Crisis House Research Articles

Enhanced photocatalytic CO2 reduction using a trimetallic organic framework as the catalyst under visible light

After adding Co, the photocatalytic CO reduction activity of Fe0.02Ni0.10–Cox–PCN-250 (x = 0.05, 0.10, 0.15, 0.20 mol) was significantly higher than that of Fe0.02Co0.10–PCN-250 and Fe0.02Co0.10–PCN-250.

A narrative literature review of the typology of psychiatric emergency services in the UK

AimsThis study aims to provide a detailed literature review of the different forms of Psychiatric Emergency Services currently available within the UK.Background1 in 6 individuals have one form of mental health disorders. Mental health crisis resulting in an individual requiring access to Psychiatric Emergency Service (PES) can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 hours. Presently, several PESs are available in the UK with the aim of providing prompt and effective assessment, management and in some cases treatment and/or referral. Over the years, economic and political influences have greatly determined the service delivery models of PES. Indeed, these services vary in name, accessibility, structure, professionals involved, outcomes and many more.MethodElectronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was carried out to identify various models of PES in the UK. Various combinations of search terms were used and studies which met the inclusion criteria were selected. Studies were included if they were written in English, conducted within the United Kingdom, and described a form of PES. Search was not limited by years and this is to help have a comprehensive overview as well as show changes over time of the various models of psychiatric emergency services. Studies which did not meet any of the criteria detailed above were excluded.ResultIn total, 59 relevant studies were found which identified nine type of PES-Crisis resolution home treatment, police officer intervention, street triage, mental health liaison services in the Emergency Department, psychiatric assessment unit, integrated services, voluntary services and crisis house. There were more papers describing Crisis resolution home treatment services than the others. Furthermore, majority of the papers reported services within England than other countries within the UK.ConclusionAll forms of PES are beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of all models of PES. This will inform researchers, educationist, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PES meet the needs as well as aid recovery of mental health service users.

Coercion or collaboration: service-user experiences of risk management in hospital and a trauma-informed crisis house

ABSTRACT Background and aims. Improving care for people in crisis remains high on the UK government agenda. Trauma-informed approaches (TIAs) have been advocated to address concerns raised about psychiatric hospital services by service-users, particularly around the use of coercion in risk management. This study explores service-users’ experiences of risk management in both hospital services and a trauma-informed crisis house. Methods. Eight women were interviewed using a semi-structured interview schedule. Interviews were transcribed and analysed using thematic analysis within a critical realist framework. Results and discussion. Four themes were developed. In the first two (‘The Medical-Custodial Approach: They Only Think About Physical Safety‘ and ‘Coercion is Counterproductive‘) participants described hospital as being dominated by a medical-custodial approach, which they said was ineffective in managing long term safety and could exacerbate distress. In the next two themes (’Talking Heals’ and ’Relationships as Risk Management’) the crisis house was described as using a relational approach to risk management that enabled women to maintain some freedom, privacy and control and was felt to be more effective long term. This research was carried out with a small sample and both recruitment and context likely privileged positive accounts of TIAs. Clinical implications and areas for further research are discussed.

The role of barriers to care on the propensity for hepatitis C virus nonreferral among people living with HIV.

: Twenty-five percent of HIV/hepatitis C virus (HCV) coinfected patients were not referred for HCV treatment despite unrestricted access in California to direct-acting antivirals (DAA) in 2018. Having unstable housing and ongoing drug use directly affected HCV treatment nonreferral. However, psychiatric history and alcohol use impacted HCV treatment nonreferral through the mediation of not being engaged in HIV care. Achieving HCV elimination requires DAA treatment outside conventional health settings, including substance rehabilitation centers, mental health crisis houses, and homeless shelters.

Efficacy of mental health crisis houses compared with acute mental health wards: a literature review

Background Crisis houses are an alternative to acute psychiatric hospital admission.Aim To review evidence of the efficacy of mental health crisis houses as an alternative to acute hospital admissions.Method A systematic search of studies drawing on eight databases was undertaken, with a total of 135 articles identified. After the selection process, six quantitative and two qualitative studies met the inclusion criteria of the review. Of these, the quantitative studies were assessed for methodological quality using a 21-item tool and all studies were analysed using thematic synthesis.Findings Four of the studies were rated methodologically strong and two as methodologically moderate. It was found that people admitted to crisis houses experience fewer negative events, have more autonomy, receive more holistic care and spend more time with staff members. They also receive more peer support and report more therapeutic relationships with staff.Conclusion Service users who access crisis houses rather than acute wards tend to rate their recovery as lower and think that pharmacological treatments are less available. Crisis house admissions are shorter and less expensive than acute ward stays, but do not always prevent admission to hospital.

