Abstract
Purpose: The Joint Crisis Plan (JCP) has received growing interest in clinical and research settings. JCP is a type of psychiatric advance statement that describes how to recognize early signs of crisis and how to manage crises. The purpose of the present study, to our knowledge the first to be conducted on this topic in the French-speaking context and to include inpatients, was to describe the content of JCPs and how they are perceived by patients and the providers.Methods: The study used an exploratory, mixed, sequential method. Existing JCPs were retrospectively collected in several clinical contexts (hospital, community settings, and sheltered accommodation). Based on their analyses, we conducted semi-structured interviews including some rating scales on the perception of the JCPs among patients and providers in these settings. For the qualitative analyses, content analyses were conducted with a hybrid approach using NVivo 12 software. Data were double-coded and discussed with a third researcher until agreement was reached.Results: One hundred eighty-four JCPs were collected retrospectively and 24 semi-structured interviews were conducted with 12 patients and 12 providers. No relatives could be included in the research process. The content of the studied JCPs was relevant and indicated that patients had good knowledge of themselves and their illness. Improvements in the quality of the therapeutic relationship, respect for patients' choices and wishes, and a greater sense of control of their illness were reported. The JCP was perceived as a very useful tool by patients and providers. Concerning JCP limitations, lack of staff training, difficulties with the shared decision-making process, and the poor availability of the JCPs when needed were reported.Conclusion: The study highlights that JCPs may be used with patients suffering from a large variety of psychiatric disorders in different care settings. The JCP is perceived as very useful by both patients and providers. The promising results of this study support the promotion of the wide use of JCPs with patients who have experienced crises. It is important to continue to research JCPs through impact studies that include family members.
Highlights
Relapse can lead to harmful consequences for people with severe mental illness and to a reduction in decision-making capacity [1]
Different Joint Crisis Plan (JCP) were used in the healthcare network, they all cover the following areas: the reasons for the current crisis; the triggers and manifestations of the crisis; the strategies to deal with the crisis; the persons that the patient can call to receive help; the care and treatments desired and to be avoided in the case of a crisis; and, the social measures to undertake to preserve the interests of the patient
The JCP sometimes seems to be used as a tool for staying healthy, whereas professionals seem to more directly link the JCP to advance directives
Summary
Relapse can lead to harmful consequences for people with severe mental illness and to a reduction in decision-making capacity [1]. The JCP implementation process and resistance to its use are questioned and investigated These factors have been reported as potential biases in randomized controlled trials [5]. This result highlights the necessity to consider the context in which the JCP is used in terms of the training and the institutional measures needed to ensure its efficiency [12]. In 2015, a local report issuing recommendations on the quality and coordination of care recommended introduction of the JCP, especially upon patient hospital discharge [16] This stage is recognized as a critical period in terms of risk of relapse, discontinuity of care, and suicide [17,18,19].
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