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Crisis intervention for people with severe mental illnesses
1Cochrane Schizophrenia Group, Summertown Pavillion, Middle Way, Oxford, UK, OX2 7LG. csgadmin@psych.ox.ac.uk
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Home care crisis treatment for serious mental illness is a viable option, reducing repeat hospital admissions and family burden. While not a pure crisis intervention, it offers acceptable care during acute episodes.
Area of Science:
- Mental Health Services Research
- Psychiatric Care Models
- Community Psychiatry
Background:
- Delivering effective care during acute phases of serious mental illness in the community presents significant challenges.
- Crisis intervention models were developed to address these difficulties in psychiatric care.
- Standard care often struggles to meet the needs of individuals during acute episodes of severe mental illness.
Purpose of the Study:
- To evaluate the effectiveness of crisis intervention models for individuals with serious mental illness during acute episodes.
- To compare crisis intervention approaches with standard care in psychiatric treatment.
- To review randomized trials assessing the impact of crisis intervention on patient outcomes.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) identified through comprehensive database searches (e.g., MEDLINE, PsycLIT, EMBASE).
- Inclusion criteria focused on RCTs comparing any form of crisis intervention with standard care for severe mental illnesses.
- Data analysis included intention-to-treat principles, calculation of odds ratios (OR), confidence intervals (CI), and number needed to treat (NNT).
Main Results:
- None of the five included studies represented pure crisis intervention; all utilized home care with crisis intervention elements.
- Home care demonstrated a potential benefit in reducing repeat hospital admissions (OR 0.63) and significantly reduced loss to follow-up and family burden.
- Home care was perceived as more satisfactory by patients and families, and studies indicated it was more cost-effective than hospital care, though data quality varied.
Conclusions:
- While robust conclusions on pure crisis intervention are difficult, home care crisis treatment appears viable and acceptable for serious mental illness.
- Home care packages show promise, offering tentative support to findings from other reviews on effective home-based mental health services.
- Future research should focus on well-designed trials for pure crisis intervention and include outcomes like staff satisfaction and burnout.