Do patients get better? A review of outcomes from a crisis house and home treatment team partnership

Aims and methodThe Tower Hamlets Crisis House (voluntary sector), in partnership with the local home treatment team, offers a brief residential alternative to psychiatric hospital admission. Here, we review clinician-reported (Health of the Nation Outcome Scales; HoNOS) and patient-reported (DIALOG) outcome scores collected from successive admissions between June 2015 and December 2016, to assess the effectiveness of the service model. We identified 153 successive admissions, and of these, 85 (55.6%) and 91 (59.5%) patients completed both admission and discharge DIALOG and HoNOS questionnaires, respectively. We analysed ten out of twelve HoNOS domains and eight patient-reported outcome measure DIALOG domains. RESULTS: We found a statistically significant improvement in nine out of ten domains of HoNOS and three out of eight domains of DIALOG.Clinical implicationsA partnership between a home treatment team and crisis house can result in positive outcomes for patients, as determined by both clinicians and patients.Declaration of interestNone.

Just a peer finding my way in a crisis house

PurposeThe purpose of this paper is to share reflections and key learning points from the experience of offering peer support within a crisis house setting.Design/methodology/approachA reflective account of experiences of offering one-to-one peer support and the learning that has been taken from these experiences.FindingsKey reflections centre on the importance of being emotionally honest and supporting personal well-being while offering peer support.Originality/valueWhile there is a great deal written about the theory of peer support work, few first persons accounts of peer working have been published. This paper provides important insights into the nature of peer support work.

Improving outcomes for people in mental health crisis: a rapid synthesis of the evidence for available models of care.

Crisis Concordat was established to improve outcomes for people experiencing a mental health crisis. The Crisis Concordat sets out four stages of the crisis care pathway: (1) access to support before crisis point; (2) urgent and emergency access to crisis care; (3) quality treatment and care in crisis; and (4) promoting recovery. To evaluate the clinical effectiveness and cost-effectiveness of the models of care for improving outcomes at each stage of the care pathway. Electronic databases were searched for guidelines, reviews and, where necessary, primary studies. The searches were performed on 25 and 26 June 2014 for NHS Evidence, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, and the Health Technology Assessment (HTA) and PROSPERO databases, and on 11 November 2014 for MEDLINE, PsycINFO and the Criminal Justice Abstracts databases. Relevant reports and reference lists of retrieved articles were scanned to identify additional studies. When guidelines covered a topic comprehensively, further literature was not assessed; however, where there were gaps, systematic reviews and then primary studies were assessed in order of priority. Systematic reviews were critically appraised using the Risk Of Bias In Systematic reviews assessment tool, trials were assessed using the Cochrane risk-of-bias tool, studies without a control group were assessed using the National Institute for Health and Care Excellence (NICE) prognostic studies tool and qualitative studies were assessed using the Critical Appraisal Skills Programme quality assessment tool. A narrative synthesis was conducted for each stage of the care pathway structured according to the type of care model assessed. The type and range of evidence identified precluded the use of meta-analysis. One review of reviews, six systematic reviews, nine guidelines and 15 primary studies were included. There was very limited evidence for access to support before crisis point. There was evidence of benefits for liaison psychiatry teams in improving service-related outcomes in emergency departments, but this was often limited by potential confounding in most studies. There was limited evidence regarding models to improve urgent and emergency access to crisis care to guide police officers in their Mental Health Act responsibilities. There was positive evidence on clinical effectiveness and cost-effectiveness of crisis resolution teams but variability in implementation. Current work from the Crisis resolution team Optimisation and RElapse prevention study aims to improve fidelity in delivering these models. Crisis houses and acute day hospital care are also currently recommended by NICE. There was a large evidence base on promoting recovery with a range of interventions recommended by NICE likely to be important in helping people stay well. Most evidence was rated as low or very low quality, but this partly reflects the difficulty of conducting research into complex interventions for people in a mental health crisis and does not imply that all research was poorly conducted. However, there are currently important gaps in research for a number of stages of the crisis care pathway. Particular gaps in research on access to support before crisis point and urgent and emergency access to crisis care were found. In addition, more high-quality research is needed on the clinical effectiveness and cost-effectiveness of mental health crisis care, including effective components of inpatient care, post-discharge transitional care and Community Mental Health Teams/intensive case management teams. This study is registered as PROSPERO CRD42014013279. The National Institute for Health Research HTA programme.

