scholarly journals Psychiatric Crisis Care and the More is Less Paradox

2021 ◽  
Author(s):  
Robert E. Drake ◽  
Gary R. Bond
Keyword(s):  
Psychiatric Crisis ◽  
Crisis Care

scholarly journals Predicting Hospitalization following Psychiatric Crisis Care using Machine Learning

2019 ◽  
Author(s):  
Matthijs Blankers ◽  
Louk F. M. van der Post ◽  
Jack J. M. Dekker
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Learning Algorithms ◽  
Nearest Neighbors ◽  
Machine Learning Algorithms ◽  
Predictor Variables ◽  
Gradient Boosting ◽  
K Nearest Neighbors ◽  
Psychiatric Crisis ◽  
Crisis Care

Abstract Background: It is difficult to accurately predict whether a patient on the verge of a potential psychiatric crisis will need to be hospitalized. Machine learning may be helpful to improve the accuracy of psychiatric hospitalization prediction models. In this paper we evaluate and compare the accuracy of ten machine learning algorithms including the commonly used generalized linear model (GLM/logistic regression) to predict psychiatric hospitalization in the first 12 months after a psychiatric crisis care contact, and explore the most important predictor variables of hospitalization. Methods: Data from 2,084 patients with at least one reported psychiatric crisis care contact included in the longitudinal Amsterdam Study of Acute Psychiatry were used. The accuracy and area under the receiver operating characteristic curve (AUC) of the machine learning algorithms were compared. We also estimated the relative importance of each predictor variable. The best and least performing algorithms were compared with GLM/logistic regression using net reclassification improvement analysis. Target variable for the prediction models was whether or not the patient was hospitalized in the 12 months following inclusion in the study. The 39 predictor variables were related to patients’ socio-demographics, clinical characteristics and previous mental health care contacts. Results: We found Gradient Boosting to perform the best (AUC=0.774) and K-Nearest Neighbors performing the least (AUC=0.702). The performance of GLM/logistic regression (AUC=0.76) was above average among the tested algorithms. Gradient Boosting outperformed GLM/logistic regression and K-Nearest Neighbors, and GLM outperformed K-Nearest Neighbors in a Net Reclassification Improvement analysis, although the differences between Gradient Boosting and GLM/logistic regression were small. Nine of the top-10 most important predictor variables were related to previous mental health care use. Conclusions: Gradient Boosting led to the highest predictive accuracy and AUC while GLM/logistic regression performed average among the tested algorithms. Although statistically significant, the magnitude of the differences between the machine learning algorithms was modest. Future studies may consider to combine multiple algorithms in an ensemble model for optimal performance and to mitigate the risk of choosing suboptimal performing algorithms.

scholarly journals “Caring for a Crisis”: Care and Control in Community Mental Health

2022 ◽  
Vol 12 ◽  
Author(s):  
Christien Muusse ◽  
Hans Kroon ◽  
Cornelis Lambert Mulder ◽  
Jeannette Pols
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Open Door Policy ◽  
Mental Health Team ◽  
Psychiatric Crisis ◽  
Crisis Care ◽  
Specific Care ◽  
And Control ◽  
Psychiatric Beds ◽  
The Relationship

In the debate on coercion in psychiatry, care and control are often juxtaposed. In this article we argue that this dichotomy is not useful to describe the more complex ways service users, care professionals and the specific care setting interrelate in a community mental health team (CMHT). Using the ethnographic approach of empirical ethics, we contrast the ways in which control and care go together in situations of a psychiatric crisis in two CMHT's: one in Trieste (Italy) and one in Utrecht (the Netherlands). The Dutch and Italian CMHT's are interesting to compare, because they differ with regard to the way community care is organized, the amount of coercive measures, the number of psychiatric beds, and the fact that Trieste applies an open door policy in all care settings. Contrasting the two teams can teach us how in situations of psychiatric crisis control and care interrelate in different choreographies. We use the term choreography as a metaphor to encapsulate the idea of a crisis situation as a set of coordinated actions from different actors in time and space. This provides two choreographies of handling a crisis in different ways. We argue that applying a strict boundary between care and control hinders the use of the relationship between caregiver and patient in care.

Consistency of Psychiatric Crisis Care With Advance Directive Instructions

2007 ◽  
Vol 58 (9) ◽  
pp. 1157-1163 ◽  
Author(s):  
Debra S. Srebnik ◽  
Joan Russo
Keyword(s):  
Advance Directive ◽  
Psychiatric Crisis ◽  
Crisis Care

scholarly journals The effects of intensive home treatment on self-efficacy in patients recovering from a psychiatric crisis

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ansam Barakat ◽  
Matthijs Blankers ◽  
Jurgen E Cornelis ◽  
Nick M Lommerse ◽  
Aartjan T F Beekman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Disorders ◽  
Self Efficacy ◽  
Psychotic Disorders ◽  
Rating Scale ◽  
Small Sample ◽  
Home Treatment ◽  
Differential Effects ◽  
Psychiatric Crisis

