeless, and experiencing acute problems; they were referred by psychiatric hospitals, the legal system, or other treatment facilities; they showed signs of substance abuse, had no income, and were severely mentally disabled. Results indicate that community-based mobile crisis services resulted in a lower rate of hospitalization than hospital-based interventions. Consumer characteristics were also associated with the risk of hospitalization.

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... The focus of IHT teams is on stabilising the psychiatric crisis in order to prevent hospitalisation and facilitate early hospital discharge by providing intensive care three times a week (5,6). Earlier studies have found that IHT achieves a modest positive reduction of acute psychiatric hospitalisation and inpatient days (1,(7)(8)(9)(10). Nevertheless, like any other treatment, IHT is no magic bullet and hospitalisation is not prevented in all patients. ...
... Particularly the "aggression" domain is often presented in the literature as a predictor of psychiatric hospitalisation of IHT patients. Certain factors in this domain, such as not being amenable to assessment, violence during an episode of illness or referral by the judiciary, have repeatedly been found to be positively associated with hospitalisation (7,11,14). We therefore expected the "aggression" domain to explain the highest percentage of variance in hospitalisation and that individual factors in this domain would continue to be positively associated with hospitalisation, even after adjustment for the other domains. ...
... The relative risk and absolute risk of hospitalisation within 6 weeks were lower for those employed participants compared to unemployed. Having higher income or paid employment was found to be associated with preventing hospitalisation, which is in line with the previous findings in the literature (7,8). The evidence is mixed regarding gender as a predictive factor of hospitalisation. ...
Article
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Objective: This study aims to determine factors associated with psychiatric hospitalisation of patients treated for an acute psychiatric crisis who had access to intensive home treatment (IHT). Methods: This study was performed using data from a randomised controlled trial. Interviews, digital health records and eight internationally validated questionnaires were used to collect data from patients on the verge of an acute psychiatric crisis enrolled from two mental health organisations. Thirty-eight factors were assigned to seven risk domains. The seven domains are “sociodemographic”, “social engagement”, “diagnosis and psychopathology”, “aggression”, “substance use”, “mental health services” and “quality of life”. Multiple logistic regression analysis (MLRA) was conducted to assess how much pseudo variance in hospitalisation these seven domains explained. Forward MLRA was used to identify individual risk factors associated with hospitalisation. Risks were expressed in terms of relative risk (RR) and absolute risk difference (ARD). Results: Data from 183 participants were used. The mean age of the participants was 40.03 (SD 12.71), 57.4% was female, 78.9% was born in the Netherlands and 51.4% was employed. The range of explained variance for the domains related to “psychopathology and care” was between 0.34 and 0.08. The “aggression” domain explained the highest proportion ( R ² = 0.34) of the variance in hospitalisation. “Quality of life” had the lowest explained proportion of variance ( R ² = 0.05). The forward MLRA identified four predictive factors for hospitalisation: previous contact with the police or judiciary (OR = 7.55, 95% CI = 1.10–51.63; ARD = 0.24; RR = 1.47), agitation (OR = 2.80, 95% CI = 1.02–7.72; ARD = 0.22; RR = 1.36), schizophrenia spectrum and other psychotic disorders (OR = 22.22, 95% CI = 1.74–284.54; ARD = 0.31; RR = 1.50) and employment status (OR = 0.10, 95% CI = 0.01–0.63; ARD = −0.28; RR = 0.66). Conclusion: IHT teams should be aware of patients who have histories of encounters with the police/judiciary or were agitated at outset of treatment. As those patients benefit less from IHT due to the higher risk of hospitalisation. Moreover, type of diagnoses and employment status play an important role in predicting hospitalisation.
... Use of MCO services was associated with fewer bed requests made by ED providers. Our rates of MCO patient hospitalization were similar to those reported by Guo et al. 16 Reductions in hospitalization with the use of MCO were found by Guo et al and Hugo et al. 16,17 Fisher et al found no difference in psychiatric admission rates between communities that provided mobile crisis services and those that did not. 18 The disparity in results is likely due to differences in study populations. ...
... Use of MCO services was associated with fewer bed requests made by ED providers. Our rates of MCO patient hospitalization were similar to those reported by Guo et al. 16 Reductions in hospitalization with the use of MCO were found by Guo et al and Hugo et al. 16,17 Fisher et al found no difference in psychiatric admission rates between communities that provided mobile crisis services and those that did not. 18 The disparity in results is likely due to differences in study populations. ...
... The methodology used by Guo et al and Hugo et al was similar to what we used in our study in that they compared hospitalization rates between patients who used MCO services with those who did not, while Fisher et al compared patients who had MCO services in their communities to those who did not have communitybased MCO services. [16][17][18] We speculate that the ED used the MCO when a patient needed an alternative disposition other than hospitalization. ...
Article
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Introduction: Mental health and substance use disorder (MHSUD) patients in the emergency department (ED) have been facing increasing lengths of stay due to a shortage of inpatient beds. Previous research indicates mobile crisis outreach (MCO) reduces long ED stays for MHSUD patients. Our objective was to assess the impact of MCO contact on future ED utilization. Methods: We conducted a retrospective chart review of patients presenting to a large Midwest university ED with an MHSUD chief complaint from 2015-2018. We defined the exposure as those who had MCO contact and any MHSUD-related ED visit within 30 days of MCO contact. The MCO patients were 2:1 propensity score-matched by demographic data and comorbidities matched to patients with no MCO contact. Outcomes were all-cause and psychiatric-specific reasons for return to the ED within one year of the index ED visit. We report descriptive statistics and odds ratios (OR) to describe the difference between the two groups, and hazard ratios (HR) to estimate the risk of return ED visit. Results: The final sample included 106 MCO and 196 non-MCO patients. The MCO patients were more likely to be homeless (OR 14.8; 95% confidence interval [CI],1.87, 117), less likely to have adequate family or social support (OR 0.51; 95% CI, 0.31, 0.84), and less likely to have a hospital bed requested for them in the index visit by ED providers (OR 0.50; 95% CI, 0.29, 0.88). For those who returned to the ED, the median time for all-cause return to the ED was 28 days (interquartile range [IQR]: 6-93 days) for the MCO patients and 88 days (IQR: 20-164 days) for non-MCO patients. The risk of all-cause return to the ED was greater among MCO patients (67%) compared to non-MCO patients (49%) (adjusted HR: 1.66; 95% CI, 1.22, 2.27). Conclusion: The MCO patients had less family and social support; however, they were less likely to require hospitalization for each visit, likely due to MCO involvement. Patients with MCO contact presented to the ED more frequently than non-MCO patients, which implies a strong linkage between the ED and MCO in our community. An effective referral to community service from the ED and MCO and collaboration could be the next step to improve healthcare utilization.
... In Europe, the Anglo-Saxon ambulatory care model shares some commonalities with BTCs, which include care units such as a Crisis Resolution Team (CRT) or mobile crisis units and Community Health Centers. Indeed, drawing particularly on the American experience of mobile crisis units, since the 2000s, British health authorities have developed crisis resolution teams that have been proven to prevent hospitalizations and to reduce costs [6][7][8][9]. Crisis resolution units are mobile, multidisciplinary teams that can be requested at any time, offering home crisis interventions that can potentially result in several psychiatric interventions per day. ...
... Crisis resolution team) shares some commonalities with BTCs. Indeed, the crisis resolution teams that have been proven to prevent hospitalizations and to reduce costs [6][7][8][15][16][17]. ...
