Crisis intervention for people with severe mental illnesses

Abstract

Background A particularly difficult challenge for community treatment of people with serious mental illnesses is the delivery of an acceptable level of care during the acute phases of severe mental illness. Crisis intervention models of care were developed as a possible solution. Objectives To review the effects of crisis intervention models for anyone with serious mental illness experiencing an acute episode, compared with ‘standard care’. Search methods We updated the 1998, 2003 and 2006 searches with a search of the Cochrane Schizophrenia Group’s Register of trials (2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE, and PsycINFO. Selection criteria We included all randomised controlled trials of crisis intervention models versus standard care for people with severe mental illnesses. Data collection and analysis We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CI). We assumed that people who left early from a trial had no improvement. Main results Three new studies have been found since the last review in 2006 to add to the five studies already included in this review. None of the previously included studies investigated crisis intervention alone; all used a form of home care for acutely ill people, which included elements of crisis intervention. However, one of the new studies focuses purely on crisis intervention as provided by Crisis Resolution Home Teams within the UK; the two other new studies investigated crisis houses i.e. residential alternatives to hospitalisation providing home-like environments. Crisis intervention appears to reduce repeat admissions to hospital after the initial ‘index’ crises investigated in the included studies, this was particularly so for mobile crisis teams supporting patients in their own homes. Crisis intervention reduces the number of people leaving the study early, reduces family burden, is a more satisfactory form of care for both patients and families and at three months after crisis, mental state is superior to standard care. We found no differences in death outcomes. Some studies found crisis interventions to be more cost effective than hospital care but all numerical data were either skewed or unusable. No data on staff satisfaction, carer input, complications with medication or number of relapses were available. Authors’ conclusions 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. If this approach is to be widely implemented it would seem that more evaluative studies are still needed.

Necesidades de los familiares de pacientes con esquizofrenia en situaciones de crisis

“…31 Las razones por las que un paciente recae son muy diversas, aunque se ha reportado que el índice de recaídas es mayor en los pacientes que sólo reciben tratamiento farmacológi-co en comparación con aquellos que recibieron tratamiento psicosocial y psicoeducación en conjunto con el tratamiento farmacológico. 15 Sin embargo, también se ha visto que muchos pacientes con esquizofrenia reciben medicación en las dosis preescritas y a pesar de eso presentan recaídas. 27 Las recaídas que mencionan los familiares que participaron en el grupo de discusión fueron provocadas por mal manejo o retiro de medicamentos.…”

“…), ya que están implicados en la problemática de la enfermedad y se ven afectados por la carga que conlleva el cuidado de su familiar enfermo. Existen estudios sobre el tratamiento integral [15][16][17] que demuestran una notable mejoría en el autocuidado, la socialización, el apego terapéutico y en la mejoría de las relaciones familiares que normalmente están alteradas en el paciente con esquizofrenia.…”

“…[9][10][11][12][13][14][15][16][17][18] Sin embargo, pocos estudios toman en cuenta los problemas que enfrentan los familiares cuando necesitan atención en momentos de crisis.…”

Invest in community-based solutions that address individuals’ needs: not more beds

“…While briefer follow-up looked promising, 4 this longer follow-up eventually found AO to do scarcely better than the CMHT for a lot more clinical effort and presumably, cost. 3 Early intervention for psychosis services, too, have had questionable benefits.…”

Mental health care in hospitals and primary care: an unsustainable balance

“…A recent systematic review of crisis intervention for severe mental illness found just six studies evaluating the effect of community crisis teams on 984 patients and judged their methodology to be 'poor'. 4 These six studies excluded service users with alcohol or drug misuse, or those in danger of harming themselves or others, and so are atypical of populations managed by community teams in England.…”