Abstract
Aims and method To assess whether a home treatment team acute relapse prevention (ARP) strategy reduces admissions to hospital with mania. A retrospective design was used to analyse records for manic admissions since 2002. The number and length of admissions and detentions pre- and post-ARP were determined and rates of admissions and detentions calculated from this.Results We found reductions in admission and detention rates following the introduction of the ARP: 0.3 fewer admissions per person per year (95% bootstrap CI 0.09–0.62) and 0.25 fewer detentions per person per year (95% bootstrap CI 0.0–0.48). Wilcoxon signed-rank tests gave P<0.0001.Clinical implications A person-centred care plan such as the ARP which enables quick action in response to relapse-warning signs of mania appears to reduce rates of admission to hospital. The ARP could be used anywhere in the UK and fits with current mental health policy.
Highlights
There were fewer admissions and detentions post-acute relapse prevention (ARP) than pre-ARP via the home treatment team (HTT), and statistical testing of the differences in the rates of admissions and detentions revealed statistically significant reductions in the rates of admissions and detentions post-ARP compared with pre-ARP
There is a large body of evidence advocating early recognition and collaborative management of relapse signs of mania, including guidelines from the National Institute for Health and Care Excellence (NICE).[6]
Selfmanagement approaches based on recognition of early warning signs of mania or depression are popular with patient groups.[7]
Summary
A significant proportion of SMI patients were excluded from the SMI register and only a third of people on the register had an annual physical health check recorded. The screening template was taken up by 75% of GP practices and was associated with better quality screening than usual care, doubling the rate of cardiovascular risk recording and the early detection of high cardiovascular risk. People with a diagnosis of severe mental illness (SMI) such as schizophrenia and bipolar disorder die 15-20 years earlier than the general population, mainly from natural causes.[1] In particular, they have an increased risk of cardiovascular disease.[2] This health inequality was reviewed by the Disability Rights Commission in a 2006 report titled Equal Treatment: Closing the Gap.[3] Deprivation and lifestyle were major factors, but not sufficient to account for the health inequalities. Since evidence has grown that there are high death rates from cardiovascular disease and other natural causes.[10,11,12,13] The risk of dying from cardiovascular disease alone significantly exceeds the risk of dying from Death in people with SMI has been recognised since the 1990s.8,9 Since evidence has grown that there are high death rates from cardiovascular disease and other natural causes.[10,11,12,13] The risk of dying from cardiovascular disease alone significantly exceeds the risk of dying from
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