Service use preceding and following first referral for psychiatric emergency care at a short-stay crisis unit: A cohort study across three cities and one rural area in England

Goldsmith, Lucy Pollyanna ORCID: https://orcid.org/0000-0002-6934-1925, Anderson, Katie ORCID: https://orcid.org/0000-0002-3156-7427, Clarke, Geraldine, Crowe, Chloe, Jarman, Heather, Johnson, Sonia, Lomani, Jo, McDaid, David, Park, A-La, Smith, Jared G. and Gillard, Steven (2022) Service use preceding and following first referral for psychiatric emergency care at a short-stay crisis unit: A cohort study across three cities and one rural area in England. International Journal of Social Psychiatry . 002076402211425. ISSN 0020-7640 [Article] (Published online first) (doi:10.1177/00207640221142530)

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Abstract

Background: Internationally, hospital-based short-stay crisis units have been introduced to provide a safe space for stabilisation and further assessment for those in psychiatric crisis. The units typically aim to reduce inpatient admissions and psychiatric presentations to emergency departments. Aims: To assess changes to service use following a service user’s first visit to a unit, characterise the population accessing these units and examine equality of access to the units. Methods: A prospective cohort study design (ISCTRN registered; 53431343) compared service use for the 9 months preceding and following a first visit to a short-stay crisis unit at three cities and one rural area in England. Included individuals first visited a unit in the 6 months between 01/September/2020 and 28/February/2021. Results: The prospective cohort included 1189 individuals aged 36 years on average, significantly younger (by 5–13 years) than the population of local service users (<.001). Seventy percent were White British and most were without a psychiatric diagnosis (55%–82% across sites). The emergency department provided the largest single source of referrals to the unit (42%), followed by the Crisis and Home Treatment Team (20%). The use of most mental health services, including all types of admission and community mental health services was increased post discharge. Social-distancing measures due to the COVID-19 pandemic were in place for slightly over 50% of the follow-up period. Comparison to a pre-COVID cohort of 934 individuals suggested that the pandemic had no effect on the majority of service use variables. Conclusions: Short-stay crisis units are typically accessed by a young population, including those who previously were unknown to mental health services, who proceed to access a broader range of mental health services following discharge.

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