Background
Methods
Aims
Context
Design
Recruitment and preparations of the crisis resolution teams
Measures
Outcome measures
Independent variables
Categorical variables | N | % | ||
Age group | ||||
Under 20 years | 23 | 4.8 | ||
20–29 years | 145 | 30.5 | ||
30–39 years | 105 | 22.1 | ||
40–49 years | 85 | 17.9 | ||
50–59 years | 66 | 13.9 | ||
60–69 years | 38 | 8.0 | ||
70–79 years | 9 | 1.9 | ||
80–89 years | 4 | 0.8 | ||
Sex | ||||
Male | 189 | 39.8 | ||
Female | 286 | 60.2 | ||
Living alone | ||||
No | 317 | 66.7 | ||
Yes | 158 | 33.3 | ||
Previously known mental illness | ||||
No | 317 | 66.7 | ||
Yes | 158 | 33.3 | ||
Psychosis | ||||
No | 437 | 92.0 | ||
Yes | 38 | 8.0 | ||
Earlier contact with crisis team | ||||
No | 361 | 76.0 | ||
Yes | 114 | 24.0 | ||
Crisis how acute | ||||
Sudden event | 58 | 12.2 | ||
Developed quickly | 70 | 14.7 | ||
Gradually development | 147 | 30.9 | ||
Has lasted for a long time | 200 | 42.1 | ||
Crisis duration | ||||
Last 24 h | 7 | 1.5 | ||
Last days | 46 | 9.7 | ||
Last 1–2 weeks | 89 | 18.7 | ||
Several weeks | 333 | 70.1 | ||
Self-referral (direct contact) | ||||
No | 386 | 81.3 | ||
Yes | 89 | 18.7 | ||
Time to first meeting after referral | ||||
Same day | 186 | 39.2 | ||
Next day | 145 | 30.5 | ||
2–3 days | 75 | 15.8 | ||
4–7 days | 51 | 10.7 | ||
More than a week | 18 | 3.8 | ||
Seen on referral day | ||||
No | 289 | 60.8 | ||
Yes | 186 | 39.2 | ||
Continuous variables | Mean | SD | ||
Problems at the start of treatment | ||||
Patient-reported symptoms CORE10 | 2.44 | 0.61 | ||
Clinician-reported problems HONOS | 0.93 | 0.40 | ||
Crisis Support Scale | 4.25 | 0.97 | ||
Crisis experience (CSAS subscale) | 4.39 | 0.71 | ||
Not coping with crisis (CSAS subscale) | 3.72 | 0.78 | ||
Characteristics of crisis treatment | ||||
Treatment length (weeks) | 3.05 | 2.64 | ||
Treatment intensity (sessions pr week) | 1.56 | 0.71 | ||
Average duration of sessions (ordinal scale) | 3.05 | 0.53 | ||
Ordinal scale | Minutes | N (%) | ||
1 | 05–20 | 83 ( 4.7%) | ||
2 | 25–40 | 221 (12.6%) | ||
3 | 45–60 | 1089 (62.2%) | ||
4 | 65–90 | 353 (20.2%) | ||
5 | 90 or more | 4 ( 0.2%) | ||
Proportions of sessions outside team’s location | 0.38 | 0.43 | ||
Proportions of sessions outside working hours | 0.20 | 0.30 | ||
Proportion with various interventions | ||||
Practical support | 0.08 | 0.19 | ||
Psychological interventions | 0.90 | 0.21 | ||
Family involvement | 0.12 | 0.24 | ||
Medication management | 0.11 | 0.23 | ||
Collaboration with mental health inpatient units | 0.05 | 0.17 | ||
Collaboration with GPs and primary care | 0.14 | 0.26 | ||
CORE CRT Fidelity Scale | ||||
Fidelity total mean (range 1 to 5) | 2.75 | 0.29 | ||
Fidelity total score (range 39 to 195) | 107 | 11 |
Crisis treatment provided by the crisis resolution teams
Recruitment of service users and data collection
Participants
Data analyses
Results
Outcomes and service user satisfaction
Clinical outcome | Start of treatment | End of treatment | Change from start of treatment to end of treatment | ||
Patient-reported outcome | |||||
Psychiatric symptoms (CORE-10) | Mean (SD) | Mean (SD) | Mean (SD) | P | Cohen’s d |
1. Felt tense, anxious or nervous | 3.26 (0.81) | 2.54 (1.04) | 0.72 (1.05) | < .001 | 0.68 |
2. Felt have someone to turn to for support | 2.37 (1.13) | 2.68 (1.02) | -0.31 (1.28) | < .001 | -0.24 |
3. Felt able to cope when things go wrong | 1.77 (0.93) | 2.20 (0.92) | -0.43 (1.14) | < .001 | -0.37 |
