Crisis resolution/home treatment team workers’ understandings of the concept of crisis

Tobitt, Simon; Kamboj, Sunjeev K.

doi:10.1007/s00127-010-0234-y

Cited by 14 publications

(4 citation statements)

References 16 publications

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“…According to crisis theory, the patient passes through periods, where the benefit of addressing the patients' difficulties is increased, i.e. there might be a window-of-opportunity [38]. Our results support the idea that one window-of-opportunity is the period right after discharge.…”

Section: Discussionsupporting

confidence: 79%

Intensive Transitional Post-discharge Service for Patients with Depression

Arnfred¹

2014

J Depress Anxiety

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Introduction: Psychiatric treatment for depression initiated during admission is often planned to be continued after discharge, yet outpatient follow-up service frequently fails to meet even modest standards for service regarding timeliness and frequency of contact. Here we present data from a newly designed transitional, day-to-day, CBTbased psychiatric aftercare service. Methods:The program consisted of at least one psychiatric consultation, week-day telephone outreach and CBT-based individual therapy twice a week (in total five times), followed by group therapy twice a week for four weeks. In individual therapy, focus was on collaborative goal setting and next-of-kin participation. The group format was open, trans-diagnostic and highly structured. Self-ratings (WHO-5 Well-Being Scale (WHO-5); Becks Depression Inventory -II (BDI)) were obtained at the first day, at the end of individual therapy (after 3 weeks) and at end of group therapy (after 6-10 weeks). User evaluations were obtained at the latter two time points. Descriptive data is presented and ratings are analysed in an intention-to-treat design.Results: In 23 months 189 patients with unipolar depression were referred to the aftercare program. 165 patients completed the initial questionnaires, which showed a high level of depression symptoms (BDI 30.9 (STD 11.4 N=166) the first day of the program (right after discharge). 114 patients continued in group therapy. 11 (5.8 %) patients were re-admitted, 74 (39.2%) patients continued treatment in regional mental health clinics and 89 (47.1%) patients were discharged to primary sector service. BDI scores improved at each time point. Overall user satisfaction, measured with Client Satisfaction Questionnaire (CSQ), was high. Conclusion:Symptom reduction was evident during the aftercare program, and patients were satisfied with the service content. However, the results have to be interpreted with caution as we lack data from a comparable patient group receiving no service or a different type of post-discharge aftercare.

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Section: Discussionsupporting

confidence: 79%

Intensive Transitional Post-discharge Service for Patients with Depression

Arnfred¹

2014

J Depress Anxiety

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“…21,22 Irrespective of psychiatric diagnoses, a mental health crisis can also be defined as a reaction to adverse life events, leading to increasing disruption for the person and their family whereby their usual coping strategies have failed. 23 Being in a state of crisis can also be conceived as an opportunity for change and may enable people to develop new ways of coping. 24 Mental health crises are serious, are sometimes life-threatening and are often associated with increased risks to the safety and well-being of the person or others.…”

Section: Background and Rationalementioning

confidence: 99%

Explanation of context, mechanisms and outcomes in adult community mental health crisis care: the MH-CREST realist evidence synthesis

