When a person is discharged from a psychiatric inpatient facility, the hope is that he or she will receive the necessary outpatient mental health care to avoid future hospitalization. In England, many procedures are in place to assist with this goal, including the Care Programme Approach (CPA), which provides a plan for outpatient mental health care, social services, care workers, and reviews. However, high rates of readmission still occur.
To address this issue, England recently implemented a Joint Crisis Plan (JCP) which is a collaborative effort negotiated by the client and the mental health staff to ensure that a client’s preferences are carried out in times of psychological crisis. The JCP is aimed at preserving the wishes of client when they are unable to make healthcare determinations for themselves. In this regard, a JCP may provide a window of opportunity to address serious mental challenges before they progress to a point of crisis and hospitalization.
To determine if this collaborative approach results in better readmission outcomes among the seriously mentally ill than CPA alone, Professor Graham Thornicroft, PhD, of the Health Service and Population Research Department of the Institute of Psychiatry at King’s College in London recently enrolled 569 participants who had been inpatients at mental health facilities in the previous 24 months. Half of the participants received CPA alone while the other half received JCP and CPA. Outcomes were measured based on future admission, therapeutic relationship, and overall well-being. Thornicroft discovered that although the therapeutic relationships were stronger for the JCP participants, readmission rates were similar in both groups.
The lack of reduced readmission rates was discouraging and could be the result of several factors. First, participants reported that their wishes were not carried out when they reached a crisis point. Second, they did not have dedicated JCP meetings with staff and healthcare workers, but rather had brief JCP discussions during the course of CPA meetings. Further, many times, key mental health workers were absent from JCP meetings and overall, the mental health professionals did not see JCP as specialized but merely as an obligatory adjunct to the CPA.
Finally, “Qualitative analysis found that although some patients had a positive experience of JCP, many described how clinical services struggled to put it into practice,” added Thornicroft. In sum, the results of this study show that the JCPs have the potential to help reduce readmission rates and benefit mental health clients, but their significance must be emphasized and their stipulations more stringently adhered to in order to provide the maximum benefit possible to the client.
Thornicroft, Graham, et al. (2013). Clinical outcomes of joint crisis plans to reduce compulsory treatment for people with psychosis: A randomised controlled trial. The Lancet 381.9878 (2013): 1634-41. ProQuest. Web.
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