Article
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Background: Brief therapy centers (BTCs) are outpatient mental health units based initially on a psychodynamic model of crisis intervention, and evolving later into a global care approach. The main objective of BTC is to provide mentally ill patients with a viable alternative to hospitalization. Methods: We undertook a retrospective study of 323 patients admitted to a BTC in Geneva in order to understand the evolution of our patients care over the changes in psychiatry over the last 2 decades. To this end, we considered predictive factors of relapse for 160 individuals with repeated “revolving door” admissions compared to 163 patients with a single admission to the BTC. To analyze data, we mainly use analysis of variance and logistic regression with SPSS software. Results: Living alone, lower socio-educational levels, unstable working conditions, crisis factor of professional trouble, and preexisting psychiatric conditions, such as depression, bipolar disorders, psychotic disorders or borderline personality disorder, that required multiple social and systemic interventions, and medical treatments (such as antipsychotics and mood stabilizers) increase probability that patients relapse and require multiple BTC admissions. Conclusions: The results of the present study that are considered as preliminary, support the development of ambulatory mental health units that attempt to adapt their intervention practices to different populations in order to prevent the revolving door phenomenon and therefore contribute to improve the global system of mental health.
... Guo i wsp. [28] poddali ocenie wpływ programu mobilnej interwencji kryzysowej w ramach opieki środowiskowej na częstość i długość hospitalizacji. Mobilny zespół interwencji kryzysowej zmniejszył liczbę hospitalizacji o 8%. ...
... It has been shown that community-based treatment does not change the burden of the family, but reduces disruptive behaviors as assessed by family members. Guo et al. [28] evaluated the impact of a community-based mobile crisis intervention program on the frequency and duration of hospitalizations. A Mobile Crisis Intervention Team reduced hospitalizations by 8%. ...
... Regarding other illness-related factors and socio-demographic characteristics, little is known about what types of patient benefit most from HT Murphy et al. 2015). There is some evidence that being older, female and employed might reduce the risk of hospital admission during HT (Cotton et al. 2007;Glover et al. 2006;Guo et al. 2001). Another study, without multivariate analysis, found that living alone was a risk factor for hospital admission during HT (Dean and Gadd 1990). ...
... Half of the treatment cases were classified as more successful in the sense that they spent > 50% of the total treatment episode in HT, their treatment duration was < 40 days and the treatment was terminated by mutual agreement. Similar to a previous study (Guo et al. 2001), we found that patients with lower symptom severity and those who were fully or partially employed were more likely to have a successful replacement of hospital care by HT. In addition, patients who were directly admitted to HT had a higher likelihood of successful replacement. ...
Article
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Home treatment (HT) has been proposed as an alternative to inpatient treatment for individuals in acute mental crises. However, there is limited evidence concerning the effectiveness of HT to date. The aim of this study was to investigate which patients benefit most from HT. The concept and utilization of two HT services in Switzerland were retrospectively compared based on routine medical data of all patients who were treated in one of the two HT services between July 2016 and December 2017. We examined which patient characteristics were related to successful replacement of hospital care by HT based on a calculated success score using binary regression analyses. The whole sample included 408 individuals with an average age of 43 years and of whom 68% were female. As a result of conceptual similarities, in both HT settings, the typical patient was middle-aged, female and having an affective disorder as the main diagnosis. Half of the treatment cases met the criteria of successful replacement of hospital care (> 50% of the total treatment episodes in HT, treatment duration < 40 days and treatment terminated by mutual agreement). The results of the regression analyses indicated that patients with a lower symptom severity at admission (lower HoNOS score) and those who were employed had more likely a successful replacement of hospital care.The findings suggest that patients with acute mental disorders who have a certain level of functioning and social support might benefit most from HT in the sense of successful replacement of hospital care.
... The authors concluded that care based on crisis intervention principles, with or without an ongoing home care package, appears to be a viable and acceptable way of treating people with serious mental illnesses, however more evaluative studies are needed. Guo et al (2001) compared emergency mobile crisis intervention and hospital based intervention cohorts, each with 1100 patients and found that patients treated via hospital based intervention was 51% more likely to be hospitalized within one month following the crisis (p<.001). This study N o v a S c i e n c e P u b l i s h i n g , I n c . ...
Book
This book summarizes findings of studies that are united by a common theme of needs of psychiatric patients in Israel. The studies were performed from 2001-2010, in the Research Unit of Mental Health Services at the Ministry of Health and were motivated by the authors' deep need to learn more about the met and mainly unmet needs of mentally ill people, and an urgent demand to develop innovative health services or adjust the existing ones to both meet the needs and improve the quality of care and quality of life of their patients. Although the conception of need is a composite one and can be defined in multiple ways to include different aspects of common wishes motivating human activities and ways of their fulfillment, the authors' used the Bradshaw definition of need (1972) as 'perceived' need or what individuals believe they require. Within the context of health care, a need was considered a lack of health or welfare, or a lack of access to care. All the investigations were conducted in parallel with the Mental Health Reform in Israel and therefore reflect the specific needs and demands of deinstitutionalization. The selection of topics, the emphasis on briefly summarizing research findings rather than exhaustively reviewing the scientific literature and providing practical recommendations are intended to make the book an interesting and useful resource for policymakers, clinicians, and other health professionals, such as clinical psychologists, social workers, occupational therapists, general and family medical practitioners, nursing personnel, family members and other support persons, and perhaps mentally ill persons themselves.
... Other options include community crisis teams, community crisis beds and specialized mental health units within police forces to deal with emergency mental health situations. 7,8 Residents' exposure to these additional models of care will vary, depending on the location of the particular program and the region it services. An understanding of these components can be introduced in core teaching and followed up with elective experiences as permitted. ...
... Recently, Fleisch et al. [18] reported on a street psychiatry rotation for residents, which focused on learning to engage homeless people on the street in order to connect them with case management. Student-run clinics also provide opportunities for medical students in particular to learn about the homeless population [19], and mobile crisis services may also provide a rich team-based milieu that can demonstrate effective outreach [20]. ...
... The longer inpatient stays in China may reflect fewer available community-based treatment options [7]. Previous studies in other countries indicated that community-based programs were effective to lower hospitalization rates among psychiatric patients, and they can divert patients from inpatient care to community-based treatment [45,46]. A survey in 50 low-and middle-income countries suggested that people with schizophrenia in low-and middle-income countries had limited access to specialized mental health services, and inpatient mental health facilities only modestly contributed to overall service accessibility [47]. ...
Article
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Background Schizophrenia is one of the leading public health issues in psychiatry and imposes a heavy financial burden on the healthcare systems. This study aims to report the direct medical costs and the associated factors for patients with schizophrenia in Guangzhou city, Southern China. Methods This was a retrospective 4-year cohort study. Data were obtained from urban health insurance claims databases of Guangzhou city, which contains patients’ sociodemographic characteristics, direct medical costs of inpatient and outpatient care. The study cohort (including all the reimbursement claims submitted for schizophrenia inpatient care during November 2010 and October 2014) was identified using the International Classification of Diseases Tenth version (F20). Their outpatient care information was merged from outpatient claims database. Descriptive analysis and the multivariate regression analysis based on Generalized Estimating Equations model were conducted. Results A total of 2971 patients were identified in the baseline. The cohort had a mean age of 50.3 years old, 60.6% were male, and 67.0% received medical treatment in the tertiary hospitals. The average annual length of stay was 254.7 days. The average annual total direct medical costs per patient was 41,972.4 Chinese Yuan (CNY) ($6852.5). The inpatient costs remained as the key component of total medical costs. The Urban Employee Basic Medical Insurance enrollees with schizophrenia had higher average costs for hospitalization (CNY42,375.1) than the Urban Resident Basic Medical Insurance enrollees (CNY40,917.3), and had higher reimbursement rate (85.8% and 61.5%). The non-medication treatment costs accounted for the biggest proportion of inpatient costs for both schemes (55.8% and 64.7%). Regression analysis suggested that insurance type, age, hospital levels, and length of stay were significantly associated with inpatient costs of schizophrenia. Conclusions The direct annual medical costs of schizophrenia were high and varied by types of insurance in urban China. The findings of this study provide vital information to understand the burden of schizophrenia in China. Results of this study can help decision-makers assess the financial impact of schizophrenia.
