Improving care for people going through a mental health crisis

UCL research has helped shape acute mental health care policy and practice in the UK and internationally, resulting in reduced hospital admissions and improved care.

Readmission rates following mental health crisis care are high and demonstrate an urgent need for improvements in mental health care provision. Involuntary hospital detentions due to mental health crises have also more than doubled in England over the last 30 years. 

A team led by Professor Sonia Johnson and Dr Brynmor Lloyd-Evans (both UCL Division of Psychiatry) has conducted research into how best to support people in a mental health crisis within the community and avoid acute hospitalisation.  

Home treatment as an alternative  

Crisis Resolution Teams (CRTs) are a service model that has been implemented internationally and in all English health care regions since they were embedded in the NHS Plan in 2000. CRTs provide brief periods of intensive home treatment as an alternative to hospital admission for people in mental health crisis. 

A randomised controlled trial in North Islington evaluated this model. It demonstrated that CRTs reduce inpatient admissions and costs, and reduce the length of any hospital stays.

Developing a best practice model  

The UCL team went on to refine the CRT model and find new ways to improve the quality of crisis care. Through the CORE research programme they evaluated current service provision involving multiple partners to develop a best practice model, a scale for quality of care (fidelity scale) and a quality improvement process for CRTs. 

A randomised controlled trial demonstrated that this programme improved CRT model fidelity and reduced hospital admissions by 12%. This work informed the development of national audit standards for CRTs in England and supported the case for additional funding for CRTs. The Treasury has already allocated £419 million to implement CRTs and crisis alternatives over four years.

A focus on recovery and continuity of care

In a trial involving six NHS sites, the team also developed and evaluated a peer-supported self- management programme for people leaving acute care. Focussing on recovery, improved continuity of care and reducing readmissions to crisis care, the programme reduced readmissions from 38% to 29%. Implementing this programme nationally in CRTs across the NHS could save £11.7 million a year. 

A programme of work on residential crisis houses led by the research team has played a major role in establishing the national and international evidence base for this service model, which have endured as a feature of many mental health acute care systems nationally, usually working closely in partnership with local CRTs.   

Modernising the Mental Health Act

In 2017, the UCL research team was commissioned by the Department of Health and Social Care, through the NIHR Mental Health Policy Research Unit, to conduct a rapid programme of research. This was designed to support a national review of the legal frameworks and process for involuntary admission to hospital and to provide recommendations to address the steep rise in detentions and the ethnic inequalities in detention rates. 

The Mental Health Act Review’s recommendations were supported by the research team’s underpinning evidence synthesis, which strengthened the case for policy change. This included the recommendation that patients at risk of detention should routinely be supported to write Advance Choice Documents. The Review advocated that patients should maintain their right to advocacy and choice over who acts as their nominated relative; have a clear treatment plan early in detention; and be able to challenge specific treatments while detained.

In the 2019 Queen’s speech the Government endorsed all the recommendations from the MHA Review, leading to the publication of a White Paper in January 2021.

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Links

• Professor Sonia Johnson’s academic profile
• Dr Brynmor Lloyd-Evans’ academic profile
• UCL Division of Psychiatry
• UCL Faculty of Brain Sciences
• UCL Faculty of Brain Sciences - REF 2021
• Improving acute mental health care service delivery to reduce hospital admissions video

Image 

• Image credit: iStock / fizkes