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Back to Joint Crisis Plans introduction
A Study of Mental Health Crisis Cards
Project staff:
George Szmukler, Kim Sutherby
Aim:
'Crisis cards' originated as a voluntary sector initiative to
facilitate access to an advocate, and to state a service user's
preferences for treatment in an emergency - when he or she might
be too unwell to express their wishes coherently.
Method:
We conducted a study of the acceptability and feasibility of
introducing a form of crisis card, which we called a joint crisis
plan, into a sectorised community psychiatric service for psychotic
patients at high risk of crisis. Follow-up was carried out at
one month and again at 6-12 months by an independent assessor,
to establish patients' satisfaction with the process.
Current Status:
Forty percent of 106 patients meeting the study criteria wished
to develop a joint crisis plan. These users were significantly
more likely to have a diagnosis of an affective psychosis, a
history of suicide attempts or suicide risk, and to have less
frequent admissions than those not wanting a card. Patients chose
to include a wide range of information including diagnosis, current
treatment, contact information for carers and professionals,
first signs of relapse, treatment at first signs of illness,
treatment preferences and refusals, indications for admission,
and practical requests. The joint crisis plan served both a 'manifest',
practical function (to provide important information when the
patient is too ill to do so), as well as a 'latent', psychological
one (positive effects on the patient's attitude to themselves,
their illness and treatment, and their relationship with the
clinical team). There was a 30% reduction in admissions in the
year following the card.
The section is now conducting a randomised
controlled trial of the effectiveness of 'crisis cards' in a
community service.
References:
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
Sutherby K, Szmukler G (1998). Crisis cards and self-help
crisis initiatives. Psychiatric Bulletin. 22:4-7. |
