Service use preceding and following first referral for psychiatric emergency care at a short-stay crisis unit: A cohort study across three cities and one rural area in England

Abstract

Background: Internationally, hospital-based short-stay crisis units have been introduced to provide a safe space for stabilisation and further assessment for those in psychiatric crisis. The units typically aim to reduce inpatient admissions and psychiatric presentations to emergency departments. Aims: To assess changes to service use following a service user’s first visit to a unit, characterise the population accessing these units and examine equality of access to the units. Methods: A prospective cohort study design (ISCTRN registered; 53431343) compared service use for the 9 months preceding and following a first visit to a short-stay crisis unit at three cities and one rural area in England. Included individuals first visited a unit in the 6 months between 01/September/2020 and 28/February/2021. Results: The prospective cohort included 1189 individuals aged 36 years on average, significantly younger (by 5–13 years) than the population of local service users (<.001). Seventy percent were White British and most were without a psychiatric diagnosis (55%–82% across sites). The emergency department provided the largest single source of referrals to the unit (42%), followed by the Crisis and Home Treatment Team (20%). The use of most mental health services, including all types of admission and community mental health services was increased post discharge. Social-distancing measures due to the COVID-19 pandemic were in place for slightly over 50% of the follow-up period. Comparison to a pre-COVID cohort of 934 individuals suggested that the pandemic had no effect on the majority of service use variables. Conclusions: Short-stay crisis units are typically accessed by a young population, including those who previously were unknown to mental health services, who proceed to access a broader range of mental health services following discharge.

The effect of psychiatric decision unit services on inpatient admissions and mental health presentations in emergency departments: an interrupted time series analysis from two cities and one rural area in England

“…Further, in the short term, use of PDUs leads to increased service use (and increased associated costs) via signposting to community resources, at least for first-time PDU visitors, although encouragingly this does not reflect an increase in ED attendances (Goldsmith et al. , 2022). Also, there was little evidence to suggest a long-term change to the backdrop of (week-to-week) increasing frequency of ED presentations and/or psychiatric liaison episodes observed across sites (and seen across hospitals in England (Baracaia et al.…”