Crisis plans in a home treatment team before and after a quality improvement programme

Abstract

Collaborative and person-centred crisis plans are part of mental health policy in the UK, but little work has investigated take-up of crisis plans or equity in their use by crisis resolution and home treatment teams (CRHTs).Crisis plans may be a useful tool in the prevention of future hospital admissions, and they are especially relevant for CRHTs that perform a central gatekeeping role for people at risk of admission to hospital. Previous evaluations of Aims and method To measure the take-up of formal crisis plans in a specialist home treatment team (HTT) serving an ethnically diverse urban population; and to implement a quality improvement programme and measure its impact on crisis plan completion. Two audits were completed of patients before and after the implementation of a quality improvement programme. Descriptive data are shown by ethnic group, by gender, and for people with multiple hospital admissions.Results At baseline, 16.7% of patients at high risk of admission had an HTT crisis plan, compared with 26.7% of a comparison group. Only 23.1% of the crisis plans for patients with a history of frequent admission mentioned the prevention of future admissions. Crisis plan completion improved following the quality improvement programme, when 80.0% of discharges had an HTT crisis plan; of these, 73.0% mentioned admission prevention. In the follow-up audit, 22.7% of patients in the multiple admission group had been readmitted to hospital at least once. Crisis plan completion did not appear to differ by ethnic group or gender and did not appear to be related to hospital readmission.Clinical implications Crisis plan completion improved with simple practical methods, but completion was unrelated to gender, ethnicity or later readmission.Declaration of interest None.

Crisis plans in mental health: A scoping review

“…This outcome is mainly associated with the joint crisis plan and advance directives. Several quantitative studies also note a decrease in voluntary admissions (Barrett et al, 2013; Farrelly, Szmukler, et al, 2014; Ferguson et al, 2021; Ferrari et al, 2018; Flood et al, 2006; Henderson et al, 2008; Ruchlewska, 2015; Tan et al, 2012; Williams et al, 2014; Zonana et al, 2018).…”