Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-25T08:17:36.912Z Has data issue: false hasContentIssue false
  • English
  • Français

Individualisation in crisis planning for people with psychotic disorders

Published online by Cambridge University Press:  10 September 2013

S. Farrelly ,
G. Szmukler ,
C. Henderson ,
M. Birchwood ,
M. Marshall ,
W. Waheed ,
C. Finnecy  and
G. Thornicroft
S. Farrelly*
Affiliation:
Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK
G. Szmukler
Affiliation:
Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK
C. Henderson
Affiliation:
Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK
M. Birchwood
Affiliation:
Department of Psychology, University of Birmingham, Birmingham, UK
M. Marshall
Affiliation:
Division of Psychiatry, School of Medicine, University of Manchester, Manchester, UK
W. Waheed
Affiliation:
Division of Psychiatry, School of Medicine, University of Manchester, Manchester, UK
C. Finnecy
Affiliation:
Department of Psychology, University of Birmingham, Birmingham, UK
G. Thornicroft
Affiliation:
Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK
*
*Address for correspondence: S. Farrelly, Section of Community Mental Health Box PO29, Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigney Park, London SE5 8AF, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

In England, people with a serious mental illness are offered a standardized care plan under the Care Programme Approach (CPA). A crisis plan is a mandatory part of this standard; however, the quality and in particular the level of individualisation of these crisis plans are unknown. In this context, the aim of this study was to assess the quality of crisis planning and the impact of exposure to a specialized crisis planning intervention.

Method.

The crisis plans of 424 participants were assessed, before and after exposure to the Joint Crisis Plan (JCP) intervention, for ‘individualisation’ (i.e., at least one item of specific and identifiable information about an individual). Associations of individualisation were investigated.

Results.

A total of 15% of crisis plans were individualised at baseline. There was little or no improvement following exposure to the JCP. Individualised crisis plans were not associated with a history of prior crises or incidences of harm to self and others.

Conclusions.

Routine crisis planning for individuals with serious mental illness is not influenced by clinical risk profiles. ‘Top down’ implementation of the policy is unlikely to generate the best practice and compliance if clinicians do not perceive the clinical value in the process.