4. Talking to people have felt too much | 2.16 (1.13) | 1.75 (1.13) | 0.41 (1.26) | < .001 | 0.32 |
5. Felt panic or terror | 2.51 (1.16) | 1.80 (1.21) | 0.72 (1.17) | < .001 | 0.61 |
6. Made plans to end my life | 1.30 (1.34) | 0.73 (1.08) | 0.58 (1.17) | < .001 | 0.49 |
7. Had difficulty getting to sleep or staying asleep | 2.85 (1.17) | 2.23 (1.26) | 0.62 (1.28) | < .001 | 0.48 |
8. Felt despairing or hopeless | 2.95 (0.98) | 1.96 (1.22) | 0.99 (1.17) | < .001 | 0.85 |
9. Felt unhappy | 3.16 (0.94) | 2.29 (1.24) | 0.87 (1.20) | < .001 | 0.72 |
10. Distressing unwanted images or memories | 2.39 (1.31) | 2.05 (1.24) | 0.24 (1.25) | < .001 | 0.27 |
CORE-10 total sum | 24.45 (6.12) | 18.47 (7.91) | 5.97 (6.98) | < .001 | 0.86 |
Symptom level for CORE-10 total sum | N (%) | N (%) | |||
Low symptom level (0–10) | 19 (2.1) | 79 (16.6) | |||
Mild to moderate symptom level (11–25) | 211 (44.4) | 281 (59.1) | |||
Serious symptom level (26–40) | 254 (53.5) | 115 (24.2) | |||
Clinician-reported outcome | |||||
Psychiatric and other problems (HoNOS) | Mean (SD) | Mean (SD) | Mean (SD) | P | Cohen’s d |
1. Overactive, aggressive or agitated | 0.39 (0.68) | 0.25 (0.54) | 0.13 (0.68) | < .001 | 0.10 |
2. Non-accidental self-injury | 0.73 (1.10) | 0.33 (0.77) | 0.39 (1.10) | < .001 | 0.26 |
3. Problem drinking or drug-taking | 0.44 (0.97) | 0.24 (0.68) | 0.20 (.073) | < .001 | 0.18 |
4. Cognitive problems | 0.55 (0.74) | 0.34 (0.61) | 0.21 (0.76) | < .001 | 0.19 |
5. Physical illness or disability | 0.65 (1.11) | 0.45 (0.93) | 0.20 (0.82) | < .001 | 0.15 |
6. Hallucinations and delusions | 0.17 (0.60) | 0.10 (0.44) | 0.07 (0.41) | < .001 | 0.08 |
7. Depressed mood | 2.15 (0.98) | 1.45 (1.03) | 0.71 (1.07) | < .001 | 0.56 |
8. Other mental and behavior problems | 2.61 (0.93) | 1.91 (1.02) | 0.68 (1.13) | < .001 | 0.50 |
9. Problems with relationships | 1.46 (1.16) | 1.18 (1.01) | 0.28 (1.10) | < .001 | 0.17 |
10. Problems in activities of daily living | 1.08 (1.10) | 0.75 (0.94) | 0.33 (1.12) | < .001 | 0.20 |
11. Problems with living conditions | 0.27 (0.79) | 0.21 (0.65) | 0.06 (0.70) | .055 | 0.00 |
12. Problems with occupation and activities | 0.78 (1.18) | 0.68 (1.00) | 0.11 (1.17) | .039 | 0.01 |
HoNOS total sum | 11.16 (4.84) | 6.56 (4.00) | 4.59 (4.43) | < .001 | 1.04 |
End of treatment | |||||
Patient satisfaction with treatment (CSQ8) | Mean (SD) | ||||
1. How would you rate the quality of the service you have received? | 3.56 (0.62) | ||||
2. Did you get the kind of service you wanted? | 3.47 (0.61) | ||||
3. To what extent did the program meet your needs? | 3.28 (0.68) | ||||
4. If a friend were in need of similar help, would you recommend the program to him or her? | 3.71 (0.49) | ||||
5. How satisfied are you with the amount of help you have received? | 3.51 (0.68) | ||||
6. Have the services you received help you deal more effectively with your problems? | 3.47 (0.58) | ||||
7. In an overall general sense, how satisfied are you with the services you have received? | 3.58 (0.58) | ||||
8. If you were to seek help again, would you come back to the service? | 3.62 (0.58) | ||||
Service user satisfaction (CSQ8 total sum) | 28.19 (3.74) |
Factors associated with outcome
Variables | RC | CI 95% (lower, higher) | p | |
---|---|---|---|---|
Model A: Situation at the start of treatment | ||||
Living alone | -0.19 | -0.31 | -0.06 | .003 |
Previous known mental illness | -0.21 | -0.33 | -0.09 | .001 |
Patient-reported symptoms (CORE-10) at start | 0.37 | 0.27 | 0.46 | < .001 |
Crisis duration | -0.13 | -0.21 | -0.05 | .002 |
