Joint Crisis Plans and Crisis Cards in Inpatient Psychiatric Treatment—a Multicenter Randomized Controlled Trial

Area of Science:

• Psychiatry
• Clinical Psychology
• Health Services Research

Background:

• Joint Crisis Plans (JCP) and crisis cards (CC) aim to improve psychiatric crisis management but differ in resources, legal standing, and objectives.
• Existing international research on JCP effectiveness yields inconsistent findings.

Purpose of the Study:

• To compare the effectiveness of Joint Crisis Plans (JCP) against crisis cards (CC) in managing psychiatric crises.
• To evaluate the impact of JCP and CC on inpatient treatment duration and coercive measures in patients with schizophrenia or schizoaffective disorder.

Main Methods:

• A single-blinded, two-armed, multicenter randomized controlled trial (RCT) conducted from January 2018 to December 2020.
• Included 266 patients aged 18-62 with schizophrenia or schizoaffective disorder, with assessments at baseline and 18 months.
• Primary outcome: cumulative inpatient treatment duration; secondary outcome: coercive measures.

Main Results:

• No significant difference in psychiatric hospital admission rates (JCP: 64.9% vs. CC: 57.8%) or involuntary admissions (JCP: 12.2% vs. CC: 8.4%) between groups.
• Cumulative treatment duration was not significantly shorter in the JCP group (mean 42.43 days) compared to the CC group (mean 50.16 days).
• Significant improvements were observed in the JCP group regarding patient confidence in treatment teams and active participation in treatment.

Conclusions:

• Joint Crisis Plans (JCP) did not demonstrate superiority over crisis cards (CC) in reducing inpatient treatment duration or coercive measures.
• Despite not meeting primary outcome expectations, JCPs positively impacted patient-provider relationships and treatment engagement.
• JCPs are recommended for wider implementation to foster a more participative approach in routine psychiatric care.