Clibbens,

Baker,

Booth

et al. 2023

Health Soc Care Deliv Res

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Background Mental health crises cause significant disruption to individuals and families and can be life-threatening. The large number of community crisis services operating in an inter-agency landscape complicates access to help. It is unclear which underpinning mechanisms of crisis care work, for whom and in which circumstances. Aim The aim was to identify mechanisms to explain how, for whom and in what circumstances adult community crisis services work. Objectives The objectives were to develop, test and synthesise programme theories via (1) stakeholder expertise and current evidence; (2) a context, intervention, mechanism and outcome framework; (3) consultation with experts; (4) development of pen portraits; (5) synthesis and refinement of programme theories, including mid-range theory; and (6) identification and dissemination of mechanisms needed to trigger desired context-specific crisis outcomes. Design This study is a realist evidence synthesis, comprising (1) identification of initial programme theories; (2) prioritisation, testing and refinement of programme theories; (3) focused realist reviews of prioritised initial programme theories; and (4) synthesis to mid-range theory. Main outcome The main outcome was to explain context, mechanisms and outcomes in adult community mental health crisis care. Data sources Data were sourced via academic and grey literature searches, expert stakeholder group consultations and 20 individual realist interviews with experts. Review methods A realist evidence synthesis with primary data was conducted to test and refine three initial programme theories: (1) urgent and accessible crisis care, (2) compassionate and therapeutic crisis care and (3) inter-agency working. Results Community crisis services operate best within an inter-agency system. This requires compassionate leadership and shared values that enable staff to be supported; retain their compassion; and, in turn, facilitate compassionate interventions for people in crisis. The complex interface between agencies is best managed through greater clarity at the boundaries of services, making referral and transition seamless and timely. This would facilitate ease of access and guaranteed responses that are trusted by the communities they serve. Strengths and limitations Strengths include the identification of mechanisms for effective inter-agency community crisis care and meaningful stakeholder consultation that grounded the theories in real-life experience. Limitations include the evidence being heavily weighted towards England and the review scope excluding full analysis of ethnic and cultural diversity. Conclusions Multiple interpretations of crises and diverse population needs present challenges for improving the complex pathways to help in a crisis. Inter-agency working requires clear policy guidance with local commissioning. Seamless transitions between services generate trust through guaranteed responses and ease of navigation. This is best achieved where there is inter-agency affiliation that supports co-production. Compassionate leaders engender staff trust, and outcomes for people in crisis improve when staff are supported to retain their compassion. Future work Further work might explore inter-agency models of crisis delivery, particularly in rural communities. Future work could focus on evaluating outcomes across crisis care provider agencies and include evaluation of individual, as well as service-level, outcomes. The implementation and effect of mental health triage could be explored further, including via telehealth. Barriers to access for marginalised populations warrant a specific focus in future research. Study registration The study is registered as PROSPERO CRD42019141680. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 15. See the NIHR Journals Library website for further project information.

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“…Mental health crises can be defined in different ways (Newbigging et al, 2020) including as a relapse in a psychiatric condition, characterized by increased symptom severity, such as voice hearing, suicidal thoughts and risky behaviours and decreases in social functioning including reduced self‐care (Crompton & Daniel, 2006; The Department of Health, 2003). Irrespective of psychiatric diagnoses, crises can also be defined as a reaction to adverse life events, leading to increasing disruption for the person and their family where their usual coping strategies have not helped (Tobitt & Kamboj, 2011). Being in a state of crisis could for some people be conceived as an opportunity for change and may enable people to develop new ways of coping (Caplan, 1989).…”

Section: Introductionmentioning

confidence: 99%

Explaining context, mechanism and outcome in adult community mental health crisis care: A realist evidence synthesis

Clibbens,

Booth,

Sharda

et al. 2023

Int J Mental Health Nurs

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Mental health crises cause significant distress and disruption to the lives of individuals and their families. Community crisis care systems are complex, often hard to navigate and poorly understood. This realist evidence synthesis aimed to explain how, for whom and in what circumstances community mental health crisis services for adults work to resolve crises and is reported according to RAMESES guidelines. Using realist methodology, initial programme theories were identified and then tested through iterative evidence searching across 10 electronic databases, four expert stakeholder consultations and n = 20 individual interviews. 45 relevant records informed the three initial programme theories, and 77 documents, were included in programme theory testing. 39 context, mechanism, outcome configurations were meta‐synthesized into three themes: (1) The gateway to urgent support; (2) Values based crisis interventions and (3) Leadership and organizational values. Fragmented cross‐agency responses exacerbated staff stress and created barriers to access. Services should focus on evaluating interagency working to improve staff role clarity and ensure boundaries between services are planned for. Organizations experienced as compassionate contributed positively to perceived accessibility but relied on compassionate leadership. Attending to the support needs of staff and the proximity of leaders to the front line of crisis care are key. Designing interventions that are easy to navigate, prioritize shared decision‐making and reduce the risk of re‐traumatizing people is a priority.

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Crisis resolution/home treatment team workers’ understandings of the concept of crisis

Abstract: The findings suggest further development of the CR/HT model, including improving conceptual clarity (to benefit communication with referrers and judge clinical outcome), better timed intervention, and varying intervention for different clusters of crisis presentation.

Cited by 14 publications

References 16 publications

Intensive Transitional Post-discharge Service for Patients with Depression

Intensive Transitional Post-discharge Service for Patients with Depression

Explanation of context, mechanisms and outcomes in adult community mental health crisis care: the MH-CREST realist evidence synthesis

Explaining context, mechanism and outcome in adult community mental health crisis care: A realist evidence synthesis

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