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style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng216er4-lrg.png" alt="Cover of Support during an escalation of need" /></a></div><div class="bkr_bib"><h1 id="_NBK588603_"><span itemprop="name">Support during an escalation of need</span></h1><div class="subtitle">Social work with adults experiencing complex needs</div><p><b>Evidence review D</b></p><p><i>NICE Guideline, No. 216</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2022 May</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4511-5</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div></div><div class="bkr_clear"></div></div><p>This evidence report contains information on 2 reviews relating to support during an escalation of need, the first being an intervention effectiveness review and the second, a qualitative review.</p><ul><li class="half_rhythm"><div>What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of need?</div></li><li class="half_rhythm"><div>Based on the views and experiences of everyone involved, what works well and what can be improved about case management and care planning in the event of a crisis or unplanned escalation of need?</div></li></ul><div id="niceng216er4.s1"><h2 id="_niceng216er4_s1_">Support during an escalation of need</h2><div id="niceng216er4.s1.1"><h3>Review questions</h3><ul><li class="half_rhythm"><div>What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of needs?</div></li><li class="half_rhythm"><div>Based on the views and experiences of everyone involved, what works well and what can be improved about case management and care planning in the event of a crisis or unplanned escalation of need?</div></li></ul><div id="niceng216er4.s1.1.1"><h4>Introduction</h4><p>Case management and care planning responses to an unplanned escalation of need have been suggested to improve accesss to and continuity of care, and consequently reduce future crisis situations.</p><p>There is currently little guidance with regard to the effectiveness of social work approaches to case management and care planning when there is an unplanned escalation of need. The aim of this review was to determine whether social work case management and care planning could improve outcomes for adults with complex needs during an escalation of need, or crisis situation. The review also aims to identify particular aspects of what does and not does work well for these interventions, in the opinion of all those involved.</p></div><div id="niceng216er4.s1.1.2"><h4>Summary of the protocol</h4><p>See <a class="figpopup" href="/books/NBK588603/table/niceng216er4.tab1/?report=objectonly" target="object" rid-figpopup="figniceng216er4tab1" rid-ob="figobniceng216er4tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of the effectivenessreview question.</p><p>Please see <a class="figpopup" href="/books/NBK588603/table/niceng216er4.tab2/?report=objectonly" target="object" rid-figpopup="figniceng216er4tab2" rid-ob="figobniceng216er4tab2">Table 2</a> for a summary of the Population and Phenomenon of interest for the qualitative review question.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng216er4tab1"><a href="/books/NBK588603/table/niceng216er4.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng216er4tab1" rid-ob="figobniceng216er4tab1"><img class="small-thumb" src="/books/NBK588603/table/niceng216er4.tab1/?report=thumb" src-large="/books/NBK588603/table/niceng216er4.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICO table) - effectiveness question." /></a><div class="icnblk_cntnt"><h4 id="niceng216er4.tab1"><a href="/books/NBK588603/table/niceng216er4.tab1/?report=objectonly" target="object" rid-ob="figobniceng216er4tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO table) - effectiveness question. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng216er4tab2"><a href="/books/NBK588603/table/niceng216er4.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng216er4tab2" rid-ob="figobniceng216er4tab2"><img class="small-thumb" src="/books/NBK588603/table/niceng216er4.tab2/?report=thumb" src-large="/books/NBK588603/table/niceng216er4.tab2/?report=previmg" alt="Table 2. Summary of the protocol (population and phenomenon of interest) - qualitative question." /></a><div class="icnblk_cntnt"><h4 id="niceng216er4.tab2"><a href="/books/NBK588603/table/niceng216er4.tab2/?report=objectonly" target="object" rid-ob="figobniceng216er4tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (population and phenomenon of interest) - qualitative question. </p></div></div><p>For further details see the review protocols in <a href="#niceng216er4.appa">appendix A</a>.</p></div><div id="niceng216er4.s1.1.3"><h4>Methods and process</h4><p>This is a mixed-methods review using parallel synthesis. Effectiveness and qualitative data were analysed and synthesised separately and integrated through the committee’s interpretation of results, described in the committee’s discussion of the evidence. This was supported by a further layer of interpretation by the review team, which is set out in Table 6 and shows how some of the qualitative themes helped to explain or contextualise the quantitative findings. This table was presented to the committee along with all the effectiveness and qualitative data to help them to integrate the two data types and make recommendations.</p><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng216er4.appa">appendix A</a> and the methods document (<a href="/books/NBK588603/bin/supplement-1-methods-pdf-11020108285.pdf">supplementary document 1</a>).</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng216er4.s1.1.4"><h4>Effectiveness evidence</h4><div id="niceng216er4.s1.1.4.1"><h5>Included studies</h5><p>For the effectiveness review, we looked for systematic reviews, randomised controlled trials and observational studies reporting critical outcomes. Two prospective cohort studies from Canada (Reid 2012 and <a class="bibr" href="#niceng216er4.ref3" rid="niceng216er4.ref3">Semple 2021</a>), 1 retrospective cohort study from the UK (<a class="bibr" href="#niceng216er4.ref4" rid="niceng216er4.ref4">Timms 2016</a>), and 1 RCT from Australia (<a class="bibr" href="#niceng216er4.ref1" rid="niceng216er4.ref1">Alvarez-Jimenez 2021</a>) were included in this review. The RCT compared an online social therapy with case management, plus treatment as usual, to treatment as usual alone. The population was people with a first episode of psychotic disorder. One cohort study compared a critical time intervention with case management to a matched control group who did not receive the intervention following transfer from hospital. The population was adults experiencing homeless. One cohort study compared a crisis outreach team consisting of a police officer and a social worker to the police patrol without a social worker. The population was adults who contacted the police service in distress, including a mental health related distress. One study compared a cohort pre and post intervention, where the intervention was outreach by specialist services for people experiencing homelessness followed by a Mental Health Act assessment and detention by an approved mental health professional (AMHP).</p><p>Data were identified for the outcomes quality of life, access to care and support in a crisis measured by contact with services or health or social care practitioners, duration of crisis and hospital admissions.</p><p>No meta-analyses were conducted for the studies, as there was heterogeneity between the interventions.</p><p>The included studies are summarised in <a class="figpopup" href="/books/NBK588603/table/niceng216er4.tab3/?report=objectonly" target="object" rid-figpopup="figniceng216er4tab3" rid-ob="figobniceng216er4tab3">Table 3</a>.</p><p>See the literature search strategy in <a href="#niceng216er4.appb">appendix B</a> and study selection flow chart in <a href="#niceng216er4.appc">appendix C</a>.</p></div><div id="niceng216er4.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng216er4.appj">appendix J</a>.</p></div></div><div id="niceng216er4.s1.1.5"><h4>Summary of included studies</h4><p>Summaries of the studies that were included in the effectiveness review are presented in <a class="figpopup" href="/books/NBK588603/table/niceng216er4.tab3/?report=objectonly" target="object" rid-figpopup="figniceng216er4tab3" rid-ob="figobniceng216er4tab3">Table 3</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng216er4tab3"><a href="/books/NBK588603/table/niceng216er4.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng216er4tab3" rid-ob="figobniceng216er4tab3"><img class="small-thumb" src="/books/NBK588603/table/niceng216er4.tab3/?report=thumb" src-large="/books/NBK588603/table/niceng216er4.tab3/?report=previmg" alt="Table 3. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="niceng216er4.tab3"><a href="/books/NBK588603/table/niceng216er4.tab3/?report=objectonly" target="object" rid-ob="figobniceng216er4tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#niceng216er4.appd">appendix D</a>. No meta-analyses were conducted (and so there are no forest plots in <a href="#niceng216er4.appe">appendix E</a>).</p></div><div id="niceng216er4.s1.1.6"><h4>Qualitative evidence</h4><div id="niceng216er4.s1.1.6.1"><h5>Included studies</h5><p>A systematic review of the literature was conducted using a combined search for all qualitative questions. Eight studies were included in this review (<a class="bibr" href="#niceng216er4.ref5" rid="niceng216er4.ref5">Allen 2020</a>, <a class="bibr" href="#niceng216er4.ref6" rid="niceng216er4.ref6">Buckland 2014</a>, <a class="bibr" href="#niceng216er4.ref7" rid="niceng216er4.ref7">Hall 2017</a>, <a class="bibr" href="#niceng216er4.ref8" rid="niceng216er4.ref8">O’Hare 2013</a>, <a class="bibr" href="#niceng216er4.ref9" rid="niceng216er4.ref9">Smith 2015</a>, <a class="bibr" href="#niceng216er4.ref10" rid="niceng216er4.ref10">Stone 2019</a>, <a class="bibr" href="#niceng216er4.ref11" rid="niceng216er4.ref11">Vicary 2019</a> and <a class="bibr" href="#niceng216er4.ref12" rid="niceng216er4.ref12">Wickersham 2020</a>).</p><p>The data provided evidence on what does and does not work well in social work case management and care planning in the event of a crisis. Data collection methods included interviews, focus groups, a survey and description of a rich picture, which is a means of diagramatically expressing a situation or experience.</p><p>The studies included the views of social work and healthcare practitioners involved in mental health act assessments in a mental health crisis, and families of relatives who have been assessed under the mental health act during a mental health crisis.