... On the other hand, crisis-oriented services help to ensure that youth with mental health needs receive effective crisis stabilization services and ongoing care and are able to remain in their homes and communities whenever possible. others, as well as utilization of emergency departments, inpatient hospitalization, or arrest (Dolan & Mace, 2006;Guo, Biegel, Johnsen, & Dyches, 2001;Hugo, Smout, & Bannister, 2002;SAMHSA, 2014;Scott, 2000;Shulman & Athey, 1993;Tishler, Reiss, & Rhodes, 2007). Second, mobile crisis services reduce barriers to accessing care by providing initial responses and follow-up care primarily in homes, schools, and other community settings which may help to ameliorate the impact of stigma (Corrigan, Druss, & Perlick, 2014) and the difficulties of navigating an often fragmented system (Sturm & Sherbourne, 2001). ...
... Generally, the goals of crisis intervention include stabilization of an individual's acute distress, restoration of adaptive psychological functioning, reduction of functional impairment and facilitating access to continued care if needed (Everly & Lating 2019). This is accomplished through providing formal "real-time" access to community-or employer-based crisis intervention services in the form of telephone crisis hotlines, mobile crisis response units, CISM and psychological first aid interventions, walk-in clinics and more recently, police officers specifically trained in crisis intervention techniques (Everly, 2017;Guo et al., 2001;Hoffberg et al., 2019;Rogers et al., 2019;Sabinis & Glick, 2012). Studies have shown that access to community-based intervention and occupation-specific crisis intervention programs have been effective in reducing suicidal bereavement (Visser et al., 2014), reducing mild psychiatric symptoms (Sharifi et al., 2013) and mitigating post-traumatic stress injury among public safety and healthcare providers (Anderson et al., 2020). ...
Article
Full-text available
Two previous studies by Burnett and colleagues found preliminary support for several innate well-being and behavioral variables that contribute to one's Psychological Body Armor's TM (PBA), which is comprised of two unique interacting pathways (proactive and reactive resilience) among trained disaster mental health responders and the general population. This study sought to improve, expand, and replicate the findings of these two studies. Data was collected from 509 Amazon Mechanical Turk workers and 343 trained novice and experienced disaster mental health crisis intervention responders, who were general members of the International Critical Incident Stress Foundation or the Michigan Crisis Response Association, eight months into the COVID-19 global pandemic. Participants completed eight of the original measures used in the original studies, three revised measures, five new measures and an open-ended question about one's spiritual wellness routines. Controlling for the level of social disruption due to COVID-19, several significant correlations for both pathways were found similar to the two previous studies. Among both samples, hierarchical regression analyses revealed that mindfulness and self-efficacy were significant predictors of resilience capacity for the proactive pathway, while personal relationships with others was a significant predictor for the reactive pathway. Similar to the two previous studies, qualitative comparative analysis (QCA) revealed having professional crisis intervention training contributed more to strong resilience for both pathways. Transcendental phenomenological qualitative data analysis identified 14 spiritual wellness routines among crisis responders with prayer, reading religious literature, meditation and attending religious services being the most frequent.
... Other options include community crisis teams, community crisis beds and specialized mental health units within police forces to deal with emergency mental health situations. 7,8 Residents' exposure to these additional models of care will vary, depending on the location of the particular program and the region it services. An understanding of these components can be introduced in core teaching and followed up with elective experiences as permitted. ...
... Bien des hôpitaux dans les petites municipalités ou en région rurale n'ont pas les ressources financières ou humaines pour mettre en place un service d'urgences psychiatriques. D'autres options existent, notamment l'équipe d'intervention mobile, l'hébergement en centre de crise communautaire et l'unité de santé mentale spécialisée du service de police qui intervient dans les situations d'urgence en santé mentale 7,8 . L'exposition des résidents à ces autres modèles varie selon le lieu du programme en question et la région qu'il dessert. ...
... The hazard rate translates the length of time it takes for the event to occur into an expression of the speed with which it occurs (Wells & Guo, 2004). Those former prisoners who were not re-incarcerated are censored cases and the Cox model is appropriate for analyzing a data set that contains censored cases (Guo, Biegel, Johnsen, & Dyches, 2001). ...
Article
Sex offender outcome studies continue to produce mixed results. A common critique of these studies is their lack of methodological rigor. This study attempts to address this critique by adhering to the standards established by the Collaborative Outcome Data Committee (CODC) aimed at increasing the quality and confidence in outcome studies. We examined recidivism outcomes for a sample of formerly incarcerated sex offenders who participated in a state prison-based cognitive-behavioral-skills-based treatment program. We used propensity score analysis to compare treatment participants with a matched sample of non-participants. The final sample post-matching (n = 512) was observed for a minimum of 4 years and a maximum of 14 years. Using survival analysis, findings indicate that there were no differences in recidivism rates between treatment participants and non-participants in sexual or violent crimes. However, participants demonstrated significantly lower rates of recidivism for non-violent crimes. We discuss strengths, limitations of the study, and implications of these findings. © The Author(s) 2015.
... Mobile and pop-up clinics have been utilized as an innovative method to bring healthcare services to local communities to reduce or eliminate financial and other access barriers to health care among underserved communities and disadvantaged populations such as the homeless, uninsured and those living in rural or remote communities [18][19][20][21]. They have been used to deliver a wide range of health services such as vision, dental, and general medical care [19,21]; screening for various diseases [22][23][24][25][26][27]; as well as psychiatric crisis services [28] and treatment for alcohol and drug abuse [29]. However, to our knowledge, no mobile or pop-up clinic has been designed to provide free pharmacotherapy and brief behavioural support to assist with smoking cessation. ...
Article
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Background Provision of evidence-based smoking cessation treatment may contribute to health disparities if barriers to treatment are greater for more disadvantaged groups. We describe and evaluate the public health impact of a novel outreach program to improve access to smoking cessation treatment in Ontario, Canada. Methods We partnered with Public Health Units (PHUs) located across the province to deliver single-session workshops providing standardized evidence-based content and 10 weeks (2007–2008) or 5 weeks (2008–2016) of nicotine replacement therapy (NRT). Participants completed a baseline assessment and were followed up by phone or e-mail at 6 months. We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to evaluate the public health impact of the program from 2007 to 2016. Given the iterative design and changes in implementation over time, data is presented annually or bi-annually. ResultsThere were 26,122 enrollments from 2007 to 2016. Between 31 and 442 workshops were held annually. The annual reach was estimated to be 0.1–0.3% of eligible smokers in Ontario. Participants were older, smoked more heavily, had a lower household income, were more likely to be female and be diagnosed with a mood or anxiety disorder, and less likely to have a postsecondary degree compared to average Ontario smokers eligible for participation. The intervention was effective; at 6-month follow-up 22–33% of respondents reported abstinence from smoking. Adoption by PHUs was 81% by the second year of operation and remained high (72–97%) thereafter, with the exception of 2009–2010 (33–56%) when the program was temporarily unavailable to PHUs due to lack of funding. Implementation at the organizational level was not tracked; however, at the individual level, approximately half of participants used most or all of the NRT received. On average, maintenance of the program was high, with PHUs conducting workshops for 7 of the 10 years (2007–2016) and 4 of the 5 most recent years (2012–2016). Conclusions The smoking cessation program had a high rate of adoption and maintenance, reached smokers over a large geographic area, including individuals more likely to experience disparities, and helped them make successful quit attempts. This novel model can be adopted in other jurisdictions with limited resources.
