Lamb, Danielle, Steare, Thomas, Marston, Louise, Canaway, Alastair, Johnson, Sonia, Kirkbride, James B., Lloyd-Evans, Brynmor, Morant, Nicola, Pinfold, Vanessa, Smith, Deb, Weich, Scott and Osborn, David P. (2021) 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, 7 (2). pp. 1-8. e68. doi:10.1192/bjo.2021.30

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Abstract

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.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine R Medicine > RT Nursing
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Mental health, Mental health care teams , Mental health facilities , Mental health services, Critical care medicine, Patient monitoring, Psychiatric nursing , Mentally ill -- Home care, Mentally ill -- Services for
Journal or Publication Title:	BJPsych Open
Publisher:	Royal College of Psychiatrists
ISSN:	2056-4724
Official Date:	19 March 2021
Dates:	Date Event 19 March 2021 Published 1 March 2021 Accepted
Volume:	7
Number:	2
Page Range:	pp. 1-8
Article Number:	e68
DOI:	10.1192/bjo.2021.30
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID 15/24/17 National Institute for Health Research http://dx.doi.org/10.13039/501100000272

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