Joint crisis planning in mental health care: the challenge of implementation in randomized trials and in routine care.

Abstract

Joint crisis planning produces a plan for use during a future mental health crisis or relapse. Its distinguishing feature is facilitation by a mental health professional external to the treatment team, who engages a mental health service user and members of his/her treatment team in a process of shared decision making. To date, there have been three trials of joint crisis plans, producing two key findings. First, the process of producing and using a joint crisis plan is highly appreciated by service users, can improve therapeutic relationships and reduce the rate of involuntary measures, and is likely to be cost-effective. Second, joint crisis plans are challenging to produce and use, exemplifying the widespread difficulty within medicine of adopting shared decision making. In this context, the aim of this paper is to consider whether repeated emphasis on individualized crisis planning in policy documents will be sufficient to bring about the adoption of shared decision making in mental health care. Experience from the above-mentioned three trials provides indications of what other measures may help.