Views of service users and providers on joint crisis plans: single blind randomized controlled trial

We report participants' and case managers' use of and views on the value of Joint Crisis Plans (JCPs), shown to reduce compulsory hospitalisation and violence.

One hundred sixty people with psychosis or bipolar disorder participated in a randomized controlled trial. Intervention group participants were interviewed on receipt of the JCP, on hospitalisation, and at 15 month follow-ups; case managers were interviewed at 15 months.

Sixty-two of the 65 people who received a JCP (95%) were interviewed at least once. Depending on the question, 46-96% of JCP holders (N = 44) responded positively to questions concerning the value of the JCP at immediate follow up. At 15 months the proportions of positive responses to the different questions was 14-82% (N = 50). Thirty-nine to eighty-five per cent of case managers (N = 28) responded positively at 15 months. Comparing the total scores of participants who had completed both the initial and follow up questionnaires showed a shift in responses, from positive to no change, from the immediate follow up to 15 months (means 6.1 vs. 8.3, difference 2.2, 95% CI 0.8, 3.7, P = 0.003) where a higher score indicates less positive views. The two items that received highest endorsement also showed least shift over time, i.e. whether the participant would recommend the JCP to others (90% initial vs. 82% at 15 months) and whether they felt more in control of their mental health problem as a result (71% at initial vs. 56% at 15 months). Case managers at 15 months were more positive than service users, with total score means of 5 vs. 7.8 (difference -2.8, 95% CI -4.5, -1.2, P = 0.002).

The best supported hypothesis was that participants felt more in control of their mental health problem. Together with the previously reported outcomes, this suggests JCPs empower their holders to obtain their preferred care and treatment in a crisis. Further research is needed to more clearly identify the mechanisms of action of JCPs and how their initial positive impact can be sustained.