scholarly journals Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Hasselberg ◽  
K. H. Holgersen ◽  
G. M. Uverud ◽  
J. Siqveland ◽  
B. Lloyd-Evans ◽  
...  
Keyword(s):  
Mental Health ◽  
Multidisciplinary Teams ◽  
Evidence Based ◽  
Crisis Resolution ◽  
Health Crisis ◽  
The Core ◽  
Crisis Resolution Teams ◽  
Fidelity Scale ◽  
The Uk ◽  
Evidence Based Model

Abstract Background Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown. Methods We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT. Results The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users’ choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support. Conclusions The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.

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.

scholarly journals Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study

2021 ◽  
Vol 9 (18) ◽  
pp. 1-122
Author(s):  
David Osborn ◽  
Danielle Lamb ◽  
Alastair Canaway ◽  
Michael Davidson ◽  
Graziella Favarato ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Well Being ◽  
Service Users ◽  
Mental Health Crisis ◽  
Work Package ◽  
Crisis Resolution ◽  
Data Set ◽  
Health Crisis ◽  
Crisis Resolution Teams

Background For people in mental health crisis, acute day units provide daily structured sessions and peer support in non-residential settings as an alternative to crisis resolution teams. Objectives To investigate the provision, effectiveness, intervention acceptability and re-admission rates of acute day units. Design Work package 1 – mapping and national questionnaire survey of acute day units. Work package 2.1 – cohort study comparing outcomes during a 6-month period between acute day unit and crisis resolution team participants. Work package 2.2 – qualitative interviews with staff and service users of acute day units. Work package 3 – a cohort study within the Mental Health Minimum Data Set exploring re-admissions to acute care over 6 months. A patient and public involvement group supported the study throughout. Setting and participants Work package 1 – all non-residential acute day units (NHS and voluntary sector) in England. Work packages 2.1 and 2.2 – four NHS trusts with staff, service users and carers in acute day units and crisis resolution teams. Work package 3 – all individuals using mental health NHS trusts in England. Results Work package 1 – we identified 27 acute day units in 17 out of 58 trusts. Acute day units are typically available on weekdays from 10 a.m. to 4 p.m., providing a wide range of interventions and a multidisciplinary team, including clinicians, and having an average attendance of 5 weeks. Work package 2.1 – we recruited 744 participants (acute day units, n = 431; crisis resolution teams, n = 312). In the primary analysis, 21% of acute day unit participants (vs. 23% of crisis resolution team participants) were re-admitted to acute mental health services over 6 months. There was no statistically significant difference in the fully adjusted model (acute day unit hazard ratio 0.78, 95% confidence interval 0.54 to 1.14; p = 0.20), with highly heterogeneous results between trusts. Acute day unit participants had higher satisfaction and well-being scores and lower depression scores than crisis resolution team participants. The health economics analysis found no difference in resource use or cost between the acute day unit and crisis resolution team groups in the fully adjusted analysis. Work package 2.2 – 36 people were interviewed (acute day unit staff, n = 12; service users, n = 21; carers, n = 3). There was an overwhelming consensus that acute day units are highly valued. Service users found the high amount of contact time and staff continuity, peer support and structure provided by acute day units particularly beneficial. Staff also valued providing continuity, building strong therapeutic relationships and providing a variety of flexible, personalised support. Work package 3 – of 231,998 individuals discharged from acute care (crisis resolution team, acute day unit or inpatient ward), 21.4% were re-admitted for acute treatment within 6 months, with women, single people, people of mixed or black ethnicity, those living in more deprived areas and those in the severe psychosis care cluster being more likely to be re-admitted. Little variation in re-admissions was explained at the trust level, or between trusts with and trusts without acute day units (adjusted odds ratio 0.96, 95% confidence interval 0.80 to 1.15). Limitations In work package 1, some of the information is likely to be incomplete as a result of trusts’ self-reporting. There may have been recruitment bias in work packages 2.1 and 2.2. Part of the health economics analysis relied on clinical Health of the Nations Outcome Scale ratings. The Mental Health Minimum Data Set did not contain a variable identifying acute day units, and some covariates had a considerable number of missing data. Conclusions Acute day units are not provided routinely in the NHS but are highly valued by staff and service users, giving better outcomes in terms of satisfaction, well-being and depression than, and no significant differences in risk of re-admission or increased costs from, crisis resolution teams. Future work should investigate wider health and care system structures and the place of acute day units within them; the development of a model of best practice for acute day units; and staff turnover and well-being (including the impacts of these on care). Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 18. See the NIHR Journals Library website for further project information.

scholarly journals Development of a measure of model fidelity for mental health Crisis Resolution Teams

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Brynmor Lloyd-Evans ◽  
Gary R. Bond ◽  
Torleif Ruud ◽  
Ada Ivanecka ◽  
Richard Gray ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Crisis ◽  
Crisis Resolution ◽  
Health Crisis ◽  
Model Fidelity ◽  
Crisis Resolution Teams

scholarly journals A comparison of clinical outcomes, service satisfaction, and well-being in people using Acute Day Units and Crisis Resolution Teams: a cohort study in England