</p><p>The included studies are summarised in <a class="figpopup" href="/books/NBK588603/table/niceng216er4.tab4/?report=objectonly" target="object" rid-figpopup="figniceng216er4tab4" rid-ob="figobniceng216er4tab4">Table 4</a>.</p><p>See the literature search strategy in <a href="#niceng216er4.appb">appendix B</a> and study selection flow chart in <a href="#niceng216er4.appc">appendix C</a>.</p></div><div id="niceng216er4.s1.1.6.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng216er4.appj">appendix J</a>.</p></div></div><div id="niceng216er4.s1.1.7"><h4>Summary of included studies</h4><p>Summaries of the studies that were included in the qualitative review are presented in <a class="figpopup" href="/books/NBK588603/table/niceng216er4.tab4/?report=objectonly" target="object" rid-figpopup="figniceng216er4tab4" rid-ob="figobniceng216er4tab4">Table 4</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng216er4tab4"><a href="/books/NBK588603/table/niceng216er4.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng216er4tab4" rid-ob="figobniceng216er4tab4"><img class="small-thumb" src="/books/NBK588603/table/niceng216er4.tab4/?report=thumb" src-large="/books/NBK588603/table/niceng216er4.tab4/?report=previmg" alt="Table 4. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="niceng216er4.tab4"><a href="/books/NBK588603/table/niceng216er4.tab4/?report=objectonly" target="object" rid-ob="figobniceng216er4tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#niceng216er4.appd">appendix D</a>.</p><p>The themes identified through analysis of all the included studies are listed here:
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<ul><li class="half_rhythm"><div>Responding to an escalation of need among people with mental health problems.
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<ul class="circle"><li class="half_rhythm"><div>Alternative treatments to compulsory detention</div></li><li class="half_rhythm"><div>Understanding of mental illness</div></li><li class="half_rhythm"><div>Virtue of compulsory detention</div></li></ul></div></li><li class="half_rhythm"><div>Positive aspects of case management and what works well.
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<ul class="circle"><li class="half_rhythm"><div>What helps decision making in MHA assessments</div></li><li class="half_rhythm"><div>What helps minimise detention</div></li></ul></div></li><li class="half_rhythm"><div>Negative aspects of case management and what doesn’t work well.
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<ul class="circle"><li class="half_rhythm"><div>Approaches to recovery</div></li><li class="half_rhythm"><div>What hinders decision making in MHA assessments</div></li><li class="half_rhythm"><div>Working with other healthcare professionals</div></li></ul></div></li><li class="half_rhythm"><div>Practitioner satisfaction with case management and care planning.
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<ul class="circle"><li class="half_rhythm"><div>Guidance from mental health legislation</div></li><li class="half_rhythm"><div>The importance of professional support</div></li><li class="half_rhythm"><div>Setting of a Mental Health Act assessment</div></li></ul></div></li><li class="half_rhythm"><div>Family and carer satisfaction with case management and care planning.
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<ul class="circle"><li class="half_rhythm"><div>Communication with practitioner</div></li><li class="half_rhythm"><div>Positive aspects of out of hours service</div></li><li class="half_rhythm"><div>Negative aspects of out of hours service</div></li></ul></div></li></ul></p><p>The theme map (<a class="figpopup" href="/books/NBK588603/figure/niceng216er4.fig1/?report=objectonly" target="object" rid-figpopup="figniceng216er4fig1" rid-ob="figobniceng216er4fig1">Figure 1</a>) illustrates these overarching themers and their related themes. Overarching themes can be seen in orange and central themes in blue.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figniceng216er4fig1" co-legend-rid="figlgndniceng216er4fig1"><a href="/books/NBK588603/figure/niceng216er4.fig1/?report=objectonly" target="object" title="Figure 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng216er4fig1" rid-ob="figobniceng216er4fig1"><img class="small-thumb" src="/books/NBK588603/bin/niceng216er4f1.gif" src-large="/books/NBK588603/bin/niceng216er4f1.jpg" alt="Figure 1. Theme map." /></a><div class="icnblk_cntnt" id="figlgndniceng216er4fig1"><h4 id="niceng216er4.fig1"><a href="/books/NBK588603/figure/niceng216er4.fig1/?report=objectonly" target="object" rid-ob="figobniceng216er4fig1">Figure 1</a></h4><p class="float-caption no_bottom_margin">Theme map. </p></div></div></div><div id="niceng216er4.s1.1.8"><h4>Summary of the evidence</h4><div id="niceng216er4.s1.1.8.1"><h5>Effectiveness evidence</h5><p>One randomised controlled trial, comparing a moderated online social therapy with expert support to treatment as usual, identified data for the critical outcomes quality of life and access to care and support in a crisis, measured by emergency department visits and hospital admissions. The evidence showed an important harm in terms of quality of life, with a lower quality of life in the intervention group when compared to the control group. Both groups showed an increase in quality of life when compared to baseline; however there was a greater increase in the control group than the intervention group. There was an important benefit for the intervention when compared to the control for emergency department visits. There was no important difference for hospital admissions due to mental health but a possible important benefit from the intervention in terms of hospital admissions due to psychosis.</p><p>A matched cohort study compared outcomes for people experiencing homelessness who had used a critical time intervention and case management approach with those who had not. Data were reported for the critical outcomes access to care and support in a crisis, measured by number of emergency department visits and number of outpatient visits; the duration of crisis, measured by number of days in hospital; and hospital admissions. There was an important harm for emergency department visits, with the intervention group showing an increased rate of visits when compared to the control group. There was an important benefit for the intervention group in terms of the rate of outpatient visits. There was no important difference between the interventions for the number of days in hospital and hospital admission.</p><p>One prospective cohort study comparing a crisis outreach team for people experiencing distress with a general police response, identified data for the critical outcome access to care and support in a crisis measured by contact with services or health or social care practitioners. These were measured by involuntary admissions via apprehension under the Mental Health Act. Data were also identified for the critical outcome hospital admissions measured by voluntary admissions to hospital. The data showed an important benefit for the crisis outreach team when compared to the control group for both outcomes.</p><p>One retrospective cohort study measured outcomes pre and post intervention where the intervention was an outreach specialist team for people experiencing homelessness. Data were reported for the critical outcome access to care and support in a crisis measured by contact with services or health or social care practitioners. For this study, the outcome was measured by registration with a general practitioner pre and post intervention. The evidence showed a benefit from the specialist outreach team, as there was an increase in registration with a general practitioner post intervention compared to pre intervention.</p><p>See <a href="#niceng216er4.appf">Appendix F</a> for full GRADE tables.</p></div><div id="niceng216er4.s1.1.8.2"><h5>Qualitative evidence</h5><p>The evidence generated 5 overarching themes regarding what does and does not work well in case management and care planning in the event of an escalation of need, from the perspective of practitioners and families. Five studies provided evidence relating to the negative aspects or what does not work well. Four studies provided evidence relating to responding to an escalation of need among people with mental health problems. Three studies provided evidence for practitioner satisfaction with case management and care planning. Three studies provided evidence for positive aspects or what works well. One study provided evidence relating to family satisfaction with case management and care planning.</p><p>See <a href="#niceng216er4.appf">Appendix F</a> for full GRADE-CERQual tables.</p></div><div id="niceng216er4.s1.1.8.3"><h5>Synthesis of effectiveness and qualitative data</h5><p>Although the effectiveness and qualitative synthesis were conducted in parallel, some of the qualitative evidence did help to explain or contextualise the effectiveness findings. In Table 6 relevant themes are listed from the qualitative evidence and are matched to the effectiveness evidence. The final column of the table provides a possible explanation for the effectiveness results based on the qualitative findings. The contents of Table 6 are therefore limited to theeffectiveness results for which there was a qualitative explanation. For the complete results of the effectiveness synthesis and qualitative synthesis see the GRADE and GRADE-CERQual tables in <a href="#niceng216er4.appf">appendix F</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng216er4tab5"><a href="/books/NBK588603/table/niceng216er4.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng216er4tab5" rid-ob="figobniceng216er4tab5"><img class="small-thumb" src="/books/NBK588603/table/niceng216er4.tab5/?report=thumb" src-large="/books/NBK588603/table/niceng216er4.tab5/?report=previmg" alt="Table 5. Evidence synthesis (effectiveness and qualitative data)." /></a><div class="icnblk_cntnt"><h4 id="niceng216er4.tab5"><a href="/books/NBK588603/table/niceng216er4.tab5/?report=objectonly" target="object" rid-ob="figobniceng216er4tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Evidence synthesis (effectiveness and qualitative data). </p></div></div></div></div><div id="niceng216er4.s1.1.9"><h4>Economic evidence</h4><div id="niceng216er4.s1.1.9.1"><h5>Included studies</h5><p>A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.