The Joint Crisis Plan: A Powerful Tool to Promote Mental Health

Abstract

Purpose: The Joint Crisis Plan (JCP) has received growing interest in clinical and research settings. JCP is a type of psychiatric advance statement that describes how to recognize early signs of crisis and how to manage crises. The purpose of the present study, to our knowledge the first to be conducted on this topic in the French-speaking context and to include inpatients, was to describe the content of JCPs and how they are perceived by patients and the providers.Methods: The study used an exploratory, mixed, sequential method. Existing JCPs were retrospectively collected in several clinical contexts (hospital, community settings, and sheltered accommodation). Based on their analyses, we conducted semi-structured interviews including some rating scales on the perception of the JCPs among patients and providers in these settings. For the qualitative analyses, content analyses were conducted with a hybrid approach using NVivo 12 software. Data were double-coded and discussed with a third researcher until agreement was reached.Results: One hundred eighty-four JCPs were collected retrospectively and 24 semi-structured interviews were conducted with 12 patients and 12 providers. No relatives could be included in the research process. The content of the studied JCPs was relevant and indicated that patients had good knowledge of themselves and their illness. Improvements in the quality of the therapeutic relationship, respect for patients' choices and wishes, and a greater sense of control of their illness were reported. The JCP was perceived as a very useful tool by patients and providers. Concerning JCP limitations, lack of staff training, difficulties with the shared decision-making process, and the poor availability of the JCPs when needed were reported.Conclusion: The study highlights that JCPs may be used with patients suffering from a large variety of psychiatric disorders in different care settings. The JCP is perceived as very useful by both patients and providers. The promising results of this study support the promotion of the wide use of JCPs with patients who have experienced crises. It is important to continue to research JCPs through impact studies that include family members.

Caregiving-related experiences associated with depression severity and its symptomatology among caregivers of individuals with a severe mental disorder: an online cross-sectional study

“…Previous reports have indicated increased depression rates in general population [82] and non-clinical samples [83][84][85] during lockdown. Here, 54.4% of caregivers presented a possible depressive disorder (CES-D total score ≥ 16), thus higher than the ones reported in caregivers of subjects with bipolar disorder or schizophrenia (respectively, 22-33% and 42%) outside lockdown periods [66,[79][80][81]. This figure is in line with Chiu et al (2022) [78] reporting that 56% of family carers of older adults reported mild to severe depression between April and May 2020 (i.e., during lockdown in Hong Kong), a much higher prevalence than in the general population during the same period [79].…”

“…In regards with specific relationships with CES-D symptoms, feeling strained around the relative was predominantly associated with being fearful, further supporting the hypothesis that relative's behaviors may greatly contribute to the levels of tension that caregivers might experience when around their ill relative. In this regard, innovative strategies such as joint crisis plan could alleviate the negative impact of the relative's symptoms and behaviors on caregivers [66].…”

Crisis plans in mental health: A scoping review

“…Crisis plans as a tool for service users and their care team to state preferences in advance regarding interventions, care and treatment in a crisis situation (Maître et al, 2013; Skovgaard Larsen et al, 2016; Swanson et al, 2000) is the aim with the most consensus in the literature. It is also about facilitating crisis detection by describing or addressing signs, symptoms and manifestations that allow for early identification of the onset of a crisis situation (Henderson et al, 2004; Lequin et al, 2021; National Alliance on Mental Illness, 2016).…”

Feeling coerced during voluntary and involuntary psychiatric hospitalisation: A review and meta-aggregation of qualitative studies

“…Clarity, transparency and openness will foster patients' understanding and perceived fairness, and will help to restore partnership. The development of individual action plans based on shared goals, and the implementation of advance statements, such as Joint Crisis Plans [122,123] could be helpful to that end. These tools would not only improve patients' feeling of being actively involved in their care, but could also offer them the opportunity to process the coercive experience, to establish shared strategies for the prevention and possible management of future crisis, and to promote therapeutic alliance.…”