- constant | 0.37 | 0.01 | 0.73 | .042 |
Team level variancea: 9.4% | ||||
Model B: Treatment provided | ||||
Self-referral | -0.20 | -0.36 | -0.04 | .014 |
Time to first meeting after received referral | -0.06 | -0.11 | -0.01 | .013 |
Treatment duration (weeks) | 0.02 | 0.00 | 0.04 | .051 |
Practical support | 0.37 | 0.06 | 0.67 | .019 |
Medication management | 0.29 | 0.04 | 0.54 | .024 |
Collaboration with mental health inpatient units | -0.37 | -0.71 | -0.02 | .040 |
Patient satisfaction (CSQ-8) | 0.47 | 0.35 | 0.59 | < .001 |
- constant | -0.99 | -1.45 | -0.53 | < .001 |
Team level variancea: 8.1% | ||||
Model AB: Situation at the start of treatment and treatment provided | ||||
Previous known mental illness | -0.23 | -0.34 | -0.12 | < .001 |
Patient-reported symptoms (CORE 10) at admission | 0.38 | 0.29 | 0.47 | < .001 |
Crisis duration | -0.10 | -0.17 | -0.03 | .009 |
Self-referral | -0.21 | -0.35 | -0.06 | .005 |
Medication management | 0.36 | 0.13 | 0.60 | .002 |
Collaboration with mental health inpatient units | -0.55 | -0.88 | -0.23 | .001 |
CS Patient satisfaction (CSQ-8) | 0.51 | 0.39 | 0.63 | < .001 |
- constant | -1.60 | -2.14 | -1.05 | < .001 |
Team level variancea: 9.3% |
Variables | RC | CI 95% (lower, higher) | p | |
---|---|---|---|---|
Model A: Situation at the start of treatment | ||||
Patient-reported symptoms (CORE-10) at start | -0.09 | -0.14 | -0.03 | .002 |
Clinician-reported problems (HoNOS) at start | 0.54 | 0.45 | 0.62 | < .001 |
- constant | -0.01 | -0.14 | 0.12 | .843 |
Team level variancea: 17.2% | ||||
Model B: Treatment provided | ||||
Treatment duration (weeks) | 0.02 | 0.00 | 0.03 | .008 |
Practical support | 0.26 | 0.07 | 0.44 | .006 |
Medication management | 0.19 | 0.04 | 0.34 | .012 |
Collaboration with mental health inpatient units | -0.21 | -0.42 | 0.00 | .046 |
Patient satisfaction (CSQ-8) | 0.12 | 0.04 | 0.19 | .002 |
- constant | -0.23 | -0.49 | 0.03 | .082 |
Team level variancea: 12.9% | ||||
Model AB: Situation at the start of treatment and treatment provided | ||||
Earlier contact with crisis team | -0.09 | -0.15 | -0.02 | .013 |
Patient-reported symptoms (CORE-10) at start | -0.07 | -0.12 | -0.02 | .003 |
Clinician-reported symptoms (HoNOS) at start | 0.59 | 0.52 | 0.67 | < .001 |
Treatment duration (weeks) | 0.02 | 0.01 | 0.03 | .002 |
Average duration of sessions (ordinal scale) | -0.11 | -0.16 | -0.05 | < .001 |
Collaboration with mental health inpatient units | -0.43 | -0.60 | -0.25 | < .001 |
Patient satisfaction (CSQ-8) | 0.14 | 0.08 | 0.21 | < .001 |
- constant | -0.29 | -0.60 | 0.02 | .064 |
Team level variancea: 13.5% |
Variables | RC | CI 95% (lower, higher) | p | |
---|---|---|---|---|
Model A: Situation at the start of treatment | ||||
Age group | 0.04 | 0.01 | 0.06 | .008 |
Sex | 0.12 | 0.03 | 0.20 | .005 |
Crisis support (CSS) | 0.08 | 0.03 | 0.12 | < .001 |
- constant | 3.02 | 2.82 | 3.23 | < .001 |
Team level variancea: 6.8% | ||||
Model B: Treatment provided | ||||
Time to first meeting after referral | -0.04 | -0.08 | -0.01 | .023 |
Treatment length (weeks) | 0.02 | 0.00 | 0.04 | .018 |
- constant | 3.56 | 3.46 | 3.67 | < .001 |
Team level variancea: 6.3% | ||||
Model AB: Situation at the start of treatment and treatment provided | ||||
Age group | 0.04 | 0.01 | 0.06 | .007 |
Sex | 0.12 | 0.03 | 0.20 | .005 |
Crisis support (CSS) | 0.08 | 0.04 | 0.12 | .000 |
Treatment length (weeks) | 0.02 | 0.01 | 0.04 | .004 |
- constant | 2.92 | 2.71 | 3.14 | .000 |
Team level variancea: 9,6% |