</p><p>A single economic search was undertaken for all topics included in the scope of this guideline. See <a href="/books/NBK588603/bin/supplement-2-economic-searches-pdf-11020109581.pdf">Supplement 2</a> for details.</p></div><div id="niceng216er4.s1.1.9.2"><h5>Excluded studies</h5><p>A single economic search was undertaken for all topics included in the scope of this guideline. See <a href="/books/NBK588603/bin/supplement-2-economic-searches-pdf-11020109581.pdf">Supplement 2</a> for further information.</p></div></div><div id="niceng216er4.s1.1.10"><h4>Summary of included economic evidence</h4><p>No economic studies were identified which were applicable to this review question.</p></div><div id="niceng216er4.s1.1.11"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.</p></div><div id="niceng216er4.s1.1.12"><h4>The committee’s discussion and interpretation of the evidence</h4><div id="niceng216er4.s1.1.12.1"><h5>The outcomes that matter most</h5><p>For the effectiveness review, subjective quality of life, access to care and support in a crisis, duration of crises, and hospital admissions were considered to be critical outcomes. The committee agreed that these outcomes would best reflect whether a person was adequately supported during an escalation of need, and whether they had access to services that would ensure longer-term support. Personal resilience, satisfaction with care planning and case management, timeliness, and access to a crisis plan were considered important outcomes. The committee chose these outcomes, as they would reflect whether the support received during an escalation of need helped to build resilience for future escalations of need and would highlight whether people were satisfied with the support. Timeliness was chosen as an important outcome as the committee agreed that support during an escalation should happen quickly to minimise the negative outcomes and help to minimise further escalations. The committee also wanted to find out whether support during an escalation resulted in access to a crisis plan, as this would give an indication of whether the response to any future escalations of need had been considered.</p><p>To address what does and does not work well for those involved, the second part of the review was designed to include qualitative data and as a result, the committee could not specify in advance the data that would be located. Instead, they agreed, by consensus, on the following main themes to guide the review, although the list was not exhaustive and the committee were aware that additional themes could be identified:
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<ul><li class="half_rhythm"><div>Issues related to accessing case management and care planning in the event of a crisis or escalation of need.</div></li><li class="half_rhythm"><div>Responding to an escalation of need among people with mental health problems.</div></li><li class="half_rhythm"><div>Experiences of case management and care planning responses at key crisis points.</div></li><li class="half_rhythm"><div>Experiences and acceptability of different models of crisis support.</div></li><li class="half_rhythm"><div>The role of contingency plans.</div></li><li class="half_rhythm"><div>Positive aspects of case management and care planning and what works well.</div></li><li class="half_rhythm"><div>The extent to which case management and care planning consider professional and informal supporters and environment.</div></li><li class="half_rhythm"><div>Carers’ satisfaction with case management and care planning.</div></li><li class="half_rhythm"><div>Practitioner satisfaction with case management and care planning.</div></li></ul></p><p>These themes were chosen as they cover aspects of what works and does not work well from perspectives of everyone involved.</p></div><div id="niceng216er4.s1.1.12.2"><h5>The quality of the evidence</h5><div id="niceng216er4.s1.1.12.2.1"><h5>Effectiveness evidence</h5><p>The quality of the evidence for effectiveness outcomes was assessed with GRADE and was rated as very low to low. This was predominately because of risk of bias in most outcomes from observational studies, due to not controlling for confounding factors, and for bias in the selection of participants. Other concerns around risk of bias stemmed from participants being aware of their assignment to the intervention, missing outcome data and retrospective study designs and lack of a control group. Quality was also downgraded for imprecision around the effect estimate in some outcomes. Some outcomes were also downgraded for indirectness. This was due to inclusion of 16 and 17 years olds for some outcomes, inclusion of some case managers that were not social workers, or in some outcomes no specific mention of social worker involvement. When this was the case, social worker involvement was assumed as the intervention was delivered by case managers whose role in the intervention was similar to the role social workers undertake outside the study context.</p><p>Inconsistency was not applicable because only 1 study reported data for each outcome.</p><p>No evidence was identified for the following outcomes: personal resilience, satisfaction with care planning and case management, timeliness or access to a crisis plan.</p><p>See <a href="#niceng216er4.appf">appendix F</a> for full GRADE tables with quality ratings of all outcomes.</p></div><div id="niceng216er4.s1.1.12.2.2"><h5>Qualitative evidence</h5><p>The quality of the evidence for qualitative findings was assessed using GRADE-CERQual methodology and the overall confidence ranged from very low to high. The review findings were generally downgraded because of methodological limitations of the included studies, including, for example not enough information on data analysis, recruitment strategy or consideration of potential author bias. Some findings were also downgraded for relevance because in some cases the study context was slightly different to the review protocol and included the views on non-social worker roles. Finally, some findings were downgraded for adequacy because together, the relevant studies did not offer rich data.</p><p>See <a href="#niceng216er4.appf">appendix F</a> for full GRADE-CERQual tables with quality ratings of all review findings.</p></div><div id="niceng216er4.s1.1.12.2.3"><h5>Benefits and harms</h5><div id="niceng216er4.s1.1.12.2.3.1"><h5>Responding to an escalation of need, including urgent support</h5><p>The committee discussed that the quantitative and qualitative evidence were both exclusively focused on mental health crises, and largely on Mental Health Act assessments. They discussed that a crisis or an unplanned escalation of need can occur for all adults with complex needs, and recognised this represents a gap in the evidence. Where possible, the committee tried to make recommendations that would be relevant to all crisis situations. The committee also highlighted that there was a lack of representation of the views of adults with complex needs in the qualitative evidence.</p><p>The committee discussed the quantitative evidence that showed an important harm in terms quality of life, in people who receive the social therapy with case management intervention, compared to treatment as usual. They discussed that although quality of life in the intervention group increased from baseline, it did not increase as much as the treatment as usual group. The committee discussed that this could be due to a number of reasons and that the evidence did not sufficiently provide enough information for an explanation. Due to concerns over the involvement of the social worker in the intervention also, the committee did not feel confident to use this data to inform recommendations. The committee also discussed the quantitative evidence that showed an important benefit of social work approaches in terms of more outpatient visits and more registrations with a GP, for people experiencing homelessness. They also discussed the evidence that showed an important benefit of a social work approach in crisis outreach teams, in terms of fewer involuntary admissions via apprenhension under the Mental Health Act, and fewer voluntary admissions to hospital. However, the committee had concerns over the quality of the evidence, and the degree of social worker involvement in some of the interventions. They agreed that they could not confidently make a recommendation for the specific approaches described by the studies. The committee felt the synthesis of the qualitative and quantitative evidence created an interesting connection between the data, however due to the concerns over quality for the quantitative evidence they did not feel they could comment on whether this was an accurate reflection of what happens in practice. They also discussed that some of the results from the quantitative evidence may be specific to the needs of people experiencing homelessness and unlikely to reflect the wider population of adults with complex needs.</p><p>The review finding (D2.1.2 Professionals’ own values; high quality) that suggested professionals use their own values to help them make decisions during a Mental Health Act assessment, led the committee to discuss the social work professional capabilities framework. The framework sets out the ethical principles and critical reflection practices that a social worker must apply to guide their decision-making. The committee used their expertise, and drew on this framework to recommend that social workers should take into account the person’s social circumstances and cultural background when planning the best approach during a crisis situation. The committee discussed that depending on their social circumstances or cultural background, a person’s needs may differ and the appropriateness and suitability of approaches will differ. They also discussed the importance of respecting these differences, and ensuring that any approach taken to care following a Mental Health Act assessment, should have the person in mind and should be able to meet their specific needs. The committee agreed that the recommendation would achieve this and would ensure delivery of personalised and appropriate care, and as a result improve engagement in adults with complex needs. The recommendation is also supported by the Mental Health Act code of practice (14.8).