2020 ◽  
Author(s):  
Danielle Lamb ◽  
Thomas Steare ◽  
Louise Marston ◽  
Alastair Canaway ◽  
Sonia Johnson ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Care Pathway ◽  
Well Being ◽  
Service Users ◽  
Mental Health Crisis ◽  
Crisis Resolution ◽  
Readmission Rates ◽  
Health Crisis ◽  
Crisis Resolution Teams

AbstractBackgroundFor people in mental health crisis, Acute Day Units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to Crisis Resolution Teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly in comparison to those receiving CRT care alone.AimsTo investigate readmission rates, satisfaction, and wellbeing outcomes for ADU and CRT service users.MethodsA cohort study comparing readmission to acute mental health care during a six-month period for ADU and CRT participants. Secondary outcomes included satisfaction (CSQ), wellbeing (SWEMWBS), and depression (CES-D).ResultsWe recruited 744 participants (ADU: 431, 58%; CRT 312, 42%) across 4 NHS Trusts/health regions. There was no statistically significant overall difference in readmissions; 21% of ADU participants (versus 23% CRT) were readmitted over 6 months (adjusted HR 0.78, 95%CI 0.54, 1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire (CSQ) scores (2.5, 95% CI 1.4 to 3.5, p<0.001) and wellbeing scores (1.3, 95%CI 0.4 to 2.1, p=0.004), and lower depression scores (−1.7, 95%CI −2.7 to −0.8, p<0.001) than CRT participants.ConclusionsService users who accessed ADUs demonstrated better outcomes for satisfaction, wellbeing, and depression, and no significant differences in risk of readmission compared to those who only used CRTs. Given the positive outcomes for service users, and the fact that ADUs are inconsistently provided across the country, their value and place in the acute care pathway needs further consideration and research.

scholarly journals Brief Behavioural Activation (Brief BA) for Adolescent Depression: A Pilot Study

2017 ◽  
Vol 46 (2) ◽  
pp. 182-194 ◽  
Author(s):  
Laura Pass ◽  
Carl W. Lejuez ◽  
Shirley Reynolds
Keyword(s):  
Mental Health ◽  
Pilot Study ◽  
Young People ◽  
Adolescent Depression ◽  
Psychological Intervention ◽  
Clinical Effectiveness ◽  
Evidence Based ◽  
Behavioural Activation ◽  
Evidence Based Treatments ◽  
The Uk

Background: Depression in adolescence is a common and serious mental health problem. In the UK, access to evidence-based psychological treatments is limited, and training and employing therapists to deliver these is expensive. Brief behavioural activation for the treatment of depression (BATD) has great potential for use with adolescents and to be delivered by a range of healthcare professionals, but there is limited empirical investigation with this group. Aims: To adapt BATD for depressed adolescents (Brief BA) and conduct a pilot study to assess feasibility, acceptability and clinical effectiveness. Method: Twenty depressed adolescents referred to the local NHS Child and Adolescent Mental Health service (CAMHs) were offered eight sessions of Brief BA followed by a review around one month later. Self- and parent-reported routine outcome measures (ROMs) were collected at every session. Results: Nineteen of the 20 young people fully engaged with the treatment and all reported finding some aspect of Brief BA helpful. Thirteen (65%) required no further psychological intervention following Brief BA, and both young people and parents reported high levels of acceptability and satisfaction with the approach. The pre–post effect size of Brief BA treatment was large. Conclusions: Brief BA is a promising innovation in the treatment of adolescent depression. This approach requires further evaluation to establish effectiveness and cost effectiveness compared with existing evidence-based treatments for adolescent depression. Other questions concern the effectiveness of delivery in other settings and when delivered by a range of professionals.

Leveraging Twitter Using Artificial Intelligence to Explore Mental Health Insights in the UK During the COVID-19 Pandemic (Preprint)

2021 ◽  
Author(s):  
Christopher Marshall ◽  
Kate Lanyi ◽  
Rhiannon Green ◽  
Georgie Wilkins ◽  
Fiona Pearson ◽  
...  
Keyword(s):  
Mental Health ◽  
Artificial Intelligence ◽  
Language Processing ◽  
Mental Health Problems ◽  
Well Being ◽  
Research Activity ◽  
Health Crisis ◽  
Key Topics ◽  
The Uk ◽  
The Impact

