Joint Crisis Plans reduce coercive treatment

Henderson, Claire; Flood, Chris; Morven, Leese; Thornicroft, Graham; Sutherby, Kim; Szmukler, George
January 2007
BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1
Academic Journal
Background To investigate whether a form of advance agreement for people with severe mental illness can reduce the use of inpatient services and compulsory admission. Methods Design: Single blind randomized controlled trial. Setting: Eight community mental health teams in southern England. Participants: 160 people with psychotic or bipolar disorder who had had a hospital admission within the previous two years. Intervention: The joint crisis plan was formulated by the patient, care coordinator, psychiatrist, and project worker and contained contact information, details of mental and physical illnesses, treatments, indicators for relapse, and advance statements of preferences for care in the event of future relapse. Results Over 15 month follow up, use of the Mental Health Act was significantly reduced for the intervention group, 13% (10/80) of whom experienced compulsory admission or treatment compared with 27% (21/80) of the control group (risk ratio 0.48, 95% confidence interval 0.24 to 0.95, p = 0.028). The intervention group had fewer admissions (risk ratio 0.69, 0.45 to 1.04, P = 0.07). There was no evidence for differences in bed days (total number of days spent as an inpatient) (means 32 and 36, difference 4, -18 to 26, p = 0.15 for the whole sample; means 107 and 83, difference -24, -72 to 24, p = 0.39 for those admitted). Fewer episodes of violence (3/74 episodes versus 11/76, p = 0.046) and self harm (1/74 episodes versus 7/76, p = 0.063) occurred in the active intervention group. Conclusion This is the first structured clinical intervention that seems to reduce compulsory admission and treatment in mental health services. The reduction in overall admission was less. Joint crisis plans may also reduce violence to others and self-harm associated with relapse of mental illness but the mechanism requires further investigation.


Related Articles

  • Crisis intervention and acute psychiatry in Amsterdam: 20 years of change? A historical comparison of consultations in 1983 and 2004 - 2005. Dekker, Jack; van der Post, Louk; Visch, Irene; Schoevers, Robert // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Background To establish a picture of the changes in emergency psychiatry that have contributed to the sharp increase in the number of acute compulsory admissions in the Netherlands since 1992. Treatment in Amsterdam psychiatric clinics is in danger of being dominated by coercive treatment. These...

  • A prediction model for the incidence of civil detention for crisis patients with psychiatric illnesses; the Amsterdam study of acute psychiatry VII. Post, Louk; Peen, Jaap; Dekker, Jack // Social Psychiatry & Psychiatric Epidemiology;Feb2014, Vol. 49 Issue 2, p283 

    Objective: Given raised numbers of civil detentions in the Netherlands and other European countries, it is important to assess the patient risk profile with respect to the incidence of those far-reaching treatment decisions. The aim of the ASAP study is to develop a comprehensive prediction...

  • outside the box. Faulkner, Alison // Mental Health Today;Sep/Oct2014, p15 

    No abstract available.

  • Keeping calm and carrying on. Lester, Nicola // Mental Health Practice;Nov2011, Vol. 15 Issue 3, p9 

    In the article, the author discusses her experiences as a former community mental health team member in London, England. She claims that the job of crisis resolution teams in mental health is very unpredictable, which includes unscheduled visits to police stations and hospital emergency...

  • Network. Yiannoullou, Sarah // Mental Health Today;Sep/Oct2014, p21 

    No abstract available.

  • Someone to talk to. Scott, Paula // Mental Health Today;Sep/Oct2014, p28 

    No abstract available.

  • Street triage takes the heat out of mental health crises. Cole, Elaine // Mental Health Practice;Nov2014, Vol. 18 Issue 3, p8 

    The article discusses the Devon Partnership National Health Service (NHS) Trust street triage program that aims to prevent people with mental health problem detained in police custody. It states that the program has reduced the number of people detained under S136. It notes that the program uses...

  • In the spotlight. Beresford, Peter // Mental Health Today;Nov/Dec2014, p7 

    No abstract available.

  • Together we’re stronger. Farebrother, Thomas // Mental Health Today;Nov/Dec2014, p12 

    No abstract available.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics