Crisis intervention for people with severe mental illnesses

Abstract

Background: A particularly difficult challenge for community treatment of people with serious mental illnesses is the delivery of an acceptable level of care during the acute phases of severe mental illness. Crisis intervention models of care were developed as a possible solution.

Objectives: To review the effects of crisis intervention models for anyone with serious mental illness experiencing an acute episode, compared with 'standard care'.

Search methods: We updated the 1998, 2003 and 2006 searches with a search of the Cochrane Schizophrenia Group's Register of trials (2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE, and PsycINFO.

Selection criteria: We included all randomised controlled trials of crisis intervention models versus standard care for people with severe mental illnesses.

Data collection and analysis: We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CI). We assumed that people who left early from a trial had no improvement.

Main results: Three new studies have been found since the last review in 2006 to add to the five studies already included in this review. None of the previously included studies investigated crisis intervention alone; all used a form of home care for acutely ill people, which included elements of crisis intervention. However, one of the new studies focuses purely on crisis intervention as provided by Crisis Resolution Home Teams within the UK; the two other new studies investigated crisis houses i.e. residential alternatives to hospitalisation providing home-like environments.Crisis intervention appears to reduce repeat admissions to hospital after the initial 'index' crises investigated in the included studies, this was particularly so for mobile crisis teams supporting patients in their own homes.Crisis intervention reduces the number of people leaving the study early, reduces family burden, is a more satisfactory form of care for both patients and families and at three months after crisis, mental state is superior to standard care. We found no differences in death outcomes. Some studies found crisis interventions to be more cost effective than hospital care but all numerical data were either skewed or unusable. No data on staff satisfaction, carer input, complications with medication or number of relapses were available.

Authors' conclusions: Care based on crisis intervention principles, with or without an ongoing home care package, appears to be a viable and acceptable way of treating people with serious mental illnesses. If this approach is to be widely implemented it would seem that more evaluative studies are still needed.

Figure 1

Study flow diagram (2010 UPDATE).

Figure 2

Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.

Figure 3

Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.