Supplementary material is available online at https://doi.org/10.1192/bjo.2023.595This paper presents independent research commissioned and funded by the National Institute
for Health and Care Research (NIHR) Policy Research Programme, conducted by the NIHR
Policy Research Unit (PRU) in Mental Health. Research by N.S. is supported by the NIHR
Applied Research Collaboration (ARC) South London at King’s College Hospital NHS
Foundation Trust. N.S. is a member of King’s Improvement Science, which offers co-funding
to the NIHR ARC South London and is funded by King’s Health Partners (Guy’s and St
Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, King’s College
London and South London and Maudsley NHS Foundation Trust), and the Guy’s and St
Thomas’ Foundation. Research by A.R.-G. is also supported by the Spanish Ministry of
Universities and the Next Generation European Union funds. The views expressed are those
of the authors and not necessarily those of the NIHR, the Department of Health and Social
Care or its arm’s-length bodies, or other government departments.Background
In England, a range of mental health crisis care models and approaches to organising crisis care systems have been implemented, but characteristics associated with their effectiveness are poorly understood.
Aims
To (a) develop a typology of catchment area mental health crisis care systems and (b) investigate how crisis care service models and system characteristics relate to psychiatric hospital admissions and detentions.
Method
Crisis systems data were obtained from a 2019 English national survey. Latent class analyses were conducted to identify discernible typologies, and mixed-effects negative binomial regression models were fitted to explore associations between crisis care models and admissions and detention rates, obtained from nationally reported data.
Results
No clear typology of catchment area crisis care systems emerged. Regression models suggested that provision of a crisis telephone service within the local crisis system was associated with a 11.6% lower admissions rate and 15.3% lower detention rate. Provision of a crisis cafe was associated with a 7.8% lower admission rates. The provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with a 12.8% higher admission rate.
Conclusions
The configuration of crisis care systems varies considerably in England, but we could not derive a typology that convincingly categorised crisis care systems. Our results suggest that a crisis phone line and a crisis cafe may be associated with lower admission rates. However, our findings suggest crisis assessment teams, separate from home treatment teams, may not be associated with reductions in admission and detentions.National Institute for Health and Care Research (NIHR) Policy Research ProgrammeNIHR Applied Research Collaboration (ARC) South London at King’s College Hospital NHS Foundation TrustKing’s Health Partners (Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, King’s College London and South London and Maudsley NHS Foundation Trust)Spanish Ministry of Universities and the Next Generation European Union fund
