A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England
Background For people in mental health crisis, acute day units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to crisis resolution teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particular...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2021-03-01
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| Series: | BJPsych Open |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472421000302/type/journal_article |
| _version_ | 1811156991228248064 |
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| author | Danielle Lamb Thomas Steare Louise Marston Alastair Canaway Sonia Johnson James B. Kirkbride Brynmor Lloyd-Evans Nicola Morant Vanessa Pinfold Deb Smith Scott Weich David P. Osborn |
| author_facet | Danielle Lamb Thomas Steare Louise Marston Alastair Canaway Sonia Johnson James B. Kirkbride Brynmor Lloyd-Evans Nicola Morant Vanessa Pinfold Deb Smith Scott Weich David P. Osborn |
| author_sort | Danielle Lamb |
| collection | DOAJ |
| description | Background
For people in mental health crisis, acute day units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to crisis resolution teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly compared with those receiving CRT care alone.
Aims
We aimed to investigate readmission rates, satisfaction and well-being outcomes for people using ADUs and CRTs.
Method
We conducted a cohort study comparing readmission to acute mental healthcare during a 6-month period for ADU and CRT participants. Secondary outcomes included satisfaction (Client Satisfaction Questionnaire), well-being (Short Warwick–Edinburgh Mental Well-being Scale) and depression (Center for Epidemiologic Studies Depression Scale).
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.
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| first_indexed | 2024-04-10T04:58:52Z |
| format | Article |
| id | doaj.art-29a40dcabe3b42439d1aaa88dc597227 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T04:58:52Z |
| publishDate | 2021-03-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-29a40dcabe3b42439d1aaa88dc5972272023-03-09T12:29:06ZengCambridge University PressBJPsych Open2056-47242021-03-01710.1192/bjo.2021.30A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in EnglandDanielle Lamb0https://orcid.org/0000-0003-1526-9793Thomas Steare1https://orcid.org/0000-0002-3881-2018Louise Marston2Alastair Canaway3Sonia Johnson4James B. Kirkbride5https://orcid.org/0000-0003-3401-0824Brynmor Lloyd-Evans6https://orcid.org/0000-0001-9866-788XNicola Morant7Vanessa Pinfold8Deb Smith9Scott Weich10David P. Osborn11https://orcid.org/0000-0003-2519-1539NIHR ARC North Thames, Department of Applied Health Research, University College London, UKDivision of Psychiatry, University College London, UKDepartment of Primary Care and Population Health, University College London, UKClinical Trials Unit, University of Warwick, UKDivision of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UKDivision of Psychiatry, University College London, UKDivision of Psychiatry, University College London, UKDivision of Psychiatry, University College London, UKMcPin Foundation, UKMcPin Foundation, UKSchool of Health and Related Research, University of Sheffield, UKDivision of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UKBackground For people in mental health crisis, acute day units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to crisis resolution teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly compared with those receiving CRT care alone. Aims We aimed to investigate readmission rates, satisfaction and well-being outcomes for people using ADUs and CRTs. Method We conducted a cohort study comparing readmission to acute mental healthcare during a 6-month period for ADU and CRT participants. Secondary outcomes included satisfaction (Client Satisfaction Questionnaire), well-being (Short Warwick–Edinburgh Mental Well-being Scale) and depression (Center for Epidemiologic Studies Depression Scale). 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. https://www.cambridge.org/core/product/identifier/S2056472421000302/type/journal_articleCommunity mental health teamsepidemiologyout-patient treatmentpsychiatric nursing |
| spellingShingle | Danielle Lamb Thomas Steare Louise Marston Alastair Canaway Sonia Johnson James B. Kirkbride Brynmor Lloyd-Evans Nicola Morant Vanessa Pinfold Deb Smith Scott Weich David P. Osborn 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 Community mental health teams epidemiology out-patient treatment psychiatric nursing |
| title | A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England |
| title_full | A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England |
| title_fullStr | A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England |
| title_full_unstemmed | A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England |
| title_short | A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England |
| title_sort | comparison of clinical outcomes service satisfaction and well being in people using acute day units and crisis resolution teams cohort study in england |
| topic | Community mental health teams epidemiology out-patient treatment psychiatric nursing |
| url | https://www.cambridge.org/core/product/identifier/S2056472421000302/type/journal_article |
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