</p><p>The committee discussed the qualitative evidence (D2.2 What helps minimise detention; high quality) that suggested that having the involved professionals present during a Mental Health Act assessment would help avoid detention. They were also aware of statutory requirements in the Mental Health Act code of practice (14.45) which states that, where possible, the Approved Mental Health Professional and at least one doctor involved in the Mental Health Act assessment should assess jointly. They discussed that the evidence was specific to Mental Health Act assessments, and that from their experience, having all the involved professionals, present at the same time in other crises was unlikely to be helpful. However, they agreed that there is value, for most crises, in having a joint assessment with colleagues who have the most knowledge of the person’s care needs (for example, requesting a community Care and Treatment Review or a case conference). They also agreed that consulting with colleagues and the family (with consent of the person) who have the most knowledge of a person’s care would enable social workers to have the best information available to inform decision-making. The committee were aware of statutory requirements in the Mental Health Act (14.69) that supported this. Based on statutory requirements and the evidence available, they agreed that this approach would help to advocate for interventions that have the least detrimental impact on a person’s rights. The committee highlighted the potential resource impact and logistical issues around trying to get all the relevant practioners together in one location and at short notice. To address these issues, they specified in the recommendation that practitioners should make joint assessments, as long as it is practical. The committee discussed the importance of upholding the person’s preferences, especially when various practitioners are involved in the response to an unplanned escalation of need, as supported by the recommendation described above. They agreed that it was essential to make a recommendation, which was supported by the Mental Health Act, to take into account the person’s wishes and preferences. The committee agreed that this would address any concerns with regard to decisions made with only the views and opinions of practitioners. The committee also discussed the importance of upholding the person’s preferences and ensuring a person-centred response to an escalation of need and agreed, from experience, that this would be a way of improving a person’s engagement in their care, and consequently future outcomes.</p><p>The committee discussed the evidence (D1.1 Alternative treatments to compulsory detention; high quality) that suggested there was a lack of time and resources for social workers to consider alternative treatments to detention under the Mental Health Act. They discussed that a recommendation for more resources was not in the remit of this guideline so they agreed not to make a recommendation to address this issue. However, the committee were aware of statutory requirements in the Mental Capacity Act (S1, (6), the Mental Health Act (14.13 and 14.52) and the Care Act (Chapter 1, 1.14 (h)), that were relevant and state that the least restrictive options to a person’s rights and freedom must be explored. Therefore, the committee made a strong recommendation to ensure social workers explore the alternative options. Although the evidence (D1.1 Alternative treatments to compulsory detention; high quality), which led to the committee discussion, was focused on crises in mental health, the legislation that supports the recommendation is generalisable to all types of crises. The committee also discussed the importance of the recommendation focusing on options that have the least detrimental impact on a person’s rights, rather than the least restrictive option. They discussed non-mental health crises and used an example where an older person is moved to a care home. They recognised that in this situation moving to a care home is the most restrictive option. However, this could be the best option to enable more freedom with the appropriate care and support that would otherwise not have been possible at home, on their own.</p><p>The discussion regarding alternative options, led the committee to discuss situations when people have made an advance statement. The committee were aware of statutory requirements in the Mental Capacity Act (S4) and the Mental Health Act codes of practice, which state that a person’s advance statement, must be taken into account. Therefore, the committee agreed to recommend that in the event of a crisis, social workers establish whether an advanced statement or a joint crisis plan is in place. They discussed that there can be times when practitioners do not check whether an advanced statement is in place and this may be in part due to time pressures. To address this, the committee agreed that it was essential for the decision making process to be documented, including whether and how an advanced statement has been used and taken into account. The committee discussed the importance of considering the views of people important to adults with complex needs, when planning during a crisis or unplanned escalation of need. The committee discussed the evidence (D2.1.1 Considering the wider support network; moderate quality) that suggested practitioners use the wider support network of friends family, carers and people important to adults with complex needs, to help them make decisions during a Mental Health Act assessment. Although the evidence was specific to a Mental Health Act assessment, based on their experience the committee agreed that a wider support network could help in decision making in other crises. The committee were also aware of statutory requirements, namely in the Mental Health Act code of practice (4.39, 14.69), which supported their recommendation. The guidance supports consulting with carers and people who know the person to provide extra knowledge.</p><p>The committee discussed the evidence (D3.2.2 Risk aversion; high quality) that suggested there was a cultural tendency for risk aversion, which might lead to practitioners choosing the most restrictive treatment option to avoid blame if something were to go wrong. They agreed it was important to recognise the responsibility of the organisation to support social workers working in crises. The committee agreed on a recommendation for organisations to provide social workers with appropriate support after working with someone in crisis. They highlighted the Social Work England professional standards for social workers (4) which state social workers should discuss, reflect on and share best practice. The committee agreed that by reflecting on practice, social workers would be able to identify potential risks to themselves and others and support decision making in future crisis work, and agreed to include this in the recommendation. The committee agreed that this recommendation would address the issues raised in the evidence (D3.2.2 Risk aversion; high quality) regarding risk aversion leading to choosing the most restrictive option. They agreed that if social workers had prompt and appropriate support when working in crises, they would be able to address their concerns as soon as possible, and be able to make decisions that are in the best interests of the person.</p><p>The committee also discussed the qualitative evidence (D4.2 The importance of professional support; low quality) that suggested practitioners value professional support and supervision, and without this support their own anxiety could be exacerbated after supporting someone through a crisis. The committee agreed that the recommendation to ensure social workers are given prompt support and the opportunity for reflection when they have worked with someone in a crisis would address this. They nevertheless recognised that this may exacerbate current resource pressures by requiring additional social worker and manager time. However, they agreed that the benefits of this recommendation to the wellbeing of social workers outweighed the potential impact on services.</p><p>The committee discussed statutory guidance in the Mental Health Act (14.35) code of practice which states that local authorities have a statutory duty to have arrangements in place to provide a 24-hour service, to respond to a person’s needs if they are being assessed under the Mental Health Act. The committee also discussed the review finding (D5.3 Negative aspects of out of hours services; low quality) which suggested that relatives of adults with complex needs were dissatisfied with the availability of out of hour’s services and the time taken for an assessment to take place. They recognised that the evidence and statutory guidance were specific for mental health crises, but agreed that it was important to highlight this with a recommendation. The committee also recognised that any crisis situation, not only mental health crises can deteriorate rapidly without timely support, and that it was essential services were quick to respond to a person’s needs and were available at all times. On the basis of the evidence they therefore expanded the recommended that local authorities have arrangements in place to provide prompt support ito a person’s escalating needs. The committee recommended quick and clear communication between services as they realised, from their experience, that this continuity was essential.</p><p>In light of the almost exclusive focus in this evidence review, on mental health crises and crises interventions provided by professionals other than social workers, the committee agreed to make a research recommendation to address the gap in evidence on social work intervention in crises for others with complex needs. In particular, they recommended research to establish the most effective approach to responding to an escalation of need in this broader population as well as the acceptability of those approaches to people being supported and those providing support.</p></div></div></div><div id="niceng216er4.s1.1.12.3"><h5>Cost effectiveness and resource use</h5><p>No economic evidence was identified for this topic.</p><p>The recommendation for a joint assessment may lead an increase in resource use as this is not currently usual practice in England. Such a recommendation would require relevant practitioners to be together in the same location or meet via telephone or video conferencing often at short notice. This may require additional staff time to cover the casework of practitioners or require them to work outside of their usual working hours. Travel at short notice is also likely to be needed in circumstances where remote meetings are not appropriate. Whilst this recommendation will lead to an increase in resource use, such assessments should only take place where it is both practical and it would be of benefit to the person. These meetings can be done remotely, where it will not affect the quality of an assessment or the person’s ability to participate, reducing both the time needed and costs. Such meetings are likely to allow for the people with the most relevant information on a person‘s care needs to be present during decision making and will lead to interventions which minimise any unnecessary detriment to a person’s rights and quality of life.