... Home treatment is a safe and feasible alternative to hospital care that is not only valuable in its own right, but is useful as part of a comprehensive community strategy (Smyth & Hoult 2000). Community based crisis intervention and home treatment services have also been shown to reduce hospitalization rates (Guo et al. 2001). The UK mental health policy implementation guideline proposes the development of crisis resolution and home treatment (CRHT) services across the country (DoH 2001). ...
Article
AIMS: To define the demographic and clinical profile of individuals referred to an emergency mental health assessment team. To identify factors associated with being admitted to inpatient psychiatric services or not admitted following an emergency assessment. BACKGROUND: Crisis resolution and home treatment services are being developed across the UK, targeted towards people with severe mental health problems, who would otherwise require hospitalization. Further information about people presenting to an emergency mental health assessment service may clarify the skills that are required to deliver effective crisis resolution and home treatment services. METHOD: Over a six-month period referrals to, and admission decisions by, an emergency mental health assessment team were recorded. Measures used were the Health of the Nation Outcome Scale and the Crisis Triage Rating Scale. Age, sex and postcode data were recorded. Postcode data were used to identify the Townsend Deprivation Index for each individual. Reasons given for the referral were categorized. A preliminary descriptive analysis was performed for all people referred. The Demographic and clinical characteristics of referrals admitted and not admitted were then compared. A multivariate logistic regression was performed in order to investigate the possible impact of demographic and clinical characteristics on admission status. RESULTS: A total of 375 individuals were referred. Forty-eight (12.8%) were admitted. Higher referral rates were significantly associated with more deprived areas of the city. Referrers most frequently identified suicide risk as the reason for referral, followed by deterioration of an existing serious mental health problem. The mean Health of the Nation Outcome Scale score of all people referred was 10.5. Those admitted had a significantly greater mean Health of the Nation Outcome Scale score than those not admitted. The mean Crisis Triage Rating Scale score of all people referred was 11.0. Those admitted had a significantly lower (worse) mean Crisis Triage Rating Scale score than those not admitted. Individuals with lower Crisis Triage Rating Scale scores tended to have a higher (more deprived) Townsend index scores. Crisis Triage Rating Scale and Health of the Nation Outcome Scale scores were significantly negatively correlated. Conclusions. Crisis resolution and home treatments need to target areas of greatest deprivation. Social interventions will be important. Presentations related to suicide risk are likely to be common. The Crisis Triage Rating Scale may be a useful brief alternative to Health of the Nation Outcome Scale. RELEVANCE TO CLINICAL PRACTICE: This study highlights the valuable role of mental health nurses in frontline emergency mental health care in particular mental health nurses skills in conducting a risk assessment in an emergency.
... However, international evidence has shown that community-based programs are an effective means to lower hospitalization rates compared to the hospital-based interventions among people with mental health conditions. 42 Moreover, these services have been shown to reduce hospital use by diverting patients from hospital admissions into community-based treatment programs. 43,44 In this way, the medical care of patients could be supported and more efficiently designed using innovative outpatient treatment options such as psycho-education, family interventions, specialist nursing care, socio-therapy, treatment provided by visiting patients at home, and care provided by caregivers. ...
Article
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Information concerning the treatment costs of schizophrenia is scarce in People's Republic of China. The aims of this study were to quantify health care resource utilization and to estimate the direct medical costs for patients with schizophrenia in Tianjin, People's Republic of China. Data were obtained from the Tianjin Urban Employee Basic Medical Insurance (UEBMI) database. Adult patients with ≥1 diagnosis of schizophrenia and 12-month continuous enrollment after the first schizophrenia diagnosis between 2008 and 2009 were included. Both schizophrenia-related, psychiatric-related, and all-cause related resource utilization and direct medical costs were estimated. A total of 2,125 patients were included with a mean age of 52.3 years, and 50.7% of the patients were female. The annual mean all-cause costs were $2,863 per patient with psychiatric-related and schizophrenia-related costs accounting for 84.1% and 62.0% respectively. The schizophrenia-related costs for hospitalized patients were eleven times greater than that of patients who were not hospitalized. For schizophrenia-related health services, 60.8% of patients experienced at least one hospitalization with a mean (median) length of stay of 112.1 (71) days and a mean cost of $1,904 per admission; 59.0% of patients experienced at least one outpatient visit with a mean (median) number of visits of 6.2 (4) and a mean cost of $42 per visit during the 12-month follow-up period. Non-medication treatment costs were the most important element (45.7%) of schizophrenia-related costs, followed by laboratory and diagnostic costs (19.9%), medication costs (15.4%), and bed fees (13.3%). The costs related to the treatment of patients with schizophrenia were considerable in Tianjin, People's Republic of China, driven mainly by schizophrenia-related hospitalizations. Efforts focusing on community-based treatment programs and appropriate choice of drug treatment have the potential to reduce the use of inpatient services and may lead to better clinical and economic outcomes in the management of patients with schizophrenia in People's Republic of China.
... One study of a communitybased mobile crisis intervention showed an eight percent reduction in hospitalization rates when compared to hospital based interventions. 65 Another study indicated patients were more than three times as likely to be hospitalized if assessed by the hospital based component of the emergency service than if assessed by the mobile community based component, regardless of presenting symptom acuity. 66 This body of evidence, along with the theory that these services in turn reduce cost of care by preventing hospitalization, established a foundation for the popularity of mobile crisis services around the country. ...
... Outcomes assessed were admission rates, health status at discharge, and service user and carer satisfaction. 2. CRTs versus standard care (Additional file 3: Table DS3) (n = 16) [8,9,12,13,[36][37][38][39][40][41][42][43][44][45][46][47]: Two studies were randomised controlled trials, three were non-randomised (naturalistic) two-group comparison studies; and 11 were naturalistic pre-post comparison studies. Two studies were Australian, one German, one American, and 12 British; studies were published between 1993 and 2011. ...
Article
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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 .
... Psychosis accounts for 60 percent of mental health hospitalizations [65] as hospitals are better equipped to contain risk. However, the de-institutionalization movement in most developed countries has emphasized the need for greater community-based mental health care [66][67][68]. ...
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Background: Psychiatric disorders may occur as a single episode or be persistent and relapsing, sometimes leading to suicidal behaviours. The exact causes of psychiatric disorders are hard to determine but easy access to health care services can help to reduce their severity. The aim of this study was to investigate the factors associated with repeated hospitalizations among the patients with psychiatric illness, which may help the policy makers to target the high-risk groups in a more focused manner. Methods: A large linked administrative database consisting of 200,537 patients with psychiatric diagnosis in the years of 2008-2012 was used in this analysis. Various counts regression models including zero-inflated and hurdle models were considered for analyzing the hospitalization rate among patients with psychiatric disorders within three months follow-up since their index visit dates. The covariates for this study consisted of socio-demographic and clinical characteristics of the patients. Results: The results show that the odds of hospitalization are significantly higher among registered Indians, male patients and younger patients. Hospitalization rate depends on the patients' disease types. Having previously visited a general physician served a protective role for psychiatric hospitalization during the study period. Patients who had seen an outpatient psychiatrist were more likely to have a higher number of psychiatric hospitalizations. This may indicate that psychiatrists tend to see patients with more severe illnesses, who require hospital-based care for managing their illness. Conclusions: Providing easier access to registered Indian people and youth may reduce the need for hospital-based care. Patients with mental health conditions may benefit from greater and more timely access to primary care.
