Crisis intervention for people with severe mental illnesses

Area of Science:

• Mental Health
• Psychiatry
• Health Services Research

Background:

• Community treatment of serious mental illnesses faces challenges in delivering adequate care during acute phases.
• Crisis intervention models emerged as a potential solution to improve acute care delivery.

Purpose of the Study:

• To review the effectiveness of crisis intervention models for acute episodes in individuals with serious mental illness compared to standard care.
• To assess the impact of crisis intervention on hospital admissions, patient/family satisfaction, and cost-effectiveness.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing crisis intervention with standard care.
• Searches updated through January 2006 using the Cochrane Schizophrenia Group's Register.
• Data analyzed on an intention-to-treat basis, calculating relative risk ratios (RR) and weighted mean differences (WMD).

Main Results:

• Home-based crisis intervention, while not always preventing initial hospital admission (45%), significantly reduced repeat admissions (RR 0.72) and early study dropout (RR 0.74).
• This model decreased family burden (RR 0.34) and was rated as more satisfactory by patients and families.
• No significant differences were observed in mortality or mental state outcomes; home care was found to be more cost-effective, though data were heterogeneous or unusable.

Conclusions:

• Home care crisis treatment, integrated with ongoing support, presents a viable and acceptable method for managing serious mental illnesses during acute phases.
• Further evaluative studies are necessary for widespread implementation of this home-based approach.