A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England

Lamb, Danielle; Steare, Thomas; Marston, Louise; Canaway, Alastair; Kirkbride, James; Lloyd‐Evans, Brynmor; Morant, Nicola; Pinfold, Vanessa; Smith, Deb; Weich, Scott; Osborn, David

doi:10.1192/bjo.2021.30

Cited by 7 publications

(9 citation statements)

References 17 publications

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“…A review in 2011 found that for some service users, ADUs were a viable alternative to inpatient admission with similar rates of readmission [10]. More recent studies carried out in England found that people supported by ADUs had a positive experience [11] and similar readmission rates to service users of CRTs [12]. Although ADUs can be found across Europe [13], in England they are much less widely implemented than CRTs [14].…”

Section: Introductionmentioning

confidence: 99%

Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems

Dalton-Locke

Harju-Seppänen

Lyons

et al. 2021

BMC Health Serv Res

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Background Inpatient psychiatric care is unpopular and expensive, and development and evaluation of alternatives is a long-standing policy and research priority around the world. In England, the three main models documented over the past fifty years (teams offering crisis assessment and treatment at home; acute day units; and residential crisis services in the community) have recently been augmented by several new service models. These are intended to enhance choice and flexibility within catchment area acute care systems, but remain largely undocumented in the research literature. We therefore aimed to describe the types and distribution of crisis care models across England through a national survey. Methods We carried out comprehensive mapping of crisis resolution teams (CRTs) using previous surveys, websites and multiple official data sources. Managers of CRTs were invited to participate as key informants who were familiar with the provision and organisation of crisis care services within their catchment area. The survey could be completed online or via telephone interview with a researcher, and elicited details about types of crisis care delivered in the local catchment area. Results We mapped a total of 200 adult CRTs and completed the survey with 184 (92%). Of the 200 mapped adult CRTs, there was a local (i.e., within the adult CRT catchment area) children and young persons CRT for 84 (42%), and an older adults CRT for 73 (37%). While all but one health region in England provided CRTs for working age adults, there was high variability regarding provision of all other community crisis service models and system configurations. Crisis cafes, street triage teams and separate crisis assessment services have all proliferated since a similar survey in 2016, while provision of acute day units has reduced. Conclusions The composition of catchment area crisis systems varies greatly across England and popularity of models seems unrelated to strength of evidence. A group of emerging crisis care models with varying functions within service systems are increasingly prevalent: they have potential to offer greater choice and flexibility in managing crises, but an evidence base regarding impact on service user experiences and outcomes is yet to be established.

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Section: Introductionmentioning

confidence: 99%

Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems

Dalton-Locke

Harju-Seppänen

Lyons

et al. 2021

BMC Health Serv Res

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“…Even taking into account these differences between the groups, there was no significant difference between them in terms of re-admission (HR 0.94, 95% CI 0.67 to 1.32). At 8-12 weeks, after accounting for baseline differences in participant characteristics, ADU participants had significantly higher satisfaction [CSQ score: 26.66 (SD 5.04) vs. 24.37 (SD 6.57)], with better well-being 19.02 (SD 5.03)] and lower depression [CES-D-10 14.4 (SD 6.0) vs. 16.6 (SD 5.7)] than CRT participants. These results indicate that, despite serving a more unwell client group, ADUs produce comparable outcomes in terms of re-admission, and better satisfaction, depression and well-being results than CRTs.…”

Section: Summary Of Resultsmentioning

confidence: 99%

“…Chapter 6 Work package 2.1: cohort studya comparison of re-admission rates, satisfaction and mental health outcomes in people using acute day units and people using only crisis resolution teams in four localities in England P arts of this chapter have been reproduced from Lamb et al 19 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/ licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.…”

Section: Adumentioning

confidence: 99%

“…Secondary outcomes: results from linear regression of satisfaction, well-being and depression at 8-12 weeks Data are coefficients from linear regression (95% CI). Adapted with permission from Lamb et al19 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.WORK PACKAGE 2.1 NIHR Journals Library www.journalslibrary.nihr.ac.uk [SWEMWBS score: 20.51 (SD 4.96) vs.…”

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Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study