... It may be that these patients, known to ED and specialized services, were provided with more intensive care that prevented readmission as well as their risk of becoming high ED users. Previous Quebec MH or SRD reforms reinforced programs such as assertive community treatment, intensive case management, 72 home treatment teams, 73 SRD liaison model at ED, 50,74 and community-based crisis interventions, 75 all of which are known to reduce ED visits and hospitalizations. Our results also demonstrated that patients hospitalized 16 to 29 days were less likely to be readmitted early, as compared to those hospitalize 1 to 3 days. ...
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Objective: This study evaluated the contributions of clinical, sociodemographic, and service use variables to the risk of early readmission, defined as readmission within 30 days of discharge following hospitalization for any medical reason (mental or physical illnesses), among patients with mental disorders in Quebec (Canada). Methods: In this longitudinal study, 2,954 hospitalized patients who had visited 1 of 6 Quebec emergency departments (ED) in 2014 to 2015 (index year) were identified through clinical administrative databanks. The first hospitalization was considered that may have occurred at any Quebec hospital. Data collected between 2012 and 2013 and 2013 and 2014 on clinical, sociodemographic, and service use variables were assessed as related to readmission/no readmission within 30 days of discharge using hierarchical binary logistic regression. Results: Patients with co-occurring substance-related disorders/chronic physical illnesses, serious mental disorders, or adjustment disorders (clinical variables); 4+ outpatient psychiatric consultations with the same psychiatrist; and patients hospitalized for any medical reason within 12 months prior to index hospitalization (service use variables) were more likely to be readmitted within 30 days of discharge. Patients who made 1 to 3 ED visits within 1 year prior to the index hospitalization, had their index hospitalization stay of 16 to 29 days, or consulted a physician for any medical reason within 30 days after discharge or prior to the readmission (service use variables) were less likely to be rehospitalized. Conclusions: Early hospital readmission was more strongly associated with clinical variables, followed by service use variables, both playing a key role in preventing early readmission. Results suggest the importance of developing specific interventions for patients at high risk of readmission such as better discharge planning, integrated and collaborative care, and case management. Overall, better access to services and continuity of care before and after hospital discharge should be provided to prevent early hospital readmission.
... The Cox model is well suited for this data set because the data include former prisoners that recidivated within 5 years of exiting prison and those without new involvement with NCDOC. These latter cases are censored cases; the Cox model is appropriate for analyzing a data set that contains censored cases (Guo et al., 2001). Censored cases include those in which the event under study has not occurred by the end of the predefined study period or in which the event that occurs differs from the one under investigation (Wells & Guo, 2004). ...
Article
Increasing the effectiveness of programs designed to treat individuals who have sexually offended is a critical step in reducing the rates of sexual violence in our communities. Yet, the research on such programs have yielded inconsistent results with regards to their effectiveness in reducing sexual recidivism among participants. Some researchers have explored whether the dose of treatment impacts recidivism, but there remains limited knowledge around the dose-response relationship for individuals who have sexually offended. The current study examines recidivism rates among 343 individuals who participated in and completed the programs administered by the North Carolina Department of Public Safety (NCDPS): Pre-SOAR (preparatory program), SOAR (full high-dose treatment program), and the combination of both Pre-SOAR and SOAR. Findings demonstrated that men who participated in Pre-SOAR only had the highest rates of recidivism among the three groups. Specifically, the Pre-SOAR only group returned to prison over a year sooner than the other two groups. These findings elucidate that the Pre-SOAR program is not sufficient or the most efficacious as a stand-alone program to reduce recidivism among sex offenders. Next, the Pre-SOAR program did show benefit when combined with the SOAR program, in that approximately 8% fewer of the individuals were reincarcerated during the study window compared to those who only completed the SOAR program. While those individuals who participated in the Pre-SOAR and SOAR programming group returned to prison approximately three days faster than the SOAR-only group, we do not see this to be a significant difference. Programming implications are discussed.
... 18 Similarly, literature on the use of mobile crisis and community-based outreach teams indicate decreased admission rates, greater symptom improvements, greater patient satisfaction, and cost effectiveness. [23][24][25][26] ...
Article
Research has shown that follow-up rates with aftercare recommenda-tions upon discharge from psychiatric emergency services are low. These patients are in need of additional wrap-around support services. This article illustrates how an innovative program has been effective in utilizing crisis intervention services and mobile crisis outreach within an emergency room (ER) setting and how these unique services can be integral in preventing psychiatric decompensation and repeated presentations to the ER. In addition, implementing these services helps ensure better compliance with follow-up recommendations, allowing for the resolution of the crisis, enhanced diagnositic clarification, and identification of barriers to continued care in the community. Essential elements of successful application of this model include providing an immediate appointment, having close follow up, and ensuring a collaborative and interdisciplinary approach that addresses the biopsy-chosocial needs of patients. Further research is needed to better under-stand the patient characteristics and systemic factors that contribute to issues of compliance with community mental health services upon discharge from a psychiatric emergency service.
... Da ovennevnte studier i varierende grad omhandler akutte tilstander og akuttilbud som kan aksepteres som tradisjonell akuttbehandling, presenterer vi ikke-randomiserte komparative studier på området. Gjennomgang av disse avdekket fire komparative studier som har sammenliknet akutteam med tradisjonell akuttbehandling (26)(27)(28)(29). En studie ble inkludert, selv om den hadde antall behandlede pasienter og behandlingskostnader som effektmål (26). ...
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Bakgrunn. Vi gir her en kort oversikt over alternative behandlingstilbud til personer med akutt psykisk lidelse. Det blir lagt størst vekt på akutteam, da dette planlegges innført ved alle distriktspsykiatriske sentre i Norge. Materiale og metode. Vi har søkt etter randomiserte, kontrollerte studier som har sammenliknet effekten av alternative behandlingstiltak med tradisjonell sykehusbasert akuttbehandling. Kvasieksperimentelle studier av akutteam ble også inkludert. Resultater og fortolkning. Vi identifiserte følgende tre alternative akuttbehandlingstiltak: akutte dagsenter/avdelinger, ambulante akutteam og åpne lavterskel sengeenheter. Akuttbehandling i dagavdeling er assosiert med færre innleggelsesdøgn, raskere bedring og lavere kostnader enn tradisjonell akuttbehandling i døgnavdeling. Vi identifiserte seks randomiserte kontrollerte studier og fire kvasieksperimentelle studier av akutteam. Studiene tyder på at akutteam er et godt alternativ til tradisjonell akuttbehandling for store pasientgrupper. De synes å ha en klinisk effekt som er sammenliknbar med tradisjonell akuttpsykiatrisk behandling, er assosiert med reduserte innleggelser og gjeninnleggelser/tilbakefall samt er rimeligere i drift. Ingen av de alternative tiltakene gjør akuttinnleggelser unødvendig. Selv om studier av alternative akuttiltak har flere sammenfallende resultater, er det ikke mulig å trekke sikre konklusjoner om effekten av slike tiltak.
... For example, various residential alternatives to hospitalization have been used for many years in Europe and the U.S. (Lloyd-Evans & Johnson, 2019). Similarly, crisis call lines and outreach teams have been used in the U.S. for over 40 years (Guo et al., 2001;Stein & Test, 1980). These recommendations are reasonable and practical, and some reflect common sense. ...
Article
Psychiatric crisis care in the U.S. exemplifies the “more is less paradox” of U.S. health care. We spend more for health care than any other high-income country, yet our outcomes are typically poor compared to these other countries (OECD in OECD health statistics. Retrieved from https://www.oced.org/health/health-data.html, 2020). We do this, in part, by emphasizing medical treatments for problems that are inherently social, rather than addressing social determinants of health. Medical interventions for socio-economic problems are usually expensive and ineffective. For mental health crisis care, adding unfunded, untested, medical interventions to the current mélange of poorly funded, disorganized arrangements will not help. Instead, the U.S. should address social determinants, emphasize research-based interventions, and emphasize prevention—proven strategies that decrease costs and improve outcomes.
... We are advancing the model to look for opportunities in less-well-used settings where underserved populations can be reached. As an example of a setting in use that might be expanded, emergency mental health services are provided through mobile crisis units (e.g., Guo, Biegel, Johnsen, & Dyches, 2001). This form of care may be adapted to provide general, nonemergency care to individuals who can benefit from clinical interventions outside the context of a psychiatric emergency. ...
Article
Most individuals in both developing and developed countries who experience mental illness do not receive psychological services. The dominant model of delivering services used in developed countries (individual therapy by a highly trained mental health professional) can provide effective (i.e., evidence-based) treatments but is greatly limited as a means of reaching the large swath of individuals in need. We highlight several models outside the mental health professions (e.g., public health, medicine, business) that are more affordable and accessible and can be scaled up to reach many individuals in need. These models include task shifting, disruptive innovations, interventions in everyday settings, best-buy interventions, lifestyle changes, and social media. We convey their key characteristics and how they have been or can be applied to mental health. We end by discussing challenges in applying the models, critical issues on which effective treatment delivery depends, and paths to make progress.
Article
It has been difficult to identify relevant correlates of inpatient psychiatric length of stay (LOS), but few have examined family burden as a potential factor. The present study investigated the association of several dimensions of family burden with LOS net of other factors. Dimensions of burden experienced by primary caregivers were evaluated in a sample of 602 psychiatric inpatients in a large hospital in Guangzhou, China within 1 week of admission. Factor analysis reduced the burden data to five factors. Bivariate association and multiple linear regression analyzes were used to investigate burden and other factors associated with LOS (average LOS=58.8 days, SD=44.3). Multiple regression analysis showed that in addition to having health insurance coverage, being diagnosed with schizophrenia, being unmarried, and not being employed; being perceived by family members as showing more violent behavior and causing higher levels of caregiver distress were independently associated with longer LOS. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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O objetivo do artigo é descrever os atendimentos e as internações nos hospitais psiquiátricos públicos de Belo Horizonte de 2002 a 2011, explorando mudanças nas características dos atendimentos e no perfil dos pacientes atendidos; no contexto da reforma da assistência em saúde mental. Estudo de séries temporais com análises de tendência por meio de regressões lineares. No período analisado, houve redução no total de atendimentos. Inversamente, constatou-se o aumento das internações com redução do tempo de permanência e manutenção da taxa de reinternação. Os atendimentos a pacientes da capital foram os mais frequentes, entretanto observou-se crescimento relativo da demanda pelos oriundos da Região Metropolitana. Houve inversão na morbidade prevalente de transtornos psicóticos para transtornos decorrentes do uso de álcool e/ou outras drogas. A alteração observada no perfil de atendimento dos hospitais psiquiátricos públicos de Belo Horizonte foi concomitante com a progressiva implantação de serviços comunitários de saúde mental que provavelmente tem suprido uma demanda que antes se dirigia a esses hospitais. Atualmente o hospital psiquiátrico não constitui a primeira e muito menos a única instância de tratamento da rede de saúde mental de Minas Gerais.
Thesis
Interactions between police and individuals suffering from mental illness are very frequent. Police forces are regularly first responders to those with mental illness. Unfortunately, on occasion interactions are violent and sometimes fatal. Despite this, training police how to best interact with individuals who have a mental illness is poorly studied. The research in this thesis primarily examines a newly developed training program, which used professional actors in a roleplay based training approach. Training was a one-day, 8-hour session, with feedback from senior officers, mental health specialists and actors. Latter feedback enforced how the officer can best approach and speak to individuals when they interact. Explicit goals were to improve officer empathy, communication skills, and ability to de-escalate stressful situations. This unique training program led to improvements in police officer behaviour which were still present 6- months after completion. More specifically, after training officers had (1) more confidence (23%) in interacting with those suffering from mental illness; (2) demonstrated behavioural improvements in empathy, communication and de-escalation strategies (determined by their supervising sergeant); (3) increased their ability to recognize mental illness, shown through increases in mental health call numbers as well as (4) increased efficiency in the time it required officers to begin and finish a mental health call. These changes led to cost savings of over $80,000 over 6 months. In contrast to changes in behaviour, attitudes did not change 6-months after training. We then conducted a 2.5 year follow up of police attitudes in officers who took training and found that officer confidence continued to increase up to 2.5 years after training (32%), however, longitudinal changes in attitudes were mixed with the majority of attitudes not changing. Thesefindings illustrate that the link between attitudes and behaviours is complex, and one that requires further research to fully explain. Another topic of study was how demographic factors affected police attitudes. Initially older officers had increased stigma towards the mentally ill, but after training this changed with younger officers exhibiting higher levels of stigma. In keeping with studies from a range of other areas, female officers were found to show decreases in authoritarian attitudes, and increases in compassion and empathy towards those with mental illness when compared to their male colleagues. In regards to officer location, officers in high crime areas, namely North and Downtown Division were found to have increases in social distance towards individuals with depression compared to Southeast Division (lower crime area). Of importance, North Division officers who received the mental health training had stronger attitudes of compassion and empathy towards individuals suffering from mental illness compared to those that did not take part in the mental health training. This latter finding is supportive of the overall success of this training program, and implies the existence of subtle factors that influence attitudes. The final research piece examined attitudes of the homeless community in Edmonton, since they have frequent interactions with police. Homeless members were surveyed to determine how police interactions affected their attitudes towards police. Interestingly, individuals arrested or handcuffed had significantly greater negative views towards police than if they were not arrested or handcuffed. This novel finding may allow police policy to change in this population. Additionally, it was clear that many individuals in the homeless population do not believe police treat them with an appropriate level of fairness and respect. These findings allow us to conclude that more training is necessary for police officers in this area. Key findings for future police training relate to the benefits of training utilizing realistic “hands-on” scenarios, focusing primarily on verbal and non-verbal communication, increasing empathy, and de-escalation strategies. We recommend organizations provide training that is properly measured for effectiveness and urge training to focus on changing behaviours and not attitudes, because there is little evidence to demonstrate that changing attitudes relates directly to positive behavioural changes. Lastly, we believe that mental health training programs need to be implemented on a repeated basis over the longer-term to maximize its impacts. It is likely that a training program given on a single occasion is not sufficient to improve interactions over the career of a police officer. Future police training needs to address these issues.
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In 2012, the SAMHSA-funded National Suicide Prevention Lifeline (Lifeline) completed implementation of the first national Policy for Helping Callers at Imminent Risk of Suicide across its network of crisis centers. The policy sought to: (1) provide a clear definition of imminent risk; (2) reflect the state of evidence, field experience, and promising practices related to reducing imminent risk through hotline interventions; and (3) provide a uniform policy and approach that could be applied across crisis center settings. The resulting policy established three essential principles: active engagement, active rescue, and collaboration between crisis and emergency services. A sample of the research and rationale that underpinned the development of this policy is provided here. In addition, policy implementation, challenges and successes, and implications for interventions to help Lifeline callers at imminent risk of suicide are detailed.
Article
Police and law enforcement providers frequently come in contact with individuals who have psychiatric disorders. Repeated studies suggest that greater understanding of psychiatric conditions by police officers would be beneficial. However, few training approaches have been examined. We present a novel approach to training police officers to interact with those who may have a psychiatric disorder. This approach involved development of a program in which police officers interacted with actors highly trained to present one of six realistic psychiatric scenarios. Confidential feedback was given, both by experienced police officers and by the actors, to improve awareness of the officers' behavior. Qualitative feedback from both officers and actors was used to determine the acceptance of role-play training. A total of 663 police officers were trained, with feedback from 381. Results showed that this approach was well accepted by most police officers, and the use of carefully controlled role play in training for police is strongly recommended. Future analysis will determine whether training improves police behavior with respect to interaction with mentally ill individuals.
