Johnson Sonia, Dalton-Locke Christian, Baker John, Hanlon Charlotte, Salisbury Tatiana Taylor, Fossey Matt, Newbigging Karen, Carr Sarah E, Hensel Jennifer, Carrà Giuseppe, Hepp Urs, Caneo Constanza, Needle Justin J, Lloyd-Evans Brynmor
Division of Psychiatry, University College London, London, UK.
Camden and Islington NHS Foundation Trust, London, UK.
World Psychiatry. 2022 Jun;21(2):220-236. doi: 10.1002/wps.20962.
Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best ap-proaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision-making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low- and middle-income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low-resource settings may lead to wider learning from locally embedded strategies.
心理健康危机的急性服务对服务使用者及其支持者非常重要，并且在许多国家消耗了大量心理健康资源。然而，急性护理往往不受欢迎，有时具有强制性，关于哪种模式最有利于患者体验和治疗结果的证据仍然非常有限，部分原因反映了对处于危机中的人进行研究存在挑战。尤其缺乏关于初始评估和即时管理的最佳方法的证据，但一些涉及扩展评估、简短干预以及使提供支持的环境和策略多样化的创新模式可能会有所帮助。急性病房在危机后的强化治疗阶段仍然至关重要，但需要开发、评估和实施新方法，以减少强制性、解决创伤问题、使治疗和住院医护人员多样化，并使决策和护理具有协作性。强化家庭治疗服务、急性日间病房和社区危机服务在使一些服务使用者避免住院方面有支持性证据：更好地了解如何在广泛背景下最佳实施这些服务以及哪种服务使用者最适用这些服务将很有价值。志愿部门的危机管理方法更灵活、更非正式：此类服务有潜力补充法定部门服务并为其提供宝贵经验，特别是对于那些往往服务不足或脱离服务的群体。此类方法通常涉及有心理健康危机个人经历的工作人员，他们在提高各部门急性护理质量方面具有重要潜在作用。许多低收入和中等收入国家存在巨大差距，这是由于难以获得高质量心理健康护理所致。应对措施需要建立在现有社区应对措施和与具体情况相关的证据基础之上。在资源匮乏环境中超越正式系统的必要性可能会带来从本地嵌入策略中获得更广泛经验的机会。