BACKGROUND There is increasing need to explore the value of soft-intelligence, leveraged using the latest artificial intelligence (AI) and natural language processing (NLP) techniques, as a source of analysed evidence to support public health research activity and decision-making. OBJECTIVE The aim of this study was to further explore the value of soft-intelligence analysed using AI through a case study, which examined a large collection of UK tweets relating to mental health during the COVID-19 pandemic. METHODS A search strategy comprising a list of terms related to mental health, COVID-19, and lockdown restrictions was developed to prospectively collate relevant tweets via Twitter’s advanced search application programming interface over a 24-week period. We deployed a specialist NLP platform to explore tweet frequency and sentiment across the UK and identify key topics of discussion. A series of keyword filters were used to clean the initial data retrieved and also set up to track specific mental health problems. Qualitative document analysis was carried out to further explore and expand upon the results generated by the NLP platform. All collated tweets were anonymised RESULTS We identified and analysed 286,902 tweets posted from UK user accounts from 23 July 2020 to 6 January 2021. The average sentiment score was 50%, suggesting overall neutral sentiment across all tweets over the study period. Major fluctuations in volume and sentiment appeared to coincide with key changes to any local and/or national social-distancing measures. Tweets around mental health were polarising, discussed with both positive and negative sentiment. Key topics of consistent discussion over the study period included the impact of the pandemic on people’s mental health (both positively and negatively), fear and anxiety over lockdowns, and anger and mistrust toward the government. CONCLUSIONS Through the primary use of an AI-based NLP platform, we were able to rapidly mine and analyse emerging health-related insights from UK tweets into how the pandemic may be impacting people’s mental health and well-being. This type of real-time analysed evidence could act as a useful intelligence source that agencies, local leaders, and health care decision makers can potentially draw from, particularly during a health crisis.

P02-08 - Mental health crisis resolution and home treatment teams: a qualitative evaluation

2010 ◽  
Vol 25 ◽  
pp. 626
Author(s):  
B. Ferguson ◽  
H. Middleton ◽  
R. Shaw ◽  
R. Collier ◽  
A. Purser
Keyword(s):  
Mental Health ◽  
Qualitative Evaluation ◽  
Home Treatment ◽  
Mental Health Crisis ◽  
Crisis Resolution ◽  
Health Crisis

The future of specialist community teams in the care of those with severe mental illness

2007 ◽  
Vol 16 (3) ◽  
pp. 225-230 ◽  
Author(s):  
Peter Tyrer
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Severe Mental Illness ◽  
Community Mental Health Services ◽  
Community Services ◽  
Crisis Resolution ◽  
Crisis Resolution Teams

SummaryAims – Specialist interventions in community psychiatry for severe mental illness are expanding and their place needs to be re-examined. Methods – Recent literature is reviewed to evaluate the advantages and disadvantages of specialist teams. Results – Good community mental health services reduce drop out from care, prevent suicide and unnatural deaths, and reduce admission to hospital. Most of these features have been also demonstrated by assertive community outreach and crisis resolution teams when good community services are not available. In well established community services assertive community teams do not reduce admission but both practitioners and patients prefer this service to other approaches and it leads to better engagement. Crisis resolution teams appear to be more successful than assertive community teams in preventing admission to hospital, although head- to-head comparisons have not yet been made. All specialist teams have the potential of fragmenting services and thereby reducing continuity of care. Conclusions – The assets of improved engagement and greater satisfaction with assertive, crisis resolution and home treatment teams are clear from recent evidence, but to improve integration of services they are probably best incorporated into community mental health services rather than standing alone.Declaration of Interest: The author has been the sole consultant in two assertive outreach teams since 1994 and might there- fore be expected to be in favour of this genre of service. He has received grants for evaluation of different services models from the Department of Health (UK) and the Medical Research Council (UK).

scholarly journals Bibliotherapy for Mental Health

2017 ◽  
Vol 2 (2) ◽  
pp. 67
Author(s):  
Jennifer Yontz-Orlando
Keyword(s):  
Mental Health ◽  
United States ◽  
Mental Illness ◽  
Medical Condition ◽  
Action Plan ◽  
The United States ◽  
World Health ◽  
Group Setting ◽  
Health Crisis ◽  
The Uk

The United States is facing an epidemic of mental illness, affecting nearly 60 million Americans annually (http://www.nami.org/ ). The World Health Organization describes mental health as “a long neglected problem” and has established an action plan for 2013-2020 (http://www.who.int/mental_health/action_plan_2013/en/). One way to combat mental illness is through bibliotherapy, which is the use of written materials including fiction, nonfiction, and poetry to support emotional and psychiatric healing.Bibliotherapy has been in existence since ancient times, but began in earnest in the United States in the 1850’s during the “Great Awakening.” At that time, mental illness began to be seen as a medical condition rather than a supernatural phenomenon. Since then, due to the changing nature of our institutions, interest in bibliotherapy waned until the 1950’s when there was a slight resurgence in its practice. However, in the last 20 years, bibliotherapy has gained a stronghold in the United Kingdom. To relieve the stress of an overcrowded mental health system, public policy in the UK has supported the use of bibliotherapy in a variety of its institutions. There are many ways to conduct bibliotherapy, but studies show that when the process is interactive, such as in a support group setting, the results are better. Also, bibliotherapy can be conducted by many sorts of professionals, including doctors, therapists, social workers, teachers, and librarians. Studies also show that when the bibliotherapists are trained in the best practices of bibliotherapy, results improve. Bibliotherapy is an effective, low-cost alternative for people in need of therapeutic assistance. The UK model should be studied and implemented in the United States and in other nations to help solve the mental health crisis.

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