Article
People with mental illness (PMI) have increased dramatically, and these individuals are at greater risk for repeated contact with the criminal justice system. Mobile crisis units (MCUs) have been heralded as effective partners with law enforcement to provide appropriate interventions to PMI and reduce the possibilities of criminalization of this population. The purpose of this research is to examine a partnership between law enforcement and a county-wide MCU to determine (1) the nature of interactions between police-referred calls to the MCU and (2) to determine the outcomes of these calls and the factors that might influence the outcomes. Significant differences in the type of PMI calls from law enforcement–referred calls to MCUs are found; the PMI are twice as likely to be violent, intoxicated, psychotic, mood-order diagnosed, and in emergent need of care. The type of referral is no longer significant when the model includes risk factors. Policy implications of the partnership between law enforcement and MCUs are discussed.
Article
Background: Young people often face barriers to psychiatric care and are increasingly seeking crisis services for mental health issues through the emergency department (ED). Urgent psychiatric care models provide youth in crisis with rapid access to time-limited mental health care on an outpatient basis. This scoping review aims to evaluate the impact of such urgent psychiatric services for youth aged 13-25 on patient and health system outcomes. Methods: We conducted a literature search on PubMed, EMBASE, MEDLINE, PsycINFO, and the Cochrane Database of Systematic Reviews for studies published from inception to November 20, 2020. We included studies that described outpatient psychiatric services designed for youth aged 13 to 25, took place in a clinical setting, and offered any combination of assessment, treatment, and referral. We excluded studies describing suicide intervention programmes. Results: Our search yielded six studies, four of which were descriptive studies and two of which were randomized controlled trials. Most studies found that access to urgent psychiatric care for youth was associated with reduced ED volumes, fewer health system costs, and fewer hospitalizations. None of the studies presented evidence that urgent psychiatric services are associated with improved patient symptomatology or functioning. Conclusions: The results of this scoping review highlight the scarcity of robust evidence evaluating the effectiveness of urgent care for youth mental health. Further experimental studies and a set of standardized quality measures for evaluating these services are needed to bridge this critical gap in mental health care for youth in crisis.
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A Home Treatment team was compared with a Psychiatric Emergency Department (PED) on preventing hospitalization among two cohorts of 448 patients matched by diagnosis, sex, and age. The logistic regression showed that HT people were 4.6 times less likely to be admitted than those from PED.
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The 2019 novel coronavirus disease emerged in China in late 2019‐early 2020 and it is spreading rapidly worldwide (1). Amongst the Spanish public health interventions aimed at reducing the transmission rate, home confinement has been enforced (2). The Royal Decree 463/2020 stated a 15‐day national emergency states starting on March 15, that has since been extended (3).
Article
The aim of this study was to assess satisfaction with care and to identify the predictors of this variable among sociodemographic, clinical and social data in a group of patients suffering from schizophrenia under treatment in community mental health teams. The study included 90 patients with a diagnosis of schizophrenia under the care of community mental health teams. Positive and Negative SyndromeScale, Verona Service Satisfaction Scale, Disability Assessment Schedule, Social Network Index and a loneliness scale (UCLA Loneliness Scale)were used in the study. Prognostic factors for higher satisfaction with care in the multivariate model involved: level of disability (Beta = -0.46, p < 0.001), duration of treatment under a CMHT (Beta = 0.36, p < 0.001), age (Beta = -0.37,p < 0.001), and education (Beta = -0.30, p = 0.002). The model explained 43% of the variance in the dependent variable. 1.Satisfaction with care in a CMHT was high. 2. Higher patient satisfaction could be predicted based on a lower level of disability, longer duration of treatment under a CMHT, lower age and lower education.
Article
People with intellectual and developmental disabilities sometimes engage in challenging behaviours. When behaviours escalate to the point where they pose imminent risk to the safety of people and environments, a crisis occurs that jeopardises community living and participation. In these situations, timely access to crisis stabilisation services is required. We conducted a systematic review of the literature to synthesise evidence on effective crisis stabilisation service models for challenging behaviours. A total of 46 publications met the inclusion criteria. The literature describes a spectrum of crisis stabilisation services of varying intensities including: outreach, outpatient, inpatient, respite, and capacity building through education and training. However, there is limited guidance on how to best structure service models. This review highlights the need for comprehensive and person-centred programme evaluations.
Article
Purpose Data shows that there is an increasing number of young people in the UK needing access to mental health services, including crisis teams. This need has been exacerbated by the current global pandemic. There is mixed evidence for the effectiveness of crisis teams in improving adult functioning, and none, to the authors’ knowledge, that empirically examines the functioning of young people following intervention from child and adolescent mental health services (CAMHS) crisis teams in the UK. Therefore, the purpose of this paper is to use CAMHS Crisis Team data, from an NHS trust that supports 1.4 million people in the North East of England, to examine a young person's functioning following a crisis. Design/methodology/approach This service evaluation compared functioning, as measured by the Outcome Rating Scale (ORS), pre- and post-treatment for young people accessing the CAMHS Crisis Team between December 2018 and December 2019. Findings There were 109 participants included in the analysis. ORS scores were significantly higher at the end of treatment (t(108) = −4.2046, p < 0.001) with a small effect size (d = −0.36). Sixteen (15%) patients exhibited significant and reliable change (i.e. functioning improved). A further four (4%) patients exhibited no change (i.e. functioning did not deteriorate despite being in crisis). No patients significantly deteriorated in functioning after accessing the crisis service. Practical implications Despite a possibly overly conservative analysis, 15% of patients not only significantly improved functioning but were able to return to a “healthy” level of functioning after a mental health crisis following intervention from a CAMHS Crisis Team. Intervention(s) from a CAMHS Crisis Team are also stabilising as some young people’s functioning did not deteriorate following a mental health crisis. However, improvements also need to be made to increase the number of patients whose functioning did not significantly improve following intervention from a CAMHS Crisis Team. Originality/value This paper evaluates a young person’s functioning following a mental health crisis and intervention from a CAMHS Crisis Team in the North East of England.
Article
BACKGROUND A number of variables have been shown to influence whether an individual who experiences an emergency psychiatric assessment is admitted to a psychiatric hospital. This study focused on the theoretical orientation of the assessing clinician as a possibly influential variable. The theoretical orientation being studied was Bowen family systems theory or Bowen theory (Bt). Overall the Bt perspective looks at the family as the primary crucible that generates symptoms but at the same time as the natural unit and the best built-in resource to deal with those symptoms. AIMS This study examined whether the theoretical orientation of the nurse psychiatric assessor would affect her inpatient admission rate of patients seen for psychiatric evaluation in an emergency department (ED). METHOD A clinician/researcher with extensive experience applying Bt in clinical practice worked in a Crisis Management Service providing psychiatric evaluation and disposition in a busy community hospital ED. Given Bt’s emphasis on the system rather than individual pathology, the clinician researcher hypothesized that her psychiatric hospitalization rate would be lower than the other clinical nurse specialists. A retrospective chart review analyzed 1 year of cases from all referrals that might have resulted in psychiatric hospitalizations ( n = 1,801). RESULTS The clinician/researcher’s psychiatric hospitalization rate was significantly lower ( p = .004) than the other clinicians. CONCLUSION An approach to psychiatric assessment in the ED applied a Bt perspective in a way that significantly reduced psychiatric hospitalizations.
