Crisis Resolution and Home Treatment in Mental Health Edited by Sonia Johnson, Justin Needle, Jonathan P. Bindman & Graham Thornicroft. Cambridge Medicine. 2008. £29.99 (pb). 336pp. ISBN: 9780521678759

The purpose of this article is to describe emotion work within a crisis resolution home treatment team in Norway. As defined by Hochschild, “emotion work” refers to managing one’s emotions according to what is culturally acceptable within a particular situation. A crisis resolution home treatment team is of particular interest when studying emotion work, because it represents a working environment where mental health crises and suicidal threat are common and where managing emotions is necessary for the team to function well. We aimed to expand current knowledge of the particular ways in which emotion work may be done by observing and describing the daily work of such a team. Our analyses showed that team members’ emotion work had five main features: (1) emotional expression was common and there seemed to be an informal rule that “vulnerable” emotions could be expressed; (2) emotional expression was most commonly observed in post-event discussions of challenging events or service users; (3) emotional expression facilitated digesting or processing of the event with the help of a fellow team member; (4) emotional expression was met with validation and support; and (5) this support seemed to increase mentalization and understanding of the situation and could be offered only by other team members. An implication of these findings is that informal exchanges of emotion are a necessary part of the work and cannot occur outside of the work context.

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Innovative digitale Versorgungsformen zur Personalisierung der stationsäquivalenten Behandlung in der alltäglichen Lebenswelt bei schweren psychischen Erkrankungen [Innovative digital forms of service delivery for personalized crisis resolution and home treatment for people with severe mental health problems]

10.31234/osf.io/7umb5 ◽

2020 ◽

Author(s):

Christian Rauschenberg ◽

Dusan Hirjak ◽

Thomas Ganslandt ◽

Anita Schick ◽

Andreas Meyer-Lindenberg ◽

...

Keyword(s):

Mental Health ◽

Service Delivery ◽

Subjective Experience ◽

Mental Health Problems ◽

Home Treatment ◽

Stationäre Behandlung ◽

Crisis Resolution ◽

Online Chat ◽

Psychiatrische Behandlung ◽

Ecological Momentary

Die stationsäquivalente psychiatrische Behandlung (StäB) wurde 2018 als neue Krankenhausleistung für Menschen eingeführt, die die Indikation für eine stationäre Behandlung erfüllen. Die rasanten Fortschritte im Bereich der Informations- und Kommunikationstechnologie bieten völlig neue Chancen für innovative digitale Versorgungsangebote wie telemedizinische, eHealth oder mHealth Verfahren. Ziel dieser Arbeit ist es einen umfassenden Überblick über neue digitale Versorgungsformen zu geben, die zur Personalisierung der StäB in der alltäglichen Lebenswelt bei schweren psychischen Erkrankungen beitragen und somit klinische und soziale Outcomes verbessern sowie direkte und indirekte Kosten reduzieren könnten. Es lassen sich vier primäre digitale Versorgungsformen identifizieren, die in diesem Sinne in der StäB gewinnbringend genutzt werden könnten: (1) Kommunikation, Behandlungskontinuität und -flexibilität durch Online-Chat und Videotelefonie; (2) Monitoring von Symptomen und Verhaltensweisen in Echtzeit durch Anwendung des ambulatorischen Assessments (Engl. Ecological Momentary Assessments (EMA)); (3) Nutzung von multimodalen EMA-Daten für die Generierung und Darbietung von personalisiertem Feedback über subjektives Erleben und Verhaltensmuster sowie (4) auf Person, Moment und Kontext zugeschnittene, adaptive ambulatorische Interventionen (Engl. Ecological Momentary Interventions (EMIs)). Neue digitale Versorgungsformen haben erhebliches Potential die Effektivität und Kosteneffektivität der aufsuchenden fachpsychiatrischen und psychotherapeutischen Behandlung zu steigern. Ein wichtiger nächster Schritt besteht nun darin, die Anwendung dieser Versorgungsformen im Bereich der StäB zu modellieren und deren Qualität aus Patientensicht, Sicherheit, und initiale Prozess- und Ergebnisqualität sowie Implementierungsbedingungen sorgfältig zu untersuchen. Abstract:Ward-equivalent treatment (StäB), a form of crisis resolution and home treatment in Germany, has been introduced in 2018 as a new model of mental health service delivery for people with an indication for inpatient care. The rapid progress in the field of information and communication technology offers entirely new opportunities for innovative digital mental health care such as telemedicine, eHealth, or mHealth interventions. This paper aims to provide a comprehensive overview of novel digital forms of service delivery in the daily lives of help-seeking individuals for personalized delivery of StäB that may contribute to improving clinical and social outcomes as well as reducing direct and indirect costs. Four primary digital forms of service delivery have been identified that can be used for personalized delivery of StäB: (1) communication, continuity of care, and flexibility through online chat and video call; (2) monitoring of symptoms and behaviour in real-time through ecological momentary assessment (EMA); (3) use of multimodal EMA data to generate and offer personalized feedback on subjective experience and behavioural patterns as well as (4) adaptive ecological momentary interventions (EMIs) tailored to the person, moment, and context in daily life. New digital forms of service delivery have considerable potential to increase the effectiveness and cost-effectiveness of crisis resolution, home treatment, and assertive outreach. An important next step is to model and initially evaluate these novel digital forms of service delivery in the context of StäB and carefully investigate their quality from the user perspective, safety, feasibility, initial process and outcome quality as well as barriers and facilitators of implementation.

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Crisis Resolution and Home Treatment in Mental Health

10.1017/cbo9780511543906 ◽

2008 ◽

Cited By ~ 31

Keyword(s):

Mental Health ◽

Home Treatment ◽

Crisis Resolution

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Impact of crisis resolution and home treatment services on user experience and admission to psychiatric hospital

The Psychiatrist ◽

10.1192/pb.bp.110.031344 ◽

2011 ◽

Vol 35 (3) ◽

pp. 106-110 ◽

Cited By ~ 36

Author(s):

Victoria Barker ◽

Mark Taylor ◽

Ihsan Kader ◽

Kathleen Stewart ◽

Pete Le Fevre

Keyword(s):

Mental Health ◽

Home Treatment ◽

Service Users ◽

Crisis Resolution ◽

Mental Health Act ◽

Psychiatric Admissions ◽

Patient Care Service ◽

Patient Stay ◽

The Mean ◽

The Impact

Aims and methodCrisis resolution and home treatment (CRHT) teams began operating in Edinburgh in late 2008. We ascertained service users' and carers' experiences of CRHT using a standardised questionnaire. We also assessed the impact of CRHT on psychiatric admissions and readmissions by analysing routinely collected data from November 2003 to November 2009.ResultsThere was a 24% decrease in acute psychiatric admissions in the year after CRHT began operating, whereas the previous 5 years saw an 8% reduction in the admission rate. The mean duration of in-patient stay fell by 6.5 days (22% decrease) in the 12 months following CRHT introduction, alongside a 4% decrease in readmissions and a 17% reduction in Mental Health Act 1983 admissions. Although the mean response rate was low (29%), 93% of patients reported clinical improvement during CRHT care, 27% of patients felt totally recovered at discharge from CRHT, 90% of patients felt safe during CRHT treatment, and 94% of carers said their friend or relative got better with CRHT input.Clinical implicationsCrisis resolution and home treatment service in Edinburgh had a positive impact during the first 12 months in terms of reduced admissions, reduced duration of in-patient stay and reduced use of the Mental Health Act. The service can catalyse a more efficient use of in-patient care. Service users and carers report high rates of improvement and satisfaction with CRHT.

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