</p><p>The recommendation to allow for 24-hour access to services in relation to detention under the Mental Helath Act, which can respond promptly to any escalating needs, is already current practice because it is a legal duty. There is statutory duty to provide a 24-hour to provide services so decisions on applications for detention under the Mental Health Act can be made (in line with <a href="https://www.gov.uk/government/publications/code-of-practice-mental-health-act-1983" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">section 14.35 of the Mental Health Act Code of Practice</a>).</p><p>All other recommendations reinforce current legislation and usual practice. These recommendations will not lead to any change in resource use or cost.</p></div><div id="niceng216er4.s1.1.12.4"><h5>Other factors the committee took into account</h5><p>In making recommendations on the basis of this review, the committee used the evidence as well as their own experiential knowledge to draw on three Acts of parliament; the Mental Health Act 1983, the Mental Capacity Act 2005 and the Care Act 2014 as well as their associated codes of practice. The committee also drew on the Social Work England professional standards for social workers.</p></div></div><div id="niceng216er4.s1.1.13"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.6.1 to 1.6.7 and research recommendation 4 on social work responses to an escalation of need.</p></div></div></div><div id="niceng216er4.rl.r1"><h2 id="_niceng216er4_rl_r1_">References – included studies</h2><ul class="simple-list"><div id="niceng216er4.rl.r2"><h3>Effectiveness</h3><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref1"><p id="p-321">
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<strong>Alvarez-Jimenez 2021</strong>
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</p>Alvarez-Jimenez
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M., Koval
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P., Schmaal
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L., Bendall
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S., O’Sullivan
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S., Cagliarini
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D., D’Alfonso
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S., Rice
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S., Valentine
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L., Penn
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D. L., Miles
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C., Russon
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P., Phillips
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J., McEnery
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C., Lederman
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R., Killackey
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E., Mihalopoulos
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C., Gonzalez-Blanch
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C., Gilbertson
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T., Lal
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S., Cotton
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S. M., Herrman
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H., McGorry
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P. D., Gleeson
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J. F. M., The Horyzons project: a randomized controlled trial of a novel online social therapy to maintain treatment effects from specialist first-episode psychosis services, World Psychiatry, 20, 233–243, 2021 [<a href="/pmc/articles/PMC8129860/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8129860</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34002511" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34002511</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref2"><p id="p-322">
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<strong>Reid 2021</strong>
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</p>Reid
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N., Mason
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J., Kurdyak
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P., Nisenbaum
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R., de Oliveira
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C., Hwang
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S., Stergiopoulos
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V., Evaluating the Impact of a Critical Time Intervention Adaptation on Health Care Utilization among Homeless Adults with Mental Health Needs in a Large Urban Center, Canadian Journal of Psychiatry, 2021 [<a href="/pmc/articles/PMC8811242/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8811242</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33611924" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33611924</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref3"><p id="p-323">
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<strong>Semple 2021</strong>
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</p>Semple
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T., Tomlin
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M., Bennell
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C., Jenkins
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B., An evaluation of a community-based mobile crisis intervention team in a small Canadian police service, Community Mental Health Journal J, 57, 567–578, 2021 [<a href="https://pubmed.ncbi.nlm.nih.gov/32676879" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32676879</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref4"><p id="p-324">
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<strong>Timms 2016</strong>
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</p>Timms
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P., Perry
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J., Sectioning on the street - futility or utility?
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BJPsych Bulletin, 40, 302, 2016 [<a href="/pmc/articles/PMC5353509/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5353509</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28377807" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28377807</span></a>]</div></p></li></ul></div><div id="niceng216er4.rl.r3"><h3>Qualitative</h3><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref5"><p id="p-325">
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<strong>Allen 2020</strong>
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</p>Allen
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S., & McCusker
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P.
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A Hidden Dynamic: Examining the Impact of Fear on Mental Health Officers’ Decisions to Use Powers of Compulsory Detention. Practice, 32, 301–315, 2020</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref6"><p id="p-326">
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<strong>Buckland 2016</strong>
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</p>Buckland
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R.
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The Decision by Approved Mental Health Professionals to Use Compulsory Powers under the Mental Health Act 1983: A Foucauldian Discourse Analysis. The British Journal of Social Work, 46, 46–62, 2014</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref7"><p id="p-327">
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<strong>Hall 2017</strong>
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</p>Hall
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P.
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Mental Health Act Assessments – Professional Narratives on Alternatives to Hospital Admission. Journal of Social Work Practice, 31, 445–459, 2017</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref8"><p id="p-328">
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<strong>O’Hare 2013</strong>
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</p>O’Hare
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P., Davidson
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G., Campbell
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J., & Maas-Lowit
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M.
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Implementing mental health law: a comparison of social work practice across three jurisdictions. The Journal of Mental Health Training, Education and Practice, 8, 196–207, 2013</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref9"><p id="p-329">
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<strong>Smith 2015</strong>
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</p>Smith
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Martin Stuart, ‘Only connect’ ‘nearest relative’s’ experiences of mental health act assessments, Journal of Social Work Practice: Psychotherapeutic Approaches in Health, 29, 339–353, 2015</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref10"><p id="p-330">
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<strong>Stone 2019</strong>
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</p>Stone
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K.
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Approved Mental Health Professionals and Detention: An Exploration of Professional Differences and Simularities. Practice, 31, 83–96, 2019</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref11"><p id="p-331">
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<strong>Vicary 2019</strong>
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</p>Vicary
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S., Young
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A., & Hicks
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S.