Osborn

Lamb

Canaway

et al. 2021

Health Serv Deliv Res

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Background For people in mental health crisis, acute day units provide daily structured sessions and peer support in non-residential settings as an alternative to crisis resolution teams. Objectives To investigate the provision, effectiveness, intervention acceptability and re-admission rates of acute day units. Design Work package 1 – mapping and national questionnaire survey of acute day units. Work package 2.1 – cohort study comparing outcomes during a 6-month period between acute day unit and crisis resolution team participants. Work package 2.2 – qualitative interviews with staff and service users of acute day units. Work package 3 – a cohort study within the Mental Health Minimum Data Set exploring re-admissions to acute care over 6 months. A patient and public involvement group supported the study throughout. Setting and participants Work package 1 – all non-residential acute day units (NHS and voluntary sector) in England. Work packages 2.1 and 2.2 – four NHS trusts with staff, service users and carers in acute day units and crisis resolution teams. Work package 3 – all individuals using mental health NHS trusts in England. Results Work package 1 – we identified 27 acute day units in 17 out of 58 trusts. Acute day units are typically available on weekdays from 10 a.m. to 4 p.m., providing a wide range of interventions and a multidisciplinary team, including clinicians, and having an average attendance of 5 weeks. Work package 2.1 – we recruited 744 participants (acute day units, n = 431; crisis resolution teams, n = 312). In the primary analysis, 21% of acute day unit participants (vs. 23% of crisis resolution team participants) were re-admitted to acute mental health services over 6 months. There was no statistically significant difference in the fully adjusted model (acute day unit hazard ratio 0.78, 95% confidence interval 0.54 to 1.14; p = 0.20), with highly heterogeneous results between trusts. Acute day unit participants had higher satisfaction and well-being scores and lower depression scores than crisis resolution team participants. The health economics analysis found no difference in resource use or cost between the acute day unit and crisis resolution team groups in the fully adjusted analysis. Work package 2.2 – 36 people were interviewed (acute day unit staff, n = 12; service users, n = 21; carers, n = 3). There was an overwhelming consensus that acute day units are highly valued. Service users found the high amount of contact time and staff continuity, peer support and structure provided by acute day units particularly beneficial. Staff also valued providing continuity, building strong therapeutic relationships and providing a variety of flexible, personalised support. Work package 3 – of 231,998 individuals discharged from acute care (crisis resolution team, acute day unit or inpatient ward), 21.4% were re-admitted for acute treatment within 6 months, with women, single people, people of mixed or black ethnicity, those living in more deprived areas and those in the severe psychosis care cluster being more likely to be re-admitted. Little variation in re-admissions was explained at the trust level, or between trusts with and trusts without acute day units (adjusted odds ratio 0.96, 95% confidence interval 0.80 to 1.15). Limitations In work package 1, some of the information is likely to be incomplete as a result of trusts’ self-reporting. There may have been recruitment bias in work packages 2.1 and 2.2. Part of the health economics analysis relied on clinical Health of the Nations Outcome Scale ratings. The Mental Health Minimum Data Set did not contain a variable identifying acute day units, and some covariates had a considerable number of missing data. Conclusions Acute day units are not provided routinely in the NHS but are highly valued by staff and service users, giving better outcomes in terms of satisfaction, well-being and depression than, and no significant differences in risk of re-admission or increased costs from, crisis resolution teams. Future work should investigate wider health and care system structures and the place of acute day units within them; the development of a model of best practice for acute day units; and staff turnover and well-being (including the impacts of these on care). Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 18. See the NIHR Journals Library website for further project information.

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“…A review in 2011 found that for some service users, ADUs were a viable alternative to inpatient admission with similar rates of readmission (8). More recent studies carried out in England found that people supported by ADUs had a positive experience (9) and similar readmission rates to service users of CRTs (10). Although ADUs can be found across Europe (11), they are much less widely implemented than CRTs in England (12).…”

Section: Introductionmentioning

confidence: 99%

Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems

Dalton-Locke

Harju-Seppänen

Lyons

et al. 2021

Preprint

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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 services; and residential crisis services in the community) have recently been augmented by several new service models. These are intended to enhance choice and flexibility within catchment area acute care systems, but remain largely undocumented in the research literature. We therefore aimed to describe the types and distribution of crisis care models across England through a national survey. Methods: We carried out comprehensive mapping of crisis resolution teams (CRTs) using previous surveys, websites and multiple official data sources. Managers of CRTs were invited to participate as key informants who were familiar with the provision and organisation of crisis care services within their catchment area. The survey could be completed online or via telephone interview with a researcher, and elicited details about types of crisis care delivered in the local catchment area. Results: We mapped a total of 200 adult CRTs and completed the survey with 184 (92%). Of the 200 mapped adult CRTs, there was a local (i.e., within the adult CRT catchment area) children and young persons CRT for 84 (42%), and an older adults CRT for 73 (37%). While all but one health region in England provided CRTs for working age adults, there was high variability regarding provision of all other community crisis service models and system configurations. Crisis cafes, street triage teams and separate crisis assessment services have all proliferated since a similar survey in 2016, while provision of acute day units has reduced. Conclusions: The composition of catchment area crisis systems varies greatly across England and popularity of models seems unrelated to strength of evidence. A group of emerging crisis care models with varying functions within service systems are increasingly prevalent: they have potential to offer greater choice and flexibility in managing crises, but an evidence base regarding impact on service user experiences and outcomes is yet to be established.

show abstract

A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England

Cited by 7 publications

References 17 publications

Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems

Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems

Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study

Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems

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