Question: In adult patients experiencing a mental health crisis, which service model is most effective in an urban area, in improving patient outcomes?

Answer:

Plain language summary

A reasonable amount of evidence suggests that crisis resolution teams and other similar interventions are effective. However more research needs to be completed to assess the cost-effectiveness of these interventions and the effect on the community and staff that run these services.

Clinical and research implications

Overall there appears to be a reasonable amount of moderate to high quality evidence suggesting that crisis resolution and home treatment teams, crisis houses and having a crisis plan can significantly reduce the risk of hospital admission compared to standard care.

The recent rapid SR of the evidence made the following implications for practice:

1. Crisis      resolution teams are more clinically effective than inpatient care for a      range of outcomes, although implementation of this model of care varies      across the UK with few teams meeting all evidence-based criteria for good      practice.
2. Crisis      houses and acute day hospitals appear as clinically effective as inpatient      treatment, but are associated with greater service user satisfaction.      (Paton et al. (2016))

 There are a number of important recommendations for future research:

1.  "As UK      government policy mandated that crisis resolution teams are established in      England and there is currently only one study then further trials      evaluating crisis resolution teams are needed. Future trials should be      large and simple and measure the burden on the community and staff      involved in the team." (Murphy et al. (2015))
2. "Further      high-quality research is needed into the clinical and cost-effectiveness      of mental health crisis care including components of inpatient care,      post-discharge transitional care and Community Mental Health of intensive      case management teams." (Paton et al. (2016))
3. "The clinicians needed intensive monitoring during the study, which suggests that implementing crisis plans in the mental health system requires additional supervision. Further research is needed into the working mechanisms, cost-effectiveness of crisis plans and whether the plan instructions were followed during a crisis." (Ruchlewska et al. (2014))

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