Crisis Intervention for People with Severe Mental Illnesses

Summary

A Cochrane review [Abstract] 1 included 8 studies with a total of 1144 subjects. The majority of participants were psychotic (most suffering from schizophrenia), but there was a substantial representation of other diagnoses such as depression and severe neuroses. For all studies, a multidisciplinary team, usually comprising psychiatrists, psychologists, nurses, occupational therapists and social workers, delivered care. The follow-up of trials ranged from 3 months to two years. Crisis intervention may reduce repeat admissions to hospital (excluding index admissions) at 6 months (RR 0.75, CI 0.50 to 1.13; 1 RCT, n = 369), but does appear to reduce family burden (at 6 months: RR 0.34 CI 0.20 to 0.59: 1 RCT, n = 120), improve mental state (Brief Psychiatric Rating Scale (BPRS) at 3 months: MD -4.03 CI -8.18 to 0.12; 2 RCTs, n = 248), and improve global state (Global Assessment Scale (GAS) 20 months: MD 5.70, -0.26 to 11.66; 1 RCT, n = 142). Participants in the crisis-intervention group were more satisfied with their care 20 months after crisis (Client Satisfaction Questionnaire (CSQ-8): MD 5.40 CI 3.91 to 6.89; 1 RCT, n = 137). However, quality of life scores at 6 months were similar between treatment groups (Manchester Short Assessment of quality of life (MANSA): MD -1.50 CI -5.15 to 2.15; 1 RCT, n = 226). Favourable results for crisis intervention were also found for leaving the study early and family satisfaction. No differences in death rates were found. Some studies suggested crisis intervention to be more cost-effective than hospital care but all numerical data were either skewed or unusable.