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‘Role Over’ or Roll Over? Dirty Work, Shift and Mental Health Act Assessments. The British Journal of Social Work, 49, 2187–2206, 2019</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng216er4.ref12"><p id="p-332">
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<strong>Wickersham 2020</strong>
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</p>Wickersham
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A., Nairi
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S., Jones
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R., & Lloyd-Evans
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B.
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The Mental Health Act Assessment Process and Risk Factors for Compulsory Admission to Psychiatric Hospital: A Mixed Methods Study. The British Journal of Social Work, 50, 642–663, 2020</div></p></li></ul></div></ul></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng216er4.appa"><h3>Appendix A. Review protocols</h3><p id="niceng216er4.appa.et1"><a href="/books/NBK588603/bin/niceng216er4-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for the review question: What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of need?</a><span class="small"> (PDF, 263K)</span></p><p id="niceng216er4.appa.et2"><a href="/books/NBK588603/bin/niceng216er4-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for the review question: Based on the views and experiences of everyone involved, what works well and what can be improved about case management and care planning in the event of a crisis or unplanned escalation of need?</a><span class="small"> (PDF, 271K)</span></p></div><div id="niceng216er4.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng216er4.appb.et1"><a href="/books/NBK588603/bin/niceng216er4-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for the review question: What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of need?</a><span class="small"> (PDF, 401K)</span></p><p id="niceng216er4.appb.et2"><a href="/books/NBK588603/bin/niceng216er4-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for the review question: Based on the views and experiences of everyone involved, what works well and what can be improved about case management and care planning in the event of a crisis or unplanned escalation of need?</a><span class="small"> (PDF, 321K)</span></p><p id="niceng216er4.appb.et3"><a href="/books/NBK588603/bin/niceng216er4-appb-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for economic studies</a><span class="small"> (PDF, 389K)</span></p></div><div id="niceng216er4.appc"><h3>Appendix C. Effectiveness and Qualitative evidence study selection</h3><p id="niceng216er4.appc.et1"><a href="/books/NBK588603/bin/niceng216er4-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of need?</a><span class="small"> (PDF, 107K)</span></p><p id="niceng216er4.appc.et2"><a href="/books/NBK588603/bin/niceng216er4-appc-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: Based on the views and experiences of everyone involved, what works well and what can be improved about case management and care planning in the event of a crisis or unplanned escalation of need?</a><span class="small"> (PDF, 99K)</span></p></div><div id="niceng216er4.appd"><h3>Appendix D. Evidence tables</h3><p id="niceng216er4.appd.et1"><a href="/books/NBK588603/bin/niceng216er4-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of needs?</a><span class="small"> (PDF, 198K)</span></p><p id="niceng216er4.appd.et2"><a href="/books/NBK588603/bin/niceng216er4-appd-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: Based on the views and experiences of everyone involved, what works well and what can be improved about case management and care planning in the event of a crisis or unplanned escalation of need?</a><span class="small"> (PDF, 358K)</span></p></div><div id="niceng216er4.appe"><h3>Appendix E. Forest plots</h3><div id="niceng216er4.appe.s1"><h4>Forest plots for review question: What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of needs?</h4><p>No meta-analyses were conducted for these review questions and so there are no forest plots.</p></div></div><div id="niceng216er4.appf"><h3>Appendix F. GRADE and GRADE-CERQual tables</h3><p id="niceng216er4.appf.et1"><a href="/books/NBK588603/bin/niceng216er4-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">GRADE tables for review question: What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of need?</a><span class="small"> (PDF, 190K)</span></p><p id="niceng216er4.appf.et2"><a href="/books/NBK588603/bin/niceng216er4-appf-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">GRADE-CERQual tables for review question: Based on the views and experiences of everyone involved, what works well and what can be improved about case management and care planning in the event of a crisis or unplanned escalation of need?</a><span class="small"> (PDF, 246K)</span></p></div><div id="niceng216er4.appg"><h3>Appendix G. Economic evidence study selection</h3><div id="niceng216er4.appg.s1"><h4>Study selection for review question: What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of needs?</h4><p>A single economic search was undertaken for all topics included in the scope of this guideline. See <a href="/books/NBK588603/bin/supplement-2-economic-searches-pdf-11020109581.pdf">Supplement 2</a> for further information.</p></div></div><div id="niceng216er4.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng216er4.apph.s1"><h4>Economic evidence tables for review question: What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of needs?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng216er4.appi"><h3>Appendix I. Economic model</h3><div id="niceng216er4.appi.s1"><h4>Economic model for review question: What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of needs?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng216er4.appj"><h3>Appendix J. Excluded studies</h3><p id="niceng216er4.appj.et1"><a href="/books/NBK588603/bin/niceng216er4-appj-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Excluded studies for review question: What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of need?</a><span class="small"> (PDF, 234K)</span></p><p id="niceng216er4.appj.et2"><a href="/books/NBK588603/bin/niceng216er4-appj-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Excluded studies for review question: Based on the views and experiences of everyone involved, what works well and what can be improved about case management and care planning in the event of a crisis or unplanned escalation of need?</a><span class="small"> (PDF, 132K)</span></p></div><div id="niceng216er4.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="niceng216er4.appk.s1"><h4>Research recommendation for review questions D1: What is the effectiveness of case management and care planning in the event of a crisis or unplanned escalation of need? And D2: Based on the views and experiences of everyone involved, what works well and what can be improved about case management and care planning in the event of a crisis or unplanned escalation of need?</h4><div id="niceng216er4.appk.s1.1"><h5>K.1.1. Research recommendation</h5><p>What is the effectiveness and acceptability of social work interventions to support people with complex needs during an escalation of need?</p></div><div id="niceng216er4.appk.s1.2"><h5>K.1.2. Why this is important</h5><p>The review showed that evidence in this area is mainly focussed on how to respond to an escalation of need amongst people with a mental illness and tends to focus on nursing and other health care professional interventions rather than input from social workers. However, there are a number of reasons why the wider population of adults with complex needs may also enter a crisis situation. These could be from a lack of access to health and social care professionals, or from unpredicted changes in life circumstances, which are not uncommon in this population. Therefore, it is important to recognise that escalation of needs, or crisis situations are likely to take place in this population group, and effective and appropriate support should be in place to respond to them. Effective responses to an escalation of need or crisis situation, could help to ensure people in those situations experience continuity of care, are provided with a support network, and also with the skills to improve resilience, consequently reducing the duration and possibly the occurrence of future crises. Providing the appropriate support for people during an escalation of need, could also have an impact on services as unplanned care contacts, such as expensive admissions to emergency services, are reduced.</p><p>The main professional group who are most likely to be working with adults with complex needs, outside of those with mental illness and in regular contact with health services, are social workers. Meaning this group is well placed to work with vulnerable people and provide de-escalation interventions. It is therefore important to study which interventions provided by social workers, are the most effective and the most accepted in adults with complex needs.</p></div><div id="niceng216er4.appk.s1.3"><h5>K.1.3. Rationale for research recommendation</h5><p id="niceng216er4.appk.et1"><a href="/books/NBK588603/bin/niceng216er4-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (171K)</span></p></div><div id="niceng216er4.appk.s1.4"><h5>K.1.4. Modified PICO table</h5><p id="niceng216er4.appk.et2"><a href="/books/NBK588603/bin/niceng216er4-appk-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (134K)</span></p></div></div></div></div></div><div class="fm-sec"><div><p>Final version</p></div><div><p>Evidence reviews underpinning recommendations 1.6.1 to 1.6.7 and research recommendation 4 in the NICE guideline</p><p>These evidence reviews were developed by the National Guideline Alliance</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div><div class="small"><span class="label">Bookshelf ID: NBK588603</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/36649470" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">36649470</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng216er4tab1"><div id="niceng216er4.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table) - effectiveness question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588603/table/niceng216er4.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng216er4.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_niceng216er4.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng216er4.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>People aged 18 or older with complex needs*.</p>
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<p>* Studies involving adults who require a high level of support with many aspects of their daily lives will be considered for inclusion. The emphasis is on complex needs, which rely on a range of health and social care services.</p>
