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Find below the results and findings from recent AD-CARE study publications and reports
- Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study
This study found that acute day units, although not routinely provided in the NHS, were highly valued by staff and service users, with some evidence of better outcomes.
Osborn D, Lamb D, Canaway A, Davidson M, Favarato G, Pinfold V, et al. Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study. Health Serv Deliv Res 2021;9(18)
- Adult mental health provision in England: a national survey of acute day units
This cross-sectional survey and cluster analysis of ADUs aimed to identify, categorise, and describe Acute Day Units (ADUs) in England.
Results
Two types of service were identified by the cluster analysis: NHS (n = 27; and voluntary sector services (n = 18). Under a third of NHS Trusts have access to ADUs. NHS services typically have multi-disciplinary staff teams, operate during office hours, offer a range of interventions (medication, physical checks, psychological interventions, group sessions, peer support), and had a median treatment period of 30 days. Voluntary sector services had mostly non-clinically qualified staff, and typically offered supportive listening on a one-off, drop-in basis. Nearly all services aim to prevent or reduce inpatient admissions. Voluntary sector services had more involvement by service users and carers in management and running of the service than NHS services.
Conclusions
The majority of NHS Trusts do not provide ADUs, despite their potential to reduce inpatient admissions. Further research of ADUs is required to establish their effectiveness and acceptability to service users, carers, and staff.
Lamb, D., Davidson, M., Lloyd-Evans, B. et al. Adult mental health provision in England: a national survey of acute day units. BMC Health Serv Res 19, 866 (2019). https://doi.org/10.1186/s12913-019-4687-8
- A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England
We aimed to investigate readmission rates, satisfaction and well-being outcomes for people using ADUs and CRTs.
Results
We recruited 744 participants (ADU: n = 431, 58%; CRT: n = 312, 42%) across four National Health Service trusts/health regions. There was no statistically significant overall difference in readmissions: 21% of ADU participants and 23% of CRT participants were readmitted over 6 months (adjusted hazard ratio 0.78, 95% CI 0.54–1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire scores (2.5, 95% CI 1.4–3.5, P < 0.001) and well-being scores (1.3, 95% CI 0.4–2.1, P = 0.004), and lower depression scores (−1.7, 95% CI −2.7 to −0.8, P < 0.001), than CRT participants.
Conclusions
Patients who accessed ADUs demonstrated better outcomes for satisfaction, well-being and depression, and no significant differences in risk of readmission, compared with those who only used CRTs. Given the positive outcomes for patients, and the fact that ADUs are inconsistently provided in the National Health Service, their value and place in the acute care pathway needs further consideration and research.
Lamb, D., Steare, T., Marston, L., Canaway, A., Johnson, S., Kirkbride, J., . . . Osborn, D. (2021). A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: Cohort study in England. BJPsych Open, 7(2), E68. doi:10.1192/bjo.2021.30
- Acute day units for mental health crises: a qualitative study of service user and staff views and experiences
This qualitative study explores the views and experiences of stakeholders who use and work in ADUs.
Results
Both service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within an environment that felt safe. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems.
Conclusions
Multi-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice and effective support within local acute care systems.
Morant, N., Davidson, M., Wackett, J. et al. Acute day units for mental health crises: a qualitative study of service user and staff views and experiences. BMC Psychiatry 21, 146 (2021). https://doi.org/10.1186/s12888-021-03140-2
- Readmission after discharge from acute mental healthcare among 231 988 people in England: cohort study exploring predictors of readmission including availability of acute day units in local areas
Aims
To assess predictors of readmission to acute mental healthcare following discharge in England, including availability of ADUs.
Results
Of a total of 231 998 eligible individuals discharged from acute mental healthcare, 49 547 (21.4%) were readmitted within 6 months, with a median time to readmission of 34 days (interquartile range 10–88 days). Most variation in readmission (98%) was attributable to individual patient-level rather than provider (trust)-level effects (2.0%). Risk of readmission was not associated with local availability of ADUs (adjusted odds ratio 0.96, 95% CI 0.80–1.15). Statistically significant elevated risks were identified for participants who were female, older, single, from Black or mixed ethnic groups, or from more deprived areas. Clinical predictors included shorter index admission, psychosis and being an in-patient at baseline.
Conclusions
Relapse and readmission to acute mental healthcare are common following discharge and occur early. Readmission was not influenced significantly by trust-level variables including availability of ADUs. More support for relapse prevention and symptom management may be required following discharge from acute mental healthcare.
Osborn, D., Favarato, G., Lamb, D., Harper, T., Johnson, S., Lloyd-Evans, B., . . . Weich, S. (2021). Readmission after discharge from acute mental healthcare among 231 988 people in England: Cohort study exploring predictors of readmission including availability of acute day units in local areas. BJPsych Open, 7(4), E136. doi:10.1192/bjo.2021.961