Background
Methods
Setting
Sample
Data collection
Measures
Approval from authorities and contributions from user groups
Data analysis
Results
Characteristics of the CRTs and differences between teams in admission practices
Team-level variables | |
---|---|
Opening hours: n | |
24/7 (24 hours/day, 7 days/week) | None |
Team operates office hours (37.5 hours/week) | 4 |
Team operates extended hours (70 hours/week) | 1 |
Team operates extended hours (75 hours/week) | 2 |
Team operates extended hours (86 hours/week) | 1 |
Number of team members (FTE) mean (range) | 9.1 (4.3–19.2) |
Full-time doctor as a part of the team: n | 5 |
Number of patients included: n (median) | 46–147 (80) |
Focus on home treatment: n | 5 |
Psychosis team in the catchment area: n | 5 |
Accept self-referral: n | 7 |
Authority to admit patients to acute in-patient wards: n | 4 |
The proportions and characteristics of admitted patients
Patient-level variables | Admitted | Not admitted |
p
a
|
---|---|---|---|
Overall admission rate to in-patient wards n (%) | 146 (21.5) | 534 (78.5) | |
Socio-demographic variables
| |||
Age (years): mean (SD) | 41.82 (14.66) | 39.63 (15.12) | 0.124 |
Gender: n (%) female | 84 (58.3) | 312 (58.9) | 0.908 |
Single, divorced, or widowed: n (%) | 97 (68.3) | 318 (60.9) | 0.107 |
Living alone: n (%) | 83 (57.6) | 313 (58.4) | 0.870 |
Employed at present: n (%) | 24 (16.7) | 151 (28.2) | 0.005 |
Custody of children aged under 18 years: n (%) | 34 (29.1) | 134 (34.6) | 0.263 |
Clinical variables
| |||
Clinical diagnosis (ICD–10): n (%) | |||
F10–19 Substance use disorders | 8 (5.8) | 45 (8.8) | 0.260 |
F20–29 Schizophrenia disorders | 28 (20.4) | 32 (6.3) | < 0.001 |
F30–39 Affective disorders | 55 (40.1) | 165 (32.3) | 0.085 |
F40–49 Neurotic, stress-related and somatoform disorders | 22 (16.1) | 125 (24.5) | 0.037 |
F60–69 Personality disorders | 3 (2.2) | 27 (5.3) | 0.126 |
GAF: mean (SD) | |||
Symptom | 39.26 (10.31) | 50.80 (10.70) | < 0.001 |
Functioning | 41.37 (10.62) | 51.78 (12.13) | < 0.001 |
Suicide risk: n (%) | |||
No suicidal thoughts/death intentions | 36 (27.9) | 221 (43.0) | 0.001 |
Passive suicidal thoughts, with no death intentions | 52 (37.1) | 209 (40.7) | 0.451 |
Concrete suicidal plans or self-injury, with no death intentions | 43 (30.7) | 67 (13.0) | < 0.001 |
Self-injury with death intentions | 6 (4.3) | 17 (3.3) | |
Severity of clinical and social problems: n (%) | |||
Non-accidental self-injury (HoNOS 2): | |||
0 No problem | 84 (58.3) | 410 (76.5) | < 0.001 |
1 Minor problem requiring no action | 18 (12.5) | 42 (7.8) | 0.080 |
2 Mild problem but definitely present | 13 (9.0) | 34 (6.3) | 0.260 |
3 Moderately severe problem | 17 (11.8) | 31 (5.8) | 0.012 |
4 Severe to very severe problem | 12 (8.3) | 19 (3.5) | 0.014 |
Substance misuse (HoNOS 3): | |||
0 No problem | 95 (66.0) | 388 (72.4) | 0.132 |
1 Minor problem requiring no action | 15 (10.4) | 52 (9.7) | 0.798 |
2 Mild problem but definitely present | 11 (7.6) | 39 (7.3) | 0.882 |
3 Moderately severe problem | 17 (11.8) | 43 (8.0) | 0.155 |
4 Severe to very severe problem | 6 (4.2) | 14 (2.6) | 0.327 |
Psychotic symptoms (HoNOS 6): | |||
0 No problem | 80 (55.6) | 438 (81.7) | < 0.001 |
1 Minor problem requiring no action | 15 (10.4) | 48 (9.0) | 0.591 |
2 Mild problem, but definitely present | 17 (11.8) | 31 (5.8) | 0.012 |
3 Moderately severe problem | 21 (14.6) | 15 (2.8) | < 0.001 |
4 Severe to very severe problem | 11 (7.6) | 4 (0.7) | < 0.001 |
Depressive symptoms (HoNOS 7): | |||
0 No problem | 16 (11.1) | 64 (11.9) | 0.784 |
1 Minor problem requiring no action | 21 (14.6) | 112 (20.9) | 0.090 |
2 Mild problem, but definitely present | 52 (36.1) | 219 (40.9) | 0.302 |
3 Moderately severe problem | 39 (27.1) | 115 (21.5) | 0.152 |
4 Severe to very severe problem | 16 (11.1) | 26 (4.9) | 0.006 |
Unwanted incidents: n (%) | |||
Attempted suicide | 6 (4.2) | 8 (1.5) | 0.031 |
Deliberate self-harm | 12 (8.3) | 20 (3.7) | 0.031 |
Physical attacks on others | 5 (3.5) | 11 (2.1) | 0.351 |
Physical attacks from others | 1 (0.7) | 4 (0.7) | |
Past psychiatric history: n (%) | |||