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</td></tr><tr><th id="hd_b_niceng216er4.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_niceng216er4.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Social work case management or care planning in the event of a crisis or unplanned escalation of need, which is individualised, collaborative, strengths focussed and/ or focussed and considers professional and informal supporters and environment.</td></tr><tr><th id="hd_b_niceng216er4.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng216er4.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies using the following comparisons will be included:<ul><li class="half_rhythm"><div>‘Standard’ case management and care planning in the event of a crisis or escalation of need.</div></li><li class="half_rhythm"><div>Different types of the specified intervention</div></li></ul></td></tr><tr><th id="hd_b_niceng216er4.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_niceng216er4.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<b>Critical</b>
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</p>
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<p>Person focused outcomes:<ul><li class="half_rhythm"><div>Subjective quality of life – measured using a validated tool such as ASCOT, ICECAP-A, MANSA or the EQ-5D</div></li><li class="half_rhythm"><div>Access to care and support in a crisis measured by contact with services or health or social care practitioners.</div></li></ul></p>
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<p>Service focused outcomes:<ul><li class="half_rhythm"><div>Duration of crises</div></li><li class="half_rhythm"><div>Hospital admissions</div></li></ul></p>
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<p>
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<b>Important</b>
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</p>
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<p>Person focused outcomes:<ul><li class="half_rhythm"><div>Personal resilience – measured using a validated tool such as the Resilience Scale for Adults or the Resilience Scale.</div></li><li class="half_rhythm"><div>Satisfaction with care planning and case management measured using a validated satisfaction scale.</div></li></ul></p>
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<p>Service focused outcomes:<ul><li class="half_rhythm"><div>Timeliness (timing of support to prevent further escalation of need or timing to provide urgent support) - as objectively reported in the study.</div></li><li class="half_rhythm"><div>Access to a crisis plan (to promote recovery and prevent future crises).</div></li></ul></p>
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</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">ASCOT: Adult social care outcomes toolkit; ICECAP-A: Investigating choice experiences capability measure for adult population; EQ-5D: European Quality of Life Five Dimension; MANSA: Manchester short assessment of quality of life</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng216er4tab2"><div id="niceng216er4.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of the protocol (population and phenomenon of interest) - qualitative question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588603/table/niceng216er4.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng216er4.tab2_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng216er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng216er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>People aged 18 or older with complex needs*.</div></li><li class="half_rhythm"><div>Families and supporters of adults with complex needs</div></li><li class="half_rhythm"><div>Relevant social-/health- care and other practitioners involved in needs assessment and review for adults with complex needs.</div></li></ul>
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<p>*Studies involving adults who require a high level of support with many aspects of their daily lives will be considered for inclusion. The emphasis is on complex needs, which rely on a range of health and social care services.</p>
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</td></tr><tr><th id="hd_b_niceng216er4.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Phenomenon of interest</th><td headers="hd_b_niceng216er4.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Social work case management or care planning in the event of a crisis or unplanned escalation of need, which is individualised, collaborative, strengths focussed and/ or focussed and considers professional and informal supporters and environment.</p>
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<p>In order to understand what works and what does not work well, from the perspective of everyone involved, the committee want to locate data about the following aspects of case management and care planning:<ul><li class="half_rhythm"><div>Issues related to accessing case management and care planning in the event of a crisis or escalation of need.</div></li><li class="half_rhythm"><div>Responding to an escalation of need among people with mental health problems.</div></li><li class="half_rhythm"><div>Experiences of case management and care planning responses at key crisis points.</div></li><li class="half_rhythm"><div>Experiences and acceptability of different models of crisis support.</div></li><li class="half_rhythm"><div>The role of contingency plans</div></li><li class="half_rhythm"><div>Positive aspects of case management and care planning and what works well.</div></li><li class="half_rhythm"><div>The extent to which case management and care planning consider professional and informal supporters and environment.</div></li><li class="half_rhythm"><div>Carers satisfaction with case management and care planning.</div></li><li class="half_rhythm"><div>Practitioner satisfaction with case management and care planning.</div></li></ul></p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng216er4tab3"><div id="niceng216er4.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588603/table/niceng216er4.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng216er4.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_niceng216er4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng216er4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng216er4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng216er4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><th id="hd_h_niceng216er4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_niceng216er4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng216er4.ref1" rid="niceng216er4.ref1">Alvarez-Jimenez 2021</a>
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</p>
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<p>Randomised controlled trial</p>
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<p>Australia</p>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=170 total participants with a first episode of psychotic disorder</p>
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<p>n=86 intervention arm</p>
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<p>n=84 control arm</p>
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<p>Age – Mean (SD) = 20.91 (2.88)</p>
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<p>Gender:</p>
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<p>Male= 52.9%</p>
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<p>Female= 47.1%</p>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<u>Horyzons intervention and treatment and usual</u>
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<ul><li class="half_rhythm"><div>A moderated online social therapy.</div></li><li class="half_rhythm"><div>Expert support provided to individuals by registered mental health clinicians. These include clinical psychologists and social workers. Their role is to tailor evidence-based interventions, monitor participants’ clinical status and ensure safety of the social network.</div></li><li class="half_rhythm"><div>Participants also received treatment as usual</div></li></ul>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<u>Treatment as usual only</u>
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<ul><li class="half_rhythm"><div>Various treatments usually available to young people.</div></li><li class="half_rhythm"><div>This involves referral to adult tertiary community mental health services or primary care depending on needs.</div></li><li class="half_rhythm"><div>Access to youth mental health services and psychological and psychiatric treatment.</div></li><li class="half_rhythm"><div>A leaflet with information on free online youth resources.</div></li></ul>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Quality of life</div></li><li class="half_rhythm"><div>Access to care and support in a crisis measure by contact with services or health or social care practitioners</div></li><li class="half_rhythm"><div>Hospital admissions</div></li></ul>
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</td></tr><tr><td headers="hd_h_niceng216er4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng216er4.ref2" rid="niceng216er4.ref2">Reid 2021</a>
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</p>
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<p>Matched cohort study</p>
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<p>Canada</p>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=375 total participants who experience homelessness and were discharged from hospital</p>
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<p>n=125 homeless adults in the intervention group</p>
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<p>n=250 matched controls</p>
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<p>Age - Mean (SD):</p>
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<p>Intervention= 41.1 (12.4)</p>
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<p>Control= 41 (12.3)</p>
|
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<p>Gender:</p>
|
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<p>Male:</p>
|
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<p>Intervention= 78.4%</p>
|
|
<p>Control= 79.2%</p>
|
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<p>Female:</p>
|
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<p>Intervention= 21.6%</p>
|
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<p>Control= 20.8%</p>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<u>Coordinated access to care for homeless adults</u>
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<ul><li class="half_rhythm"><div>A critical time intervention to support adults who experience homesless and mental health following discharge from hospital</div></li><li class="half_rhythm"><div>People are connected to case managers who coordinate access to community-based services, mental health and addiction services, medical care and peer support.</div></li></ul>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<u>Matched cohort</u>
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<ul><li class="half_rhythm"><div>Intervention group were matched to individuals who had not received the intervention, but had been hospitalised for mental health or substance use</div></li></ul>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Access to care and support in a crisis measure by contact with services or health or social care practitioners</div></li><li class="half_rhythm"><div>Duration of crisis</div></li><li class="half_rhythm"><div>Hospital admisions</div></li></ul>
