Individualisation in crisis planning for people with psychotic disorders

Abstract

Background. In England, people with a serious mental illness are offered a standardized care plan under the Care Programme Approach (CPA). A crisis plan is a mandatory part of this standard; however, the quality and in particular the level of individualisation of these crisis plans are unknown. In this context, the aim of this study was to assess the quality of crisis planning and the impact of exposure to a specialized crisis planning intervention. Method. The crisis plans of 424 participants were assessed, before and after exposure to the Joint Crisis Plan (JCP) intervention, for 'individualisation' (i.e., at least one item of specific and identifiable information about an individual). Associations of individualisation were investigated. Results. A total of 15% of crisis plans were individualised at baseline. There was little or no improvement following exposure to the JCP. Individualised crisis plans were not associated with a history of prior crises or incidences of harm to self and others. Conclusions. Routine crisis planning for individuals with serious mental illness is not influenced by clinical risk profiles. 'Top down' implementation of the policy is unlikely to generate the best practice and compliance if clinicians do not perceive the clinical value in the process.

Ordinary risks and accepted fictions: how contrasting and competing priorities work in risk assessment and mental health care planning

“…Participants in our study and elsewhere present risk as a worker priority. For example, in the following extracts, service user participants from sites in England and Wales indicate that they see care planning and safety as tasks that workers must do for the purposes of deflecting claims of responsibility rather than designed solely with their interests at heart.

[safety and risk] was their conversation, not my conversation.

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Barriers to shared decision making in mental health care: qualitative study of the Joint Crisis Plan for psychosis

“…The CPA care plan includes a ‘crisis and contingency’ section, which should cover the individual's relapse warning signs and plans for treatment. However, in a recent review of the crisis sections of CPA care plans, only 15% of plans were found to have individualized content specific to the service user about whom it was written . Instead, the plans were mostly completed by clinicians and, while meeting organizational requirements, were generic and unlikely to be useful to the service user.…”

Barriers to recovery‐focused care within therapeutic relationships in nursing: Attitudes and perceptions

“…Some nurses are aware of the lack of congruence between goals of consumers in a recovery approach, such as empowerment to address real‐life problems, social inclusion and peer support, and those of the medical culture of health care that prioritizes safety and control, leaving them at a loss as to how to proceed (McKenna et al, ). Farrelly et al 's () review of 13 articles on therapeutic relations with providers and consumers in the mental health community supports this: while providers and consumers agreed on the need for shared trust, respect and collaboration, providers felt what they were to accomplish was unclear and questioned whether or not it was congruent with their roles (Farrelly et al, ). Foster and Isobel () found that nurses in their study were aware of this incongruence and voiced uncertainty in lack of confidence over their abilities, which impacted the recovery‐focused relationship.…”