Effect of Crisis Plans on Admissions and Emergency Visits: a Randomized Controlled Trial

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2014 Mar 21

PMID 24647274

Citations 17

Authors

Asia Ruchlewska

Andre I Wierdsma

Astrid M Kamperman

Mark van der Gaag

Renee Smulders

Bert-Jan Roosenschoon

Cornelis L Mulder

Affiliations

Soon will be listed here.

Abstract

Objective: To establish whether patients with a crisis plan had fewer voluntary or involuntary admissions, or fewer outpatient emergency visits, than patients without such a plan.

Design: Multicenter randomized controlled trial with two intervention conditions and one control condition.

Participants: Adult outpatients diagnosed with psychotic or bipolar disorder who had experienced at least one psychiatric crisis in the previous two years.

Intervention: Two types of advance statement were used: (1) a crisis plan formulated by the patient with the help of a patient advocate (Patient Advocate Crisis Plan: PACP); and (2) a crisis plan developed together with the clinician (Clinician-facilitated Crisis Plan: CCP).

Outcome: The percentages of patients admitted voluntarily or involuntarily (on an emergency basis or by court order), and the percentage who made outpatient emergency visits over an 18-month follow-up period.

Results: A total of 212 patients were included: 69 in the PACP condition, 70 in the CCP condition, and 73 in the control condition. No effects of the two interventions were found on the numbers of voluntary admissions, involuntary admissions and emergency visits. Regarding involuntary admissions, there was no significant effect on emergency admissions, which were 17% (12/69) in the PACP condition, 10% (7/70) in the CCP condition, and 19% (14/73) in the control condition. There was a significant effect on planned court-ordered admissions, with 16% (11/69) in the PACP condition, 10% (7/70) in the CCP condition, and 26% (19/73) in the control condition. Finally, the interventions had no effect on outpatient emergency visits, with 32% (22/69) in the PACP group, 31% (22/70) in the CCP group, and 34% (25/73) in the control group.

Conclusions: Crisis plans may be an effective intervention for reducing court-ordered admissions in patients with psychotic and bipolar disorders.

Trial Registration: Current Controlled Trails NTR1166.

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References

Mulder C, Tielens J . [Differing opinion about severe social breakdown and self-neglect determine compulsory admission]. Tijdschr Psychiatr. 2008; 50(4):229-33. View

Henderson C, Flood C, Leese M, Thornicroft G, Sutherby K, Szmukler G . Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial. BMJ. 2004; 329(7458):136. PMC: 478218. DOI: 10.1136/bmj.38155.585046.63. View

Mulder C, Uitenbroek D, Broer J, Lendemeijer B, van Veldhuizen J, van Tilburg W . Changing patterns in emergency involuntary admissions in the Netherlands in the period 2000-2004. Int J Law Psychiatry. 2008; 31(4):331-6. DOI: 10.1016/j.ijlp.2008.06.007. View

Tait L, Birchwood M, Trower P . A new scale (SES) to measure engagement with community mental health services. J Ment Health. 2011; 11(2):191-8. DOI: 10.1080/09638230020023570-2. View

Wiznitzer M, Verhulst F, van den Brink W, Koeter M, van der Ende J, GIEL R . Detecting psychopathology in young adults: the Young Adult Self Report, the General Health Questionnaire and the Symptom Checklist as screening instruments. Acta Psychiatr Scand. 1992; 86(1):32-7. DOI: 10.1111/j.1600-0447.1992.tb03221.x. View

Swartz M, Swanson J, Hannon M . Does fear of coercion keep people away from mental health treatment? Evidence from a survey of persons with schizophrenia and mental health professionals. Behav Sci Law. 2003; 21(4):459-72. DOI: 10.1002/bsl.539. View

Salize H, Dressing H . Epidemiology of involuntary placement of mentally ill people across the European Union. Br J Psychiatry. 2004; 184:163-8. DOI: 10.1192/bjp.184.2.163. View

Swanson J, Swartz M, Elbogen E, Van Dorn R, Ferron J, Wagner H . Facilitated psychiatric advance directives: a randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness. Am J Psychiatry. 2006; 163(11):1943-51. PMC: 3747558. DOI: 10.1176/ajp.2006.163.11.1943. View

Ruchlewska A, Mulder C, Smulders R, Roosenschoon B, Koopmans G, Wierdsma A . The effects of crisis plans for patients with psychotic and bipolar disorders: a randomised controlled trial. BMC Psychiatry. 2009; 9:41. PMC: 2716324. DOI: 10.1186/1471-244X-9-41. View

10.

Wing J, Beevor A, CURTIS R, Park S, Hadden S, Burns A . Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry. 1998; 172:11-8. DOI: 10.1192/bjp.172.1.11. View

11.

Thornicroft G, Farrelly S, Szmukler G, Birchwood M, Waheed W, Flach C . Clinical outcomes of Joint Crisis Plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial. Lancet. 2013; 381(9878):1634-41. DOI: 10.1016/S0140-6736(13)60105-1. View

12.

Papageorgiou A, King M, Janmohamed A, Davidson O, Dawson J . Advance directives for patients compulsorily admitted to hospital with serious mental illness. Randomised controlled trial. Br J Psychiatry. 2002; 181:513-9. DOI: 10.1192/bjp.181.6.513. View

13.

Birchwood M, Smith J, Drury V, Healy J, Macmillan F, Slade M . A self-report Insight Scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatr Scand. 1994; 89(1):62-7. DOI: 10.1111/j.1600-0447.1994.tb01487.x. View

14.

Henderson C, Swanson J, Szmukler G, Thornicroft G, Zinkler M . A typology of advance statements in mental health care. Psychiatr Serv. 2008; 59(1):63-71. DOI: 10.1176/ps.2008.59.1.63. View

15.

Srebnik D, La Fond J . Advance directives for mental health treatment. Psychiatr Serv. 1999; 50(7):919-25. DOI: 10.1176/ps.50.7.919. View

16.

Wierdsma A, Sytema S, van Os J, Mulder C . Case registers in psychiatry: do they still have a role for research and service monitoring?. Curr Opin Psychiatry. 2008; 21(4):379-84. DOI: 10.1097/YCO.0b013e328304d99b. View

17.

Campbell L, Kisely S . Advance treatment directives for people with severe mental illness. Cochrane Database Syst Rev. 2009; (1):CD005963. PMC: 4161493. DOI: 10.1002/14651858.CD005963.pub2. View

18.

Sutherby K, Szmukler G, Halpern A, Alexander M, Thornicroft G, JOHNSON C . A study of 'crisis cards' in a community psychiatric service. Acta Psychiatr Scand. 1999; 100(1):56-61. DOI: 10.1111/j.1600-0447.1999.tb10914.x. View