Abstract Background This study evaluated whether providing intensive home treatment (IHT) to patients experiencing a psychiatric crisis has more effect on self-efficacy when compared to care as usual (CAU). Self-efficacy is a psychological concept closely related to one of the aims of IHT. Additionally, differential effects on self-efficacy among patients with different mental disorders and associations between self-efficacy and symptomatic recovery or quality of life were examined. Methods Data stem from a Zelen double consent randomised controlled trial (RCT), which assesses the effects of IHT compared to CAU on patients who experienced a psychiatric crisis. Data were collected at baseline, 6 and 26 weeks follow-up. Self-efficacy was measured using the Mental Health Confidence Scale. The 5-dimensional EuroQol instrument and the Brief Psychiatric Rating Scale (BPRS) were used to measure quality of life and symptomatic recovery, respectively. We used linear mixed modelling to estimate the associations with self-efficacy. Results Data of 142 participants were used. Overall, no difference between IHT and CAU was found with respect to self-efficacy (B = − 0.08, SE = 0.15, p = 0.57), and self-efficacy did not change over the period of 26 weeks (B = − 0.01, SE = 0.12, t (103.95) = − 0.06, p = 0.95). However, differential effects on self-efficacy over time were found for patients with different mental disorders (F(8, 219.33) = 3.75, p < 0.001). Additionally, self-efficacy was strongly associated with symptomatic recovery (total BPRS B = − 0.10, SE = 0.02, p < 0.00) and quality of life (B = 0.14, SE = 0.01, p < 0.001). Conclusions Although self-efficacy was associated with symptomatic recovery and quality of life, IHT does not have a supplementary effect on self-efficacy when compared to CAU. This result raises the question whether, and how, crisis care could be adapted to enhance self-efficacy, keeping in mind the development of self-efficacy in depressive, bipolar, personality, and schizophrenia spectrum and other psychotic disorders. The findings should be considered with some caution. This study lacked sufficient power to test small changes in self-efficacy and some mental disorders had a small sample size. Trial registration This trial is registered at Trialregister.nl, number NL6020.

scholarly journals Optimizing Scarce Resource Allocation During COVID-19: Rapid Creation of a Regional Health-Care Coalition and Triage Teams in San Diego County, California

2020 ◽  
pp. 1-7
Author(s):  
Asha Devereaux ◽  
Holly Yang ◽  
Gilbert Seda ◽  
Viji Sankar ◽  
Ryan C. Maves ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Resource Allocation ◽  
San Diego ◽  
Scarce Resource ◽  
Successful Implementation ◽  
Regional Health ◽  
Incident Command ◽  
Regional Health Care ◽  
Crisis Care

ABSTRACT Successful management of an event where health-care needs exceed regional health-care capacity requires coordinated strategies for scarce resource allocation. Publications for rapid development, training, and coordination of regional hospital triage teams to manage the allocation of scarce resources during coronavirus disease 2019 (COVID-19) are lacking. Over a period of 3 weeks, over 100 clinicians, ethicists, leaders, and public health authorities convened virtually to achieve consensus on how best to save the most lives possible and share resources. This is referred to as population-based crisis management. The rapid regionalization of 22 acute care hospitals across 4500 square miles in the midst of a pandemic with a shifting regulatory landscape was challenging, but overcome by mutual trust, transparency, and confidence in the public health authority. Because many cities are facing COVID-19 surges, we share a process for successful rapid formation of health-care care coalitions, Crisis Standard of Care, and training of Triage Teams. Incorporation of continuous process improvement and methods for communication is essential for successful implementation. Use of our regional health-care coalition communications, incident command system, and the crisis care committee helped mitigate crisis care in the San Diego and Imperial County region as COVID-19 cases surged and scarce resource collaborative decisions were required.

scholarly journals Mental health crisis resolution teams and crisis care systems in England: a national survey

2018 ◽  
Vol 42 (4) ◽  
pp. 146-151 ◽  
Author(s):  
Brynmor Lloyd-Evans ◽  
Danielle Lamb ◽  
Joseph Barnby ◽  
Michelle Eskinazi ◽  
Amelia Turner ◽  
...  
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
National Survey ◽  
Online Survey ◽  
Service Improvement ◽  
Mental Health Crisis ◽  
Crisis Resolution ◽  
Health Crisis ◽  
Crisis Resolution Teams ◽  
Crisis Care

Aims and methodA national survey investigated the implementation of mental health crisis resolution teams (CRTs) in England. CRTs were mapped and team managers completed an online survey.ResultsNinety-five per cent of mapped CRTs (n = 233) completed the survey. Few CRTs adhered fully to national policy guidelines. CRT implementation and local acute care system contexts varied substantially. Access to CRTs for working-age adults appears to have improved, compared with a similar survey in 2012, despite no evidence of higher staffing levels. Specialist CRTs for children and for older adults with dementia have been implemented in some areas but are uncommon.Clinical implicationsA national mandate and policy guidelines have been insufficient to implement CRTs fully as planned. Programmes to support adherence to the CRT model and CRT service improvement are required. Clearer policy guidance is needed on requirements for crisis care for young people and older adults.Declaration of interestNone.

Comparison of non-suicidal self-injurious behavior and suicide attempts in patients admitted to a psychiatric crisis unit

2010 ◽  
Vol 48 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Laurence Claes ◽  
Jennifer Muehlenkamp ◽  
Walter Vandereycken ◽  
Luc Hamelinck ◽  
Helga Martens ◽  
...  
Keyword(s):  
Suicide Attempts ◽  
Psychiatric Crisis
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