Keywords

Crisis planningindividualisationmental health carequality indicators
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 23 , Issue 4 , December 2014 , pp. 353 - 359
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Busseri, M, Tyler, J (2003). Interchangeability of the Working Alliance Inventory and Working Alliance Inventory, Short Form. Psychological Assessment 15, 193–197.Google Scholar
Department of Constitutional Affairs (2005). Mental Capacity Act – Code of Practice. The Stationery Office (TSO): Norwich.Google Scholar
Department of Health (1991). The Care Programme Approach. Department of Health: London.Google Scholar
Department of Health (1996). An Audit Pack for Monitoring the Care Programme Approach. Department of Health: London.Google Scholar
Department of Health (1999). National Service Framework for Mental Health. Modern Standards and Service Models. Department of Health: London.Google Scholar
Department of Health (2008). Refocusing the Care Program Approach: Policy and Positive Practice Guidance. Department of Health: London.Google Scholar
Farrelly, S (2013). Clinician attitudes to care planning. Therapeutic Relationships in Community Mental Health Settings: The Impact of the Joint Crisis Plan Intervention . PhD thesis, King's College London, London.Google Scholar
Flynn, R (2002). Clinical governance and governmentality. Health, Risk and Society 4, 155–173.Google Scholar
Funnel, S, Rogers, P (2011). Purposeful Programme Theory. Effective use of Theories of Change and Logic Models. Jossey-Bass: San Francisco.Google Scholar
Gilburt, H, Rose, D, Slade, M (2008). The importance of relationships in mental health care: A qualitative study of service users' experiences of psychiatric hospital admission in the UK. BMC Health Services Research 8, 92.Google Scholar
Gray, A (2004). Governing medicine: an introduction. In Governing Medicine: Theory and Practice (ed. Gray, A and Harrison, S), pp. 1–8. Open University Press: Maidenhead, Berkshire.Google Scholar
Grole, R, Grimshaw, J (2003). From best evidence to best practice: effective implementation of change in patients' care. Lancet 362, 1225–1230.CrossRefGoogle Scholar
Hampson, M (2007). The Care Programme Approach: views of consultant psychiatrists 15 years on. Newsletter of the Faculty of General and Community Psychiatry 12, 10.Google Scholar
Henderson, C, Flood, C, Leese, M, Thornicroft, G, Sutherby, K, Szmukler, G (2004). Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial. British Medical Journal 329, 136.Google Scholar
Henderson, C, Flood, C, Leese, M, Thornicroft, G, Sutherby, K, Szmukler, G (2009). Views of service users and providers on joint crisis plans. Social Psychiatry and Psychiatric Epidemiology 44, 369–376.CrossRefGoogle ScholarPubMed
Horvath, AO, Greenberg, LS (1989). The development of the working alliance inventory. Journal of Counseling Psychology 36, 223–233.CrossRefGoogle Scholar
Neale, MS, Rosenheck, RA (1995). Therapeutic alliance and outcome in a VA intensive case management program. Psychiatric Services 46, 719–723.Google Scholar
Schneider, J, Carpenter, J, Brandon, T (1999). Operation and organisation of services for people with severe mental illnes in the UK. A survey of the care programme approach. British Journal of Psychiatry 175, 422–425.Google Scholar
Simpson, A, Miller, C, Bowers, L (2003). Case management models and the care programme approach: how to make the CPA effective and credible. Journal of Psychiatric & Mental Health Nursing 10, 472–483.Google Scholar
Swanson, JW, Swartz, MS, Elbogen, EB, Van Dorn, RA, Ferron, J, Wagner, HR, McCauley, BJ, Kim, M (2006). Facilitated psychiatric advance directives: a randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness. American Journal of Psychiatry 163, 1943–1951.Google Scholar
Tait, L, Birchwood, M, Trower, P (2002). A new scale (SES) to measure engagement with community mental health services. Journal of Mental Health 11, 191–198.CrossRefGoogle ScholarPubMed
Tansella, M, Thornicroft, G (2009). Implementation science: understanding the translation of evidence into practice. British Journal of Psychiatry 195, 283–285.Google Scholar
Thornicroft, G, Farrelly, S, Birchwood, M, Marshall, M, Szmukler, G, Waheed, W, Byford, S, Dunn, G, Henderson, C, Lester, H, Leese, M, Rose, D, Sutherby, K (2010). CRIMSON [CRisis plan IMpact: Subjective and Objective coercion and eNgagement] Protocol: A randomised controlled trial of joint crisis plans to reduce compulsory treatment of people with psychosis. Trials 11, 102.Google Scholar
Thornicroft, G, Lempp, H, Tansella, M (2011). The place of implementation sceince in the translational medicine contiuum. Psychological Medicine 41, 2015–2021.Google Scholar
Thornicroft, G, Farrelly, S, Szmukler, G, Birchwood, M, Waheed, W, Flach, C, Barrett, B, Byford, S, Henderson, C, Sutherby, K, Lester, H, Rose, D, Dunn, G, Leese, M, Marshall, M (2013). Randomised controlled trial of joint crisis plans to reduce compulsory treatment for people with psychosis: clinical outcomes. Lancet 11, 1634–1641. http://dx.doi.org/10.1016/s0140-6736(13)60105-1.CrossRefGoogle Scholar
Watts, J, Priebe, S (2002). A phenomenological account of users' experiences of assertive community treatment. Bioethics 16, 439–454.Google Scholar
Wolfe, J, Gournay, K, Norman, S, Ramnoruth, D (1997). Care Programme Approach: evaluation of its implementation in an inner London Service. Clinical Effectiveness in Nursing 1, 85–91.Google Scholar