Safety of patients under the care of crisis resolution home treatment services in England: a retrospective analysis of suicide trends from 2003 to 2011

Hunt, Isabelle M.; Rahman, Mohammad Shaiyan; While, David; Windfuhr, Kirsten; Shaw, Jenny; Appleby, Louis; Kapur, Navneet

doi:10.1016/s2215-0366(14)70250-0

Cited by 35 publications

(31 citation statements)

References 16 publications

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“…In England we investigated the number of deaths under the care of crisis resolution home treatment teams (CRHT). 24 There has been a marked increase in this type of care in recent years and there are currently three times the number of suicide deaths under CRHT compared with in-patient settings. To an extent, this is what we would expect given the huge increase in the number of people being treated by home treatment teams.…”

Section: Trends In In-patient Suicidementioning

confidence: 99%

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Psychiatric hospitalisation and the risk of suicide

Kapur

2018

Br J Psychiatry

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SummaryThe association between current or recent psychiatric hospitalisation and increased suicide risk is well described. This relationship is generally assumed to be due to the selection of people at increased risk of suicide for psychiatric admission and subsequent failure of protection from suicide once admitted. Here, Matthew Large and Nav Kapur debate whether or not admission to hospital also selects for vulnerability to certain harmful aspects of hospitalisation and whether the increased rate of suicide in current and recently discharged psychiatric patients is, in fact, due to psychiatric hospitalisation itself.Declaration of interestM.M.L. has provided expert testimony in legal proceedings following in-patient suicide. N.K. sits on the Department of Health (England) National Suicide Prevention Strategy Advisory group.

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Section: Trends In In-patient Suicidementioning

confidence: 99%

“…30 Patient preference is a major consideration when thinking about treatment setting and of course we need to work hard to ensure that community alternatives to inpatient care are as safe and effective as possible. 24 Making in-patient care safer…”

Section: Matthew Largementioning

confidence: 99%

Psychiatric hospitalisation and the risk of suicide

Kapur

2018

Br J Psychiatry

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“…2 Suicide is a key outcome for mental health services, 9 and has previously been used as a marker of the quality and safety of care. 10 Some groups of patients, such as current or recent in-patients, 11,12 or those receiving intensive treatment at home as an alternative to admission, 13 are at particularly high risk of dying by suicide.…”

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confidence: 99%

Mental health services, suicide and 7-day working

et al. 2016

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“…Such anxieties may be well founded given the rates of suicide among those under the care of crisis resolution home treatment teams. 168 Key elements of care in the form of choice of professional or therapist to work with, diversity of treatment options and access to information about one's own care were rated lower by service user participants than by staff in most sites. Involvement and collaboration are increasingly watch-words for workers but quantitative results in this study indicate that choice is focused on personal goals and not on wider system issues such as training or involvement in management meetings.…”

Section: Recovery Therapeutic Relationships and Care Planningmentioning

confidence: 94%

“…[172][173][174] The risk of suicide in the transition from inpatient care is now firmly established 175 and there is some suggestion that this risk has been transferred from inpatient to crisis resolution and home treatment services. 168,176 Harm to others is a much rarer event but, nevertheless, is likely to have significant negative consequences for the victim, the individual with mental health problems and the wider system, including individual workers, such that risk-averse practice is common. 177 The pressure to ensure safety and avoid blame appears to be omnipresent in mental health services.…”

Section: Safety and Riskmentioning

confidence: 99%

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

Simpson

Coffey

Hannigan

et al. 2017

Health Serv Deliv Res

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BackgroundMental health service users in acute inpatient wards, whether informal or detained, should be involved in planning and reviewing their care. Care planning processes should be personalised and focused on recovery, with goals that are specific to the individual and designed to maximise their achievements and social integration.Objective(s)We aimed to ascertain the views and experiences of service users, carers and staff to enable us to identify factors that facilitated or acted as barriers to collaborative, recovery-focused care and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving 19 mental health wards in six NHS sites in England and Wales included a metanarrative synthesis of policies and literature; a survey of service users (n = 301) and staff (n = 290); embedded case studies involving interviews with staff, service users and carers (n = 76); and a review of care plans (n = 51) and meetings (n = 12).ResultsNo global differences were found across the sites in the scores of the four questionnaires completed by service users. For staff, there was significant difference between sites in mean scores on recovery-orientation and therapeutic relationships. For service users, when recovery-orientated focus was high, the quality of care was viewed highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Across all sites, staff’s scores were significantly higher than service users’ scores on the scale to assess therapeutic relationships. Staff across the sites spoke of the importance of collaborative care planning. However, the staff, service user and carer interviews revealed gaps between shared aspirations and realities. Staff accounts of routine collaboration contrasted with service user accounts and care plan reviews. Definitions and understandings of recovery varied, as did views of the role of hospital care in promoting recovery. ‘Personalisation’ was not a familiar term, although there was recognition that care was often provided in an individualised way. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.ConclusionsOur results suggest that there is positive practice taking place within acute inpatient wards, with evidence of widespread commitment to safe, respectful, compassionate care. Although ideas of recovery were evident, there was some uncertainty about and discrepancy in the relevance of recovery ideals to inpatient care and the ability of people in acute distress to engage in recovery-focused approaches. Despite the fact that staff spoke of efforts to involve them, the majority of service users and carers did not feel that they had been genuinely involved, although they were aware of efforts to keep them safe.Future workFuture research should investigate approaches that increase contact time with service users and promote personalised, recovery-focused working; introduce shared decision-making in risk assessment and management; and improve service user experiences of care planning and review and the use of recovery-focused tools during inpatient care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Safety of patients under the care of crisis resolution home treatment services in England: a retrospective analysis of suicide trends from 2003 to 2011

Cited by 35 publications

References 16 publications

Psychiatric hospitalisation and the risk of suicide

Psychiatric hospitalisation and the risk of suicide

Mental health services, suicide and 7-day working

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

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