Correction: The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Correction: The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

The relationship between therapeutic alliance and service user satisfaction in mental health inpatient wards and crisis house alternatives: a cross-sectional study.

BackgroundPoor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses.Methods and FindingsMixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically.ResultsWe found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy.Conclusions and ImplicationsWe found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed.

A mixed-methods study exploring therapeutic relationships and their association with service user satisfaction in acute psychiatric wards and crisis residential alternatives

Background Service user dissatisfaction with acute psychiatric wards is frequent. Previous studies indicate that service users prefer crisis houses, but we lack clear quantitative evidence about why. Qualitative studies suggest the quality of staff–service user relationships may be key. Aims (1) To test the hypothesis that stronger therapeutic alliances are achieved in crisis houses than in hospital. (2) To develop a model of service user satisfaction with acute services, exploring its relationship to service type, service user characteristics, therapeutic relationships, perceived peer support, recovery and negative events experienced. (3) To understand the factors that impede and facilitate good staff–service user relationships in acute settings. Method Quantitative data were collected from 108 crisis house users and 247 acute ward service users regarding service satisfaction, therapeutic relationships with staff, peer support, self-rated recovery and experience of negative events. Main outcomes were compared for crisis house and ward groups, adjusting for participants’ characteristics. A model of service user satisfaction was derived through multivariable linear regression. Qualitative interviews were conducted with 29 service users and 16 staff recruited from wards and crisis houses. Interviews were largely conducted by service user researchers and covered the characteristics of good staff–service user relationships and factors impeding or facilitating them. Interviews were analysed thematically. Results Participants’ ratings of therapeutic relationships, satisfaction and peer support were higher in crisis houses than acute wards. Therapeutic relationships, perceived peer support and experience of negative events associated with staff behaviour were all independently associated with service user satisfaction; service users’ characteristics and self-rated recovery were not. Service type ceased to be independently related to satisfaction once all these variables were included in a model. Qualitative interviews revealed that the basic human qualities of staff – such as warmth, kindness and honesty – underpin all positive therapeutic relationships. Service users also valued relationships with staff who were interested in and engaged with them, and who were professional but at times able to step beyond professional boundaries to act with compassion and humanity. Service users further identified the importance of time to talk and listen; a focus on recovery and hope; and whether or not staff appeared dedicated to their vocation. Staff participants typically had similar views, but emphasised the importance of having time to talk to service users. Factors identified as helpful in promoting good relationships included maximising freedom and autonomy; a calm and quiet service atmosphere; staff engagement in shared activities with service users; staff availability and presence; and staff morale. Conclusion This study corroborates previous findings of greater satisfaction with crisis houses compared with acute wards. This satisfaction was not closely related to service user characteristics or perceived recovery. The emphasis in interviews on staff personal qualities and willingness to engage in activities and communication suggests that initiatives to enhance effective recruitment and staff training merit further research. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Alternative Settings: Unintended Consequences

