Joint Crisis Plan in Mental Health Settings: A Reflective Process More than an Intervention Tool?

Coercion in mental health is challenged, prompting reduction interventions. Among those, the Joint Crisis Plan (JCP), which aims to document individuals' treatment preferences in case of future de-compensation, regardless of the potential loss of discernment, has been identified as a key path to study. Identified challenges related to its implementation highlight the need to adapt this intervention to the local context. Considering that in Quebec (Canada), the JCP is not widely used, but the scientific literature supports its adoption and corroborates its potential impact on reducing coercion, this study evaluates the feasibility, acceptability, and preliminary outcomes of the JCP among psychiatric and forensic inpatient settings.

A pilot mixed-methods study was conducted through 16 individual interviews with inpatients and healthcare providers, combined with a pre-post analysis of seclusion and restraint use and the violence prevention climate (VPC) based on healthcare providers' (n = 57) and inpatients' perspectives (n = 53).

Although the challenging implementation of the JCP complicated the evaluation of its effects on seclusion and restraint use, a moderate change (d = 0.40) in the VPC was identified based on healthcare providers' perspectives. Qualitative findings are also insightful to understand the acceptability and feasibility of the JCP use. A tension emerged between the perspectives of inpatients and healthcare providers: while inpatients valued the reflective process of completing the plan, providers focused more on its technical aspects.

The results support the integration of the JCP into patient care pathways, as it provides a tool to amplify patients' voices, promote patient empowerment, facilitate open dialog on alternatives to coercion, and foster more collaborative and humane mental health care.