Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial

Abstract

Objective To investigate whether a form of advance agreement for people with severe mental illness can reduce the use of inpatient services and compulsory admission or treatment. Design Single blind randomised controlled trial, with randomisation of individual patients. The investigator was blind to allocation. Setting Eight community mental health teams in southern England. Participants 160 people with an operational diagnosis of psychotic illness or non-psychotic bipolar disorder who had experienced 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. Main outcome measures Admission to hospital, bed days, and use of the Mental Health Act over 15 month follow up. Results 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). As a consequence, the mean number of days of detention (days spent as an inpatient while under a section of the Mental Health Act) for the whole intervention group was 14 compared with 31 for the control group (difference 16, 0 to 36, P = 0.04). For those admitted under a section of the Mental Health Act, the number of days of detention was similar in the two groups (means 114 and 117, difference 3, − 61 to 67, P = 0.98). 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). Conclusions Use of joint crisis plans reduced compulsory admissions and treatment in patients with severe mental illness. The reduction in overall admission was less. This is the first structured clinical intervention that seems to reduce compulsory admission and treatment in mental health services.

Discrimination against people with severe mental illness and their access to social capital: findings from the Viewpoint survey

“…This study additionally found that people with experience of a previous involuntary admission to hospital under the Mental Health Act 1983 had reduced access to social capital, while controlling for the potential confounding effect of diagnosis and length of time known to mental health services. A history of involuntary admission is likely to be a proxy of severity of mental disorder, suggesting that provision of continuous and assertive community-based care to this group, including using interventions such as joint crisis plans (Henderson et al 2004), may be required in order to help them maintain their social networks and enhance their recovery.…”

Contención mecánica: definición conceptual

“…They have been shown to reduce use of treatment under compulsion and also to reduce costs. (Henderson et al, 2004).…”

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

“…[292][293][294][295][296] However, there have been very few studies that have explored recovery experiences systematically in BD. Some qualitative studies have explored how individuals with BD stay well, focusing primarily on methods by which relapse is avoided, rather than on the subjective process of recovery, highlighting the importance of both medication and psychosocial support in the context of active condition management by the individual.…”