Back to table of contents Previous article Next article LettersFull AccessAlternative Settings: Unintended ConsequencesDieneke A. A. Hubbeling, M.Sc., M.R.C.Psych., and David Chang, M.B.B.S., M.R.C.Psych.Dieneke A. A. HubbelingSearch for more papers by this author, M.Sc., M.R.C.Psych., and David ChangSearch for more papers by this author, M.B.B.S., M.R.C.Psych.Published Online:1 Dec 2013https://doi.org/10.1176/appi.ps.641202AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: The November issue includes a timely review by Thomas and Rickwood (1) of residential alternatives to psychiatric hospitalization for patients who need acute care. Their main conclusion was that care provided in these settings can improve symptoms at least as well as care provided in psychiatric hospitals and that the alternative settings appear to be cost-effective. At a time when saving money is becoming increasingly important, it is essential to look closely at these findings. The authors noted the enormous variation among these services. They also remarked that the studies they reviewed did not provide much detail about the patients and the actual treatment and support provided. A recent review of nonresidential alternatives to psychiatric hospitalization also mentioned the omission of such details (2), and we agree with the authors that these aspects should be investigated further.However, there is a point that was not emphasized by Thomas and Rickwood. Not only are details lacking about the patients and treatments, but virtually no information has been reported about what happens in the rest of the service system when a “crisis house” is introduced. Tyrer and colleagues (3) described the introduction of a home treatment team and mentioned that the number of suicides in the catchment area increased, although none of the patients who killed themselves were under the care of the home treatment team. It may have been the case that experienced staff had moved to the home treatment team and that community mental health teams thus became less effective. Something similar might happen with the introduction of crisis houses.For economic evaluations of residential alternatives, it is also important to observe what happens in other parts of the system. For example, introduction of a home treatment team or a residential alternative may increase the number of empty hospital beds. Therefore, even though the alternative setting is cheaper per patient, the increased costs for the system of the empty beds may mean that offering care in the alternative setting is more expensive than offering standard inpatient care.The authors are affiliated with Wandsworth Crisis and Home Treatment Team, South West London, and with St. George’s Trust, London, United Kingdom.References1 Thomas KA, Rickwood D: Clinical and cost-effectiveness of acute and subacute residential mental health services: a systematic review. Psychiatric Services 64:1140–1149, 2013Link, Google Scholar2 Hubbeling D, Bertram R: Crisis resolution teams in the UK and elsewhere. Journal of Mental Health 21:285–295, 2012Crossref, Medline, Google Scholar3 Tyrer P, Gordon F, Nourmand S, et al.: Controlled comparison of two crisis resolution and home treatment teams. Psychiatrist 34:50–54, 2010Crossref, Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 64Issue 12 December 2013Pages 1278-1279 Metrics PDF download History Published online 1 December 2013 Published in print 1 December 2013

Supporting recovery in a third sector alternative to psychiatric hospital admission: evaluation of routinely collected outcome data

Purpose – To evaluate the impact of crisis house admission in terms of mental health recovery and achievement of personal goals for people using the service. Design/methodology/approach – Mental Health Recovery Star (Recovery Star) and Personal Goal Scoring data were collected at entry and exit points in routine practice as part of a bespoke support planning process from 722 adults using one of three Rethink Mental Illness Crisis Houses. The adults had mental illness diagnoses including depression, schizophrenia, bipolar disorder, personality disorder, and anxiety disorder. Findings – There were significant increases in all ten Recovery Star domains, for example: managing mental health (up 2.11 points (1-10 scale)), identity and self-esteem (up 1.56 points), trust and hope (up 1.48 points), and self-care (up 1.35 points). The analysis of Personal Goal Scoring data (scored on 1-10 scale) showed significant increases on how close people were to achieving their goals. For all goals listed there was an average increase of 2.5 point from 3 to 5.5, showing that people made progress during their stay in the service. Practical implications – Services provided by the third sector may offer an important contribution to support people's recovery and prevent admission to psychiatric hospital. Originality/value – The findings of the evaluation study support a growing body of evidence regarding the effectiveness of services offering alternatives to admission, and they highlight the value of using recovery-oriented support planning and outcome capture tools in routine practice.

Is there a crisis about crisis houses?

Is there a crisis about crisis houses?

A retrospective quasi-experimental study of a community crisis house for patients with severe and persistent mental illness

There is increasing international evidence that crisis houses can reduce the time spent in acute psychiatric inpatient units for patients with severe and persistent mental illness, at a lower cost and in an environment preferable to patients. We evaluated the Alternatives to Hospitalisation (AtH) program, a crisis house operating in outer suburban Brisbane. One hundred and ninety-three AtH patients were compared to 371 matched controls admitted to a peer hospital district acute psychiatric unit. Hospitalisations, demographics and illness acuity were compared one year before and after an acute index episode of residential care involving hospital and/or AtH. Hospital bed-days during the index episode were compared between AtH participants and controls. The cost of bed-days averted was compared to the cost of providing the AtH program. AtH participants spent 5.35 fewer days in hospital during the index episode than controls, after adjustment for illness acuity, living conditions, marital status and emergency department (ED) presentations. Per patient cost of averted psychiatric inpatient bed-days, $5948.22, was higher than the per patient cost of providing AtH, $3071.44. AtH participants had higher levels of illness acuity, ED presentations and acute psychiatric admissions than controls in the year after the index episode. For acutely unwell, stably housed patients, able to be managed outside of a secure facility, a crisis house program can reduce acute psychiatric bed-days, providing a cost saving for mental health services.