Previous mental health service contact | 94 (65.2) | 307 (57.3) | 0.063 |
Psychiatric admission past 12 months | 55 (44.4) | 87 (19.0) | < 0.001 |
Other characteristics: n (%) | |||
Pharmacological treatment | 57 (39.6) | 184 (34.3) | 0.242 |
Receiving involuntary treatment | 1 (0.7) | 2 (0.4) | |
Contact/support in 48 hours before admission: n (%) | |||
GP | 54 (37.5) | 176 (32.8) | 0.294 |
Emergency ward | 32 (22.2) | 101 (18.8) | 0.364 |
Local CMHT | 21 (14.6) | 62 (11.6) | 0.326 |
Outpatient clinics in CMHC | 21 (14.6) | 34 (6.3) | 0.001 |
Support from family and/or friends | 62 (43.1) | 208 (38.8) | 0.355 |
Referral route to the CRT: n (%) | |||
Emergency referrals | 114 (79.2) | 375 (70.0) | 0.029 |
Self-referrals | 31 (21.5) | 141 (26.3) | 0.242 |
Delivered to CRT by the police | 14 (9.7) | 13 (2.4) | < 0.001 |
Team and patient predictors of admission
Variables | Bivariate model | Multivariate model | ||||
---|---|---|---|---|---|---|
Crude ORafor admission | 95% CI |
p
c
| Adjusted ORbfor admission | 95% CI |
p
c
| |
Team level
| ||||||
Opening hours (37.5/week = ref) | ||||||
Team operates extended hours (70/week) | 0.40 | 0.20–0.79 | 0.009 | 0.20 | 0.08–0.51 | 0.001 |
Team operates extended hours (75/week) | 0.55 | 0.36–0.85 | 0.007 | 0.36 | 0.20–0.66 | 0.001 |
Team operates extended hours (86/week) | 0.58 | 0.33–1.03 | 0.063 | 0.22 | 0.10–0.49 | < 0.001 |
Number of team members | 0.97 | 0.91–1.03 | 0.313 | |||
Full-time doctor as part of the team | 0.89 | 0.49–1.61 | 0.691 | |||
Number of patients included | 0.99 | 0.99–1.00 | 0.154 | |||
Focus on home treatment | 1.39 | 0.79–2.44 | 0.256 | |||
Psychosis team in the catchment area | 1.13 | 0.62–2.06 | 0.685 | |||
Accept self-referral | 0.63 | 0.30–1.33 | 0.227 | |||
Authority to admit patients to acute in-patient wards | 0.80 | 0.46–1.40 | 0.437 | |||
Patient level
| ||||||
Age | 1.01 | 1.00–1.02 | 0.105 | 1.02 | 1.00–1.03 | 0.019 |
Gender | 1.01 | 0.69–1.47 | 0.980 | |||
Living alone | 0.95 | 0.64–1.40 | 0.786 | |||
Employed at present | 0.51 | 0.31–0.82 | 0.006 | |||
Suicide risk (0 = ref): | ||||||
1 Passive death wishes or suicidal thoughts without death intention | 1.47 | 0.92–2.34 | 0.104 | 2.29 | 1.29–4.07 | 0.005 |
2 Concrete suicidal plans or self-injury, but without death intention | 3.75 | 2.21–6.33 | < 0.001 | 6.88 | 2.48–13.63 | < 0.001 |
3 Self-injury with death intention | 2.15 | 0.78–5.88 | 0.138 | 3.22 | 0.78–13.39 | 0.108 |
Non-accidental self-injury (HoNOS 2) (0 = ref) | ||||||
1 Minor problem requiring no action | 2.32 | 1.25–4.30 | 0.008 | |||
2 Mild problem, but definitely present | 2.09 | 1.04–4.20 | 0.040 | |||
3 Moderately severe problem | 2.75 | 1.43–5.28 | 0.002 | |||
4 Severe to very severe problem | 3.40 | 1.56–7.43 | 0.002 | |||
Substance misuse (HoNOS 3) (0 = ref) | ||||||
1 Minor problem requiring no action | 1.27 | 0.68–2.38 | 0.459 | |||
2 Mild problem, but definitely present | 1.24 | 0.60–2.54 | 0.558 | |||
3 Moderately severe problem | 1.70 | 0.92–3.14 | 0.092 | |||
4 Severe to very severe problem | 1.84 | 0.68–5.00 | 0.232 | |||
Psychotic symptoms (HoNOS 6) (0 = ref) | ||||||
1 Minor problem requiring no action | 1.87 | 0.99–3.55 | 0.056 | 3.28 | 1.54–6.98 | 0.002 |
2 Mild problem, but definitely present | 3.08 | 1.60–5.91 | 0.001 | 2.33 | 1.06–5.14 | 0.037 |
3 Moderately severe problem | 8.37 | 4.04–17.35 | < 0.001 | 8.62 | 3.32–22.34 | < 0.001 |
4 Severe to very severe problem | 16.46 | 4.97–54.55 | < 0.001 | 30.83 | 5.74–165.60 | < 0.001 |
Depressive symptoms (HoNOS 7) | ||||||
1 Minor problem requiring no action | 0.75 | 0.36–1.54 | 0.428 | |||
2 Mild problem, but definitely present | 0.94 | 0.50–1.77 | 0.847 | |||
3 Moderately severe problem | 1.38 | 0.71–2.69 | 0.350 | |||
4 Severe to very severe problem | 2.77 | 1.17–6.57 | 0.021 | |||
Physical attacks on others | 1.11 | 0.58–2.14 | 0.746 | |||
Psychiatric admission past 12 months | 3.85 | 2.42–6.13 | < 0.001 | 2.69 | 1.58–4.57 | < 0.001 |
Contact/support from CMHCs in the past 48 hours | 3.09 | 1.63–5.85 | 0.001 | 3.78 | 1.56–9.21 | 0.004 |
Self-referral | 0.75 | 0.48–1.19 | 0.220 | |||
Delivered to CRT by the police | 4.00 | 1.81–8.85 | 0.001 |