Acute psychiatric care: increasing the range of services and improving access and quality of care

Sonia Johnson, Christian Dalton-Locke, J Baker, Charlotte Hanlon, Tatiana Taylor Salisbury, Matt Fossey, K Newbigging, Sarah Carr, Jennifer Hensel, G. Carrà, Urs Hepp, Constanza Caneo, Justin J. Needle, Brynmor Lloyd-Evans

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Acute services for mental health crises are of great importance to service users and their supporters, and take a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges conducting studies with people in crisis. Evidence on best approaches to initial assessment and immediate management is particularly lacking, but some innovative approaches involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision making and care collaborative. Intensive home treatment services, acute day units and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be under-served or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Informal and voluntary sector crisis response is also often central in low and middle-income countries: here as elsewhere there is a pressing need for evidence to inform improvement, but also potential wider learning from locally embedded strategies.
Original languageEnglish
JournalWorld psychiatry : official journal of the World Psychiatric Association (WPA)
DOIs
Publication statusE-pub ahead of print - 7 May 2022

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