Crisis intervention for people with severe mental illnesses.

A particularly difficult challenge for community treatment of people with serious mental illnesses is the delivery of an acceptable level of care during the acute phases of severe mental illness. Crisis intervention models of care were developed as a possible solution. To review the effects of crisis intervention models for anyone with serious mental illness experiencing an acute episode, compared with 'standard care'. We updated the 1998, 2003 and 2006 searches with a search of the Cochrane Schizophrenia Group's Register of trials (2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE, and PsycINFO. We included all randomised controlled trials of crisis intervention models versus standard care for people with severe mental illnesses. We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CI). We assumed that people who left early from a trial had no improvement. Three new studies have been found since the last review in 2006 to add to the five studies already included in this review. None of the previously included studies investigated crisis intervention alone; all used a form of home care for acutely ill people, which included elements of crisis intervention. However, one of the new studies focuses purely on crisis intervention as provided by Crisis Resolution Home Teams within the UK; the two other new studies investigated crisis houses i.e. residential alternatives to hospitalisation providing home-like environments.Crisis intervention appears to reduce repeat admissions to hospital after the initial 'index' crises investigated in the included studies, this was particularly so for mobile crisis teams supporting patients in their own homes.Crisis intervention reduces the number of people leaving the study early, reduces family burden, is a more satisfactory form of care for both patients and families and at three months after crisis, mental state is superior to standard care. We found no differences in death outcomes. Some studies found crisis interventions to be more cost effective than hospital care but all numerical data were either skewed or unusable. No data on staff satisfaction, carer input, complications with medication or number of relapses were available. Care based on crisis intervention principles, with or without an ongoing home care package, appears to be a viable and acceptable way of treating people with serious mental illnesses. If this approach is to be widely implemented it would seem that more evaluative studies are still needed.

Lessons learned in developing community mental health care in Europe.

This paper summarizes the findings for the European Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. The article presents a description of the region, an overview of mental health policies and legislation, a summary of relevant research in the region, a precis of community mental health services, a discussion of the key lessons learned, and some recommendations for the future.

A service evaluation of a community‐based mental health crisis house in inner city Liverpool

PurposeThe search for alternatives to inpatient mental health care in the UK and further afield has been going on over the last few decades of the previous century. Amongst the range of alternatives that have been developed are community‐based mental health crisis houses that seek to work with people, who may otherwise have been admitted to hospital. Amethyst House is a four‐bed mental health crisis house based in inner city Liverpool and works solely with the local Crisis Resolution Home Treatment Team (CRHTT) to work with people who require support that could not be delivered at home. The purpose of this paper is to report the findings of one element of a service evaluation: the effectiveness of the service in relation to the mental health needs of people admitted.Design/methodology/approachThe paper describes the service model, which integrates the crisis house and the CRHTT, with the latter acting as gatekeepers to the service.FindingsFindings showed improvements in mental health symptomatology and disabilities associated with the crisis between admission and discharge from the service.Originality/valueThe paper describes the profile of the people who used the service over a six‐month period in 2009, their care pathways through the service and their clinical outcomes between admission and discharge.

Effectiveness and cost-effectiveness of admissions to women's crisis houses compared with traditional psychiatric wards: pilot patient-preference randomised controlled trial

Background/Objectives: Alternative inpatient services for women in the UK have been developed which include women's crisis houses for women are not detained compulsorily. Women's crisis houses have been developed in the UK as a less stigmatising and less institutional alternative to traditional psychiatric wards and have been recommended by the UK Department of Health. We aimed to examine their effectiveness and cost-effectiveness compared with admissions to general adult psychiatric wards.

Ethical principles: research with women with severe mental illness

Background/Objectives: This presentation will reflect on the ethical challenges of conducting research with women with severe mental illness. Ethical issues will be discussed in relation to research on the effectiveness of perinatal psychiatry services and women's crisis houses in the UK. Key themes will be considered in the context of the complex health and social care needs presented by this vulnerable group. The importance of identifying and supporting women experiencing an episode of mental illness is well known. However, there is little research to guide the UK National Health Service on which services provide the best experiences and outcomes for women suffering from a psychiatric episode. Research aimed at improving outcomes for women with severe mental illness raises some important ethical considerations. This presentation will discuss these ethical issues in relation to research on the effectiveness of perinatal psychiatry services and women's crisis houses. This research and its ethical challenges will be discussed in the context of these women's complex health and social care needs.