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Short-stay crisis units for mental health patients on crisis care pathways: systematic review and meta-analysis
- Katie Anderson, Lucy P. Goldsmith, Jo Lomani, Zena Ali, Geraldine Clarke, Chloe Crowe, Heather Jarman, Sonia Johnson, David McDaid, Paris Pariza, A-La Park, Jared A. Smith, Elizabeth Stovold, Kati Turner, Steve Gillard
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- Journal:
- BJPsych Open / Volume 8 / Issue 4 / July 2022
- Published online by Cambridge University Press:
- 25 July 2022, e144
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- Article
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- Open access
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Background
Internationally, an increasing proportion of emergency department visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units.
AimsThis systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units.
MethodWe searched EMBASE, Medline, CINAHL and PsycINFO up to March 2021. All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed study risk of bias with Risk of Bias in Non-Randomized Studies – of Interventions and Risk of Bias in Randomized Trials.
ResultsData from twelve studies across six countries (Australia, Belgium, Canada, The Netherlands, UK and USA) and 67 505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared with 49.8% before intervention; difference = 7.8%; P < 0.0001) and increase out-patient follow-up care (χ2 = 37.42, d.f. = 1; P < 0.001). Meta-analysis indicated a significant reduction in length of emergency department stay (by 164.24 min; 95% CI −261.24 to −67.23 min; P < 0.001) and number of in-patient admissions (odds ratio 0.55, 95% CI 0.43–0.68; P < 0.001).
ConclusionsShort-stay mental health crisis units are effective for reducing emergency department wait times and in-patient admissions. Further research should investigate the impact of units on patient experience, and clinical and social outcomes.
Contributors
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- By Michael H. Allen, Leora Amira, Victoria Arango, David W. Ayer, Helene Bach, Christopher R. Bailey, Ross J. Baldessarini, Kelsey Ball, Alan L. Berman, Marian E. Betz, Emily A. Biggs, R. Warwick Blood, Kathleen T. Brady, David A. Brent, Jeffrey A. Bridge, Gregory K. Brown, Anat Brunstein Klomek, A. Jacqueline Buchanan, Michelle J. Chandley, Tim Coffey, Jessica Coker, Yeates Conwell, Scott J. Crow, Collin L. Davidson, Yogesh Dwivedi, Stacey Espaillat, Jan Fawcett, Steven J. Garlow, Robert D. Gibbons, Catherine R. Glenn, Deborah Goebert, Erica Goldstein, Tina R. Goldstein, Madelyn S. Gould, Kelly L. Green, Alison M. Greene, Philip D. Harvey, Robert M. A. Hirschfeld, Donna Holland Barnes, Andres M. Kanner, Gary J. Kennedy, Stephen H. Koslow, Benoit Labonté, Alison M. Lake, William B. Lawson, Steve Leifman, Adam Lesser, Timothy W. Lineberry, Amanda L. McMillan, Herbert Y. Meltzer, Michael Craig Miller, Michael J. Miller, James A. Naifeh, Katharine J. Nelson, Charles B. Nemeroff, Alexander Neumeister, Matthew K. Nock, Jennifer H. Olson-Madden, Gregory A. Ordway, Michael W. Otto, Ghanshyam N. Pandey, Giampaolo Perna, Jane Pirkis, Kelly Posner, Anne Rohs, Pedro Ruiz, Molly Ryan, Alan F. Schatzberg, S. Charles Schulz, M. Katherine Shear, Morton M. Silverman, April R. Smith, Marcus Sokolowski, Barbara Stanley, Zachary N. Stowe, Sarah A. Struthers, Leonardo Tondo, Gustavo Turecki, Robert J. Ursano, Kimberly Van Orden, Anne C. Ward, Danuta Wasserman, Jerzy Wasserman, Melinda K. Westlund, Tracy K. Witte, Kseniya Yershova, Alexandra Zagoloff, Sidney Zisook
- Edited by Stephen H. Koslow, University of Miami, Pedro Ruiz, University of Miami, Charles B. Nemeroff, University of Miami
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- Book:
- A Concise Guide to Understanding Suicide
- Published online:
- 05 October 2014
- Print publication:
- 18 September 2014, pp vii-x
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12 - Showing cats
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- By Anne Gregory, The Governing Council of the Cat Fancy, Steve Crow, The Governing Council of the Cat Fancy, Hilary Dean, The Governing Council of the Cat Fancy
- Edited by Dennis C. Turner, Patrick Bateson, University of Cambridge
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- Book:
- The Domestic Cat
- Published online:
- 05 December 2013
- Print publication:
- 21 November 2013, pp 167-184
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Summary
Introduction
The whole concept of different breeds of cat is a relatively modern one extending back only about 150 years. Other domesticated animals have a breed history much older; dogs and horses in particular were deliberately domesticated to ‘serve’ humans and were, to some extent, selectively bred from very early in their relationship with people to fit their needs. Thus the idea of selecting for different physical ‘types’, whether size, mass, speed, or certain mental abilities or characteristics is something human beings have pursued, albeit in a somewhat random way, probably for several millennia. By the eighteenth century this practice in some domestic species was quite refined, with a large number of recognisably different types of dogs, horses and, following the agricultural revolution from the mid eighteenth century onwards, of various farm animals such as cattle, sheep, pigs and fowl, all developed to meet different needs in human society. Deliberate selection had not yet been applied to the domestic cat, but by the latter half of the nineteenth century there was a growing understanding of basic genetics and as a result people realised they could select for, perpetuate and even improve certain attractive or distinctive features in domestic animals. Mendel’s findings on the principles of heredity were initially ignored, but by the beginning of the twentieth century were gaining acceptance. It was discovered, without the reasons being completely understood, that by breeding like to like or mating together closely related animals, offspring could exhibit the features particularly valued and sought after. Although the domestic cat has had a relationship with humans for at least 4000 years, this relationship has principally been one of exploitative captive, where the cat provided an effective control of rodents and other vermin in both urban and rural environments. In performing these functions the cat was regarded as extremely useful and gradually also respected as a companion animal (see Chapter 7).
The cognitive determinants of performance on the Austin Maze
- SIMON F. CROWE, LEE BARCLAY, STEVE BRENNAN, LINDA FARKAS, EMMA GOULD, SHARON KATCHMARSKY, SAMANTHA VAYDA
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- Journal:
- Journal of the International Neuropsychological Society / Volume 5 / Issue 1 / January 1999
- Published online by Cambridge University Press:
- 01 January 1999, pp. 1-9
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This study aimed to investigate which abilities are measured by the Austin Maze. One hundred and eight university students were administered a battery of eight neuropsychological tests including, the Austin Maze, the Tower of London, the Wisconsin Card Sort Test, Block Design, the Visual Spatial Learning Test, Digit Span Backwards, the Brown-Peterson Task and the Wide Range Achievement Test of Reading. Results indicated that visuospatial ability and memory both significantly contributed to performance on the Austin Maze, but differed in the degree to which they explained the performance depending on which measure of maze performance was employed. It appears that visuospatial ability is measured in early trials of the Austin Maze when individuals are orienting themselves to the path. In later trials individuals must call upon visuospatial memory to consolidate the details of the path. Executive function and working memory were not found to be significantly implicated in performance on the Austin Maze. (JINS, 1999, 5, 1–9.)