Abstract
Introduction
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.
Method
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.
Results
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).
Conclusions
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.
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References
Beisecker AE, Beisecker TD (1990) Patient information-seeking behaviours when communicating with doctors. Med Care 28:19–28
Charles C, Gafni A, Whelan T (1997) Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 44:681–692
Deegan PE, Drake RE (2006) Shared decision making and medication management in the recovery process. Psychiatr Serv 57:1636–1639
Fenton WS (2003) Shared decision making: a model for the physician-patient relationship in the 21st century? Acta Psychiatrica Scandinavica 107:401–402
Flood C, Byford S, Henderson C, Leese M, Thornicroft G, Sutherby K, Szmukler G (2006) Joint crisis plans for people with psychosis: economic evaluation of a randomised controlled trial. BMJ 333:729–732
Hamann J, Leucht S, Kissling W (2003) Shared decision making in psychiatry. Acta Psychiatr Scand 107:403–409
Henderson C, Flood C, Leese M, Thornicroft G, Sutherby K, Szmukler G (2004) Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial. BMJ 329:136–138
Kim MM, Van Dorn RA, Scheyett AM, Elbogen EE, Swanson JW, Swartz MS, McDaniel LA (2007) Understanding the personal and clinical utility of psychiatric advance directives: a qualitative perspective. Psychiatry 70(1):19–29
McGuffin P, Farmer A, Harvery I (1991) A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Arch Gen Psychiatry 48:764–770
Papageorgiou A, King M, Janmohamed A, Davidson O, Dawson J (2002) Advance directives for patients compulsorily admitted to hospital with serious mental illness: randomised controlled trial. Br J Psychiatry 181:513–519
Papageorgiou A, Janmohamed A, King M, Davidson O, Dawson J (2004) Advance directives for patients compulsorily admitted to hospital with serious mental disorders: directive content and feedback from patients and professionals. J Ment Health 13:379–388
Shannon C (2003) Better communication is key to recruiting patients to trials. BMJ 327:1368
Srebnik DS, Russo J, Sage J, Peto T, Zick E (2003) Interest in psychiatric advance directives among high users of crisis services and hospitalization. Psychiatr Serv 54:981–986
Srebnik DS, Rutherford LT, Peto T, Russo J, Zick E, Jaffe C, Holtzheimer P (2005) The content and clinical utility of psychiatric advance directives. Psychiatr Serv 56:592–598
Sutherby K, Szmukler GI (1998) Crisis cards and self-help crisis initiatives. Psychiatr Bull 22:4–7
Sutherby K, Szmukler GI, Halpern A, Alexander M, Thornicroft G, Johnson C, Wright S (1999) A study of ‘crisis cards’ in a community psychiatric service. Acta Psychiatr Scand 100:56–61
Swanson J, Swartz M, Ferron J, Elbogen E, Van DR (2006) Psychiatric advance directives among public mental health consumers in five U.S. cities: prevalence, demand, and correlates. J Am Acad Psychiatry Law 34:43–57
Swanson JW, Swartz MS, Elbogen EB, Van Dorn RA, Ferron J, Wagner HR, McCauley BJ, Kim M (2006) Facilitated psychiatric advance directives: a randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness. Am J Psychiatry 163:1943–1951
Acknowledgments
We thank all participants, their informal carers, and care staff for their help in conducting the study.Funding: CH was supported by a Medical Research Council training fellowship in health services research, and CF was supported by a South London and Maudsley Trust health services research committee grant.
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Henderson, C., Flood, C., Leese, M. et al. Views of service users and providers on joint crisis plans. Soc Psychiat Epidemiol 44, 369–376 (2009). https://doi.org/10.1007/s00127-008-0442-x
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DOI: https://doi.org/10.1007/s00127-008-0442-x