Chapter
In the United States, emergency departments (EDs) have become primary sites for emergent psychiatric evaluations and crisis intervention. These types of ED visits have been steadily increasing per year and have been found to have significantly longer lengths of stay than for non-mental-health-related visits [1–4]. Recent data demonstrate a discrepancy in disposition options for mental-health-related complaints as compared to nonmental illness presentations in the ED, with presentations due to mental illness having disproportionately higher rates of hospital admission (Figs. 40.1 and 40.2) [1, 2, 5]. ED staff treat acute medical emergencies (e.g., cardiac arrest, stroke, and pulmonary embolism), diagnose and manage new-onset illnesses, and evaluate exacerbations for chronic diseases (congestive heart failure, diabetes, and chronic obstructive pulmonary disorder), understanding that not all sickness requires inpatient medical admission. As the number of mental health presentations continues to increase, ED staff need an understanding of and access to alternative community resources to avoid the exclusive use of hospitalization as the disposition choice for mental health crises. Lack of safe, nonhospital interventions leaves ED staff to over-rely on inpatient levels of care [6]. This, in turn, contributes to the decreased availability of inpatient beds for significant crises, subsequently increasing psychiatric boarding [7–10].
Article
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Mobile crisis services for children and youth have been available in Ontario since 2000 yet little descriptive information about such services exists. In this evaluation, crisis workers gathered demographic information and details about the nature of the crisis from youth ages 12 to 17 and parents/guardians of chil- dren from birth to 17 years of age during a crisis intervention. Approximately two weeks post-intervention, participants responded to a quantitative questionnaire administered via telephone that measured levels of upset, awareness, coping, and con dence. This paper adds to the literature by describing the types of calls received, characteristics of service users, and outcomes for youth and families. The ndings suggest this type of service may be valuable in serving youth, and that more rigorous examination is required by mobile crisis services for youth to demonstrate the true contribution.
Chapter
Arrest has several substantial direct and collateral consequences for individuals and communities. Given these costs, it is important to consider the utility of alternatives to arrest. This chapter focuses on two primary forms of arrest alternatives: police-led diversion and citations in lieu of arrest. For police-led diversion, three sup-topics are discussed in detail: (1) drug offenders, (2) persons with mental illness, and (3) juvenile offenders. This chapter offers a discussion of the structure of these programs, and any preliminary evidence regarding programmatic outcomes and impacts.
Article
Though the model of home treatment presented in this book is fairly clearly defined (Chapter 6), in practice the functioning of a team will be dependent on the context in which it operates. This includes the demographic and geographical nature of the area, and also the service context - the other services available to people in a mental health crisis, to which the crisis resolution team (CRT) must relate. The relationship between the CRT and inpatient wards and casualty departments will be considered in Chapter 15, and the clinical and operational details of referral and assessment processes in Chapters 8 and 26. In this chapter, a broader perspective is taken on the way in which CRTs fit into catchment area community mental health service systems and on the problems that may arise. The need for the CRT to have multiple interfaces with other teams and parts of the service has consequences for continuity of patient care, and these consequences are discussed and some practical proposals made for dealing with them. In the initial part of the chapter, the main focus is on working with the community mental health teams (CMHTs), which take responsibility for assessments not deemed to be crises and for continuing care of most severely mentally ill service users. Some specific issues regarding other types of recently introduced functional team, particularly early intervention services and assertive outreach teams (AOT), will then be considered.
Article
Anorexia nervosa (AN) is a difficult-to-treat mental illness associated with dangerous behavioral symptomatology. Interventions that augment the outcomes of existing inpatient and outpatient protocols for AN are critically needed. In-home treatments that address environmental change as a means to further promote behavior change have been applied for the care of multiple behaviorally based psychiatric illnesses, but not for eating disorders. The present study outlines the pilot application of a posthospitalization, four-session in-home relapse prevention treatment for a woman with a long history of AN. Over a 1-, 3-, and 6-month follow-up period, the patient exhibited substantial improvements in eating disorder symptomatology, sustained a healthy body mass index, and maintained positive environmental changes made by the end of treatment. The treatment was feasible and readily accepted by the patient. These positive findings suggest that more formalized research to further evaluate this novel adjunctive treatment for AN is warranted.
Article
A conceptual model for community-based strategic planning to address the criminalization of adults with mental and substance use disorders, the Sequential Intercept Model has provided jurisdictions with a framework that overcomes traditional boundaries between the agencies within the criminal justice and behavioral health systems. This article presents a new paradigm, Intercept 0, for expanding the utility of the Sequential Intercept Model at the front end of the criminal justice system. Intercept 0 encompasses the early intervention points for people with mental and substance use disorders before they are placed under arrest by law enforcement. The addition of Intercept 0 creates a conceptual space that enables stakeholders from the mental health, substance use, and criminal justice systems to consider the full spectrum of real-world interactions experienced by people with mental and substance use disorders with regard to their trajectories, or lack thereof, through the criminal justice system.
Article
It is crucial for people to have an immediate link to community-based mental health services (CMHSs) after psychiatric crisis. This study aims to identify the determinants of people's use of CMHSs after Mobile Crisis Team (MCT) intervention. This study integrated four local administrative records and selected 1,771 adults who received MCT intervention in 2008. The authors measured the length between the last day of crisis period and the first date of using CMHSs and used the Cox proportional hazard model to estimate its predictors. Of the sample, 44.2% used CMHSs within 30 days after MCT intervention. Cox proportional hazards model identifies predictors of using CMHSs such as clients' diagnosis, substance abuse issues, treatment history, and the interventions during the crisis period. The findings reconfirm the vital roles of MCT intervention such as linking resources and referral services. Because this study simultaneously observes the process and postphase of psychiatric crisis intervention, its findings not only assist in improving interventions for people with psychiatric crisis but also support social policy and programs that strengthen the continuum of care.
Chapter
Although hidden from sight, within the correctional system, there is a disproportionate percentage of inmates with psychiatric illness. With an aging population and inmates with lengthy sentences, there is additional concern about older inmates dealing with their chronic psychiatric illnesses including the development of neurocognitive disorders and a host of gathering medical comorbidities. Correctional institutions are arguably ill equipped to deal with a growing and aging medically and psychiatrically ill population. The call for subspecialty service from geriatric psychiatry in the correctional system is almost certain, and therefore the time for careful consideration for the delivery of this service is now, before the crisis declares itself.
Article
Created at Geneva in 1980, brief therapy centres are outpatient units providing psychiatric care based on a psychodynamic crisis intervention model. Their initial purpose was to offer an alternative to hospitalisation to patients who habitually are not major consumers of hospital care. In 2001 they were assigned a new institutional role: to widen their care offering and lighten the burden on hospitals by taking in, among others, patients with much more severe psychopathologies. We conducted a retrospective pilot study including the 449 patients treated at the Servette sector 3 brief therapy centre during 2006, to improve our understanding of how practice had really evolved at these centres in response to the changes institutional therapy had undergone in the last two decades. In general we noted among these patients a high rate of psychiatric antecedents with a time to admission seldomly below 24 h. We found a high rate of referrals by psychiatric emergency departments at the expense of indications from general practitioners and psychiatrists, while the diagnosis of mood disorder (76% with 72.4% depressive disorders) was significantly represented. We also observed several significant differences between the patient group receiving crisis-type care and the group receiving only nights of support. The retrospective study we conducted showed us that the new institutional role is only partly fulfilled and raises the question of a gap between theory and practice that is widening with the passage of time.
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The mobile crisis team is uniquely equipped to provide front-line mental health care when and where it is most needed. It is able to provide on-site assessment, crisis management, treatment, referral, and educational services to patients, families, law enforcement officers, and the community at large. Mobile crisis teams provide access to mental health care for even the most under-served populations efficiently and cost-effectively. The cost-effectiveness of the team's services is defined by savings in both monetary and human terms.