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"Crisis intervention"
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Peer-supported self-management for people discharged from a mental health crisis team: a randomised controlled trial
High resource expenditure on acute care is a challenge for mental health services aiming to focus on supporting recovery, and relapse after an acute crisis episode is common. Some evidence supports self-management interventions to prevent such relapses, but their effect on readmissions to acute care following a crisis is untested. We tested whether a self-management intervention facilitated by peer support workers could reduce rates of readmission to acute care for people discharged from crisis resolution teams, which provide intensive home treatment following a crisis.
We did a randomised controlled superiority trial recruiting participants from six crisis resolution teams in England. Eligible participants had been on crisis resolution team caseloads for at least a week, and had capacity to give informed consent. Participants were randomly assigned to intervention and control groups by an unmasked data manager. Those collecting and analysing data were masked to allocation, but participants were not. Participants in the intervention group were offered up to ten sessions with a peer support worker who supported them in completing a personal recovery workbook, including formulation of personal recovery goals and crisis plans. The control group received the personal recovery workbook by post. The primary outcome was readmission to acute care within 1 year. This trial is registered with ISRCTN, number 01027104.
221 participants were assigned to the intervention group versus 220 to the control group; primary outcome data were obtained for 218 versus 216. 64 (29%) of 218 participants in the intervention versus 83 (38%) of 216 in the control group were readmitted to acute care within 1 year (odds ratio 0·66, 95% CI 0·43–0·99; p=0·0438). 71 serious adverse events were identified in the trial (29 in the treatment group; 42 in the control group).
Our findings suggest that peer-delivered self-management reduces readmission to acute care, although admission rates were lower than anticipated and confidence intervals were relatively wide. The complexity of the study intervention limits interpretability, but assessment is warranted of whether implementing this intervention in routine settings reduces acute care readmission.
National Institute for Health Research.
Journal Article
Recommended psychological crisis intervention response to the 2019 novel coronavirus pneumonia outbreak in China: a model of West China Hospital
The novel coronavirus pneumonia (COVID-19) epidemic has brought serious social psychological impact to the Chinese people, especially those quarantined and thus with limited access to face-to-face communication and traditional social psychological interventions. To better deal with the urgent psychological problems of people involved in the COVID-19 epidemic, we developed a new psychological crisis intervention model by utilizing internet technology. This new model, one of West China Hospital, integrates physicians, psychiatrists, psychologists and social workers into Internet platforms to carry out psychological intervention to patients, their families and medical staff. We hope this model will make a sound basis for developing a more comprehensive psychological crisis intervention response system that is applicable for urgent social and psychological problems.
Journal Article
The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial
Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care.
To evaluate a 1-year programme to improve CRTs' model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233).
Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated.
All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI -1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes.
The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT model fidelity and reducing acute in-patient admissions.
Journal Article
Crisis Intervention Team of Avilés. Results after three years
IntroductionThis Crisis Intervention Team was born in October 2018 with the aim of intensifying the treatment of people in psychiatric crisis situation.ObjectivesProvide an intensive and early assessment and approach in a timely manner. It also provides home care if necessary.MethodsThe team intensively performs scheduled visits, emergencys, telephone interventions and home care. It is in constant coordination with other structures of the mental health and socio-health network.ResultsA total of 83 patients have been included in our team since its inception. The youngest was 17 years old and the oldest 83 years old (exceptional case in evaluation). The mean age was 45.6 years. 67.4% were female (56 women) and 32.5% male (27 men). The delay in care did not exceed 48 hours.200 patients were evaluated into suicide protocol, with ages ranging from 15 to 85 years, with a mean age of 45.4 years. The delay in care does not exceed 10 days.ConclusionsThis is a team that offers a rapid response, dedicates the necessary time for a correct evaluation of the risk, of the evolution and tries to establish a therapeutic alliance in record time. It is able to tolerate a certain degree of uncertainty, manage and tolerate the level of risk. He stands out for being flexible and dynamic in order to be able to adapt to the patients and theirs circumstances. This requires empathy, closeness and commitment.DisclosureNo significant relationships.
Journal Article
Mobile crisis effectiveness: a systematic review and associated functions and forms framework
Background
Increased demand for mental health crisis services and falling supply of inpatient psychiatric beds in the United States (U.S.) has led to heavy investment in mobile crisis units (MCUs), teams of mental health professionals that de-escalate crises in the community and aim to prevent emergency department visits, arrests, self-harm, etc. Despite nearly two thousand such services being active in the U.S., the last review of MCUs, conducted in 1995, found no evidence of their effectiveness. It is not known if newer research validates the effectiveness of this widely used intervention, nor how aligned the goals and functions of the many MCUs are. This article systematically reviews the literature since 2000 to determine the effectiveness of MCUs in the U.S. and create a theoretical framework of their functions and forms to aid future research efforts.
Methods
A systematic review was conducted by using a keyword search in PubMed, PsycINFO, and Scopus. Articles were included through June 2025 and excluded if they were published before 2000 or were not from the U.S. Quality of included articles was assessed using the Mixed Method Appraisal Tool. The Functions and Forms Framework for describing complex healthcare interventions was used to identify the core elements of MCUs and design a theoretical framework for their functions.
Results
Of the 134 studies included in title/abstract screening, nine met inclusion criteria and were found to be medium or high quality. One quasi-experimental study found evidence against MCU effectiveness, one randomized controlled trial found little evidence of MCU effectiveness, and four quasi-experimental studies, one pretest-posttest, one qualitative, and one retrospective cohort study found evidence supporting MCU effectiveness. Primary functions of MCUs included hospital diversion, justice-system diversion, and providing accessible patient-centered care in the community.
Conclusions
The limited evidence uncovered in this review offers tentative support for MCU effectiveness. However, the current literature is too sparse to draw firm or generalized conclusions. An initial theoretical framework was created to help practitioners and policymakers document the functions and forms of MCUs to increase the comparability of these services, and research recommendations were generated to fill gaps in the literature.
Journal Article