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</td></tr><tr><td headers="hd_h_niceng216er4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
|
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<a class="bibr" href="#niceng216er4.ref3" rid="niceng216er4.ref3">Semple 2021</a>
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</p>
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<p>Prospective cohort</p>
|
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<p>Canada</p>
|
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N =498 calls (phone call or via patrol) from adults in crisis-related distress</p>
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<p>n=287 calls responded to by the intervention group</p>
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<p>n=211 calls responded to by the control group</p>
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<p>No information on age and gender</p>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<u>Crisis outreach and support team for people experiencing distress</u>
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<ul><li class="half_rhythm"><div>Team consisting of a crisis response worker and a police officer. The team connects people who call in with a distress, including mental illness, to community resources instead of hospital based resources</div></li></ul>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><u>General patrol</u><ul><li class="half_rhythm"><div>General patrol officers without a crisis response worker responding to calls from people in distress, including mental illness</div></li></ul>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Access to care and support in a crisis measure by contact with services or health or social care practitioners</div></li><li class="half_rhythm"><div>Hospital admissions</div></li></ul>
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</td></tr><tr><td headers="hd_h_niceng216er4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng216er4.ref4" rid="niceng216er4.ref4">Timms 2016</a>
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</p>
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<p>Retrospective cohort</p>
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<p>UK</p>
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=32 participants, who were rough sleepers, had a Mental Health Act assessment which led to a hospital admission, and had been discharged</p>
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<p>Age – mean (range) = 44 (24 – 84)</p>
|
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<p>Gender:</p>
|
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<p>Male= 80%</p>
|
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<p>Female= 20%</p>
|
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<u>Mental Health Act assessment</u>
|
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<ul><li class="half_rhythm"><div>Outreach by specialist homeless services, followed by a Mental Health Act assessment and detention by an approved mental health professional.</div></li></ul>
|
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</td><td headers="hd_h_niceng216er4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre-intervention</td><td headers="hd_h_niceng216er4.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Access to care and support in a crisis measured by contact with services or health or social care practitioners.</div></li></ul>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng216er4tab4"><div id="niceng216er4.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588603/table/niceng216er4.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng216er4.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng216er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study and aim of the study</th><th id="hd_h_niceng216er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Participants</th><th id="hd_h_niceng216er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods</th><th id="hd_h_niceng216er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Themes applied after thematic synthesis</th></tr></thead><tbody><tr><td headers="hd_h_niceng216er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
|
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<a class="bibr" href="#niceng216er4.ref5" rid="niceng216er4.ref5">Allen 2020</a>
|
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</p>
|
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<p>Phenomenological study</p>
|
|
<p>UK, Scotland</p>
|
|
<p>
|
|
<b>Aim of the study</b>
|
|
</p>
|
|
<p>To explore factors influencing mental health officers’ decision-making in Mental Health Act assessments.</p>
|
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</td><td headers="hd_h_niceng216er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=8 Mental health officers</td><td headers="hd_h_niceng216er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>
|
|
<b>Data collection:</b>
|
|
</p>
|
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<p>Semi-structured interviews</p>
|
|
<p>
|
|
<b>Data analysis:</b>
|
|
</p>
|
|
<p>Thematic analysis</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ul><li class="half_rhythm"><div>Negative aspects of case management and what doesn’t work well</div></li><li class="half_rhythm"><div>Practitioner satisfaction with case management and care planning</div></li><li class="half_rhythm"><div>Responding to an escalation of need among people with mental health problems</div></li></ul>
|
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</td></tr><tr><td headers="hd_h_niceng216er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
|
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<a class="bibr" href="#niceng216er4.ref6" rid="niceng216er4.ref6">Buckland 2016</a>
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</p>
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<p>General qualitative inquiry</p>
|
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<p>UK, England</p>
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<p>
|
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<b>Aim of the study</b>
|
|
</p>
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<p>To explore how AMHPs describe the process of compulsory detention and their own position in detentions.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=10 Approved Mental Heath Professionals</td><td headers="hd_h_niceng216er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Data collection:</b>
|
|
</p>
|
|
<p>Semi-structured interviews</p>
|
|
<p>
|
|
<b>Data analysis:</b>
|
|
</p>
|
|
<p>Foucauldian discourse analysis of the language used by participants</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Positive aspects of case management and what works well</div></li><li class="half_rhythm"><div>Responding to an escalation of need among people with mental health problems</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng216er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng216er4.ref7" rid="niceng216er4.ref7">Hall 2017</a>
|
|
</p>
|
|
<p>General qualitative inquiry</p>
|
|
<p>UK, England</p>
|
|
<p>
|
|
<b>Aim of the study</b>
|
|
</p>
|
|
<p>To observe how the experiences of ASW and HTPs undertaking Mental Health Act assessments fit the conceptual framework of social crisis.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=15 Approved Social Workers and Home Treatment Professionals</td><td headers="hd_h_niceng216er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Data collection:</b>
|
|
</p>
|
|
<p>Semi-structured interviews</p>
|
|
<p>
|
|
<b>Data analysis:</b>
|
|
</p>
|
|
<p>Framework analysis</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Negative aspects of case management and what doesn’t work well</div></li><li class="half_rhythm"><div>Responding to an escalation of need among people with mental health problems</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng216er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng216er4.ref8" rid="niceng216er4.ref8">O’Hare 2013</a>
|
|
</p>
|
|
<p>General qualitative inquiry</p>
|
|
<p>UK, England, Scotland and Northern Ireland</p>
|
|
<p>
|
|
<b>Aim of the study</b>
|
|
</p>
|
|
<p>To explore the views of students and experienced mental health social workers about risk, decision-making and compulsory intervention.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=28</p>
|
|
<p>n=8 mental health social work students.</p>
|
|
<p>n=20 mental health social workers.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Data collection:</b>
|
|
</p>
|
|
<p>Surveys using vignettes and open ended questions relating to a crisis situation</p>
|
|
<p>
|
|
<b>Data analysis:</b>
|
|
</p>
|
|
<p>Thematic analysis</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Negative aspects of case management and what doesn’t work well</div></li><li class="half_rhythm"><div>Practitioner satisfaction with case management and care planning</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng216er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng216er4.ref9" rid="niceng216er4.ref9">Smith 2015</a>
|
|
</p>
|
|
<p>General qualitative inquiry</p>
|
|
<p>UK, England</p>
|
|
<p>
|
|
<b>Aim of the study</b>
|
|
</p>
|
|
<p>To explore relative’s views of their experiences of mental health crises and if there were any improvements that could be made to AMHP practice.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=32 relatives of people who were assessed under the Mental Health Act.</td><td headers="hd_h_niceng216er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Data collection:</b>
|
|
</p>
|
|
<p>Telephone interviews</p>
|
|
<p>
|
|
<b>Data analysis:</b>
|
|
</p>
|
|
<p>Thematic analysis</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Family and carer satisfaction with case management and care planning</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng216er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng216er4.ref10" rid="niceng216er4.ref10">Stone 2019</a>
|
|
</p>
|
|
<p>General qualitative inquiry</p>
|
|
<p>UK, England</p>
|
|
<p>
|
|
<b>Aim of the study</b>
|
|
</p>
|
|
<p>To explore whether decisions to make a detention following a MHA assessment differs according to the professional background of an AMHP, and exploring decisions to detain.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=10 Approved Mental Health Professionals</p>
|
|
<p>n= 5 social work Approved Mental Health Professionals</p>
|
|
<p>n= 5 nurse Approved Mental Health Professionals</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Data collection:</b>
|
|
</p>
|
|
<p>Semi-structured interviews using vignettes</p>
|
|
<p>
|
|
<b>Data analysis:</b>
|
|
</p>
|
|
<p>Data was coded and themes were generated</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Postive aspects of case management and what works well</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng216er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng216er4.ref11" rid="niceng216er4.ref11">Vicary 2019</a>
|
|
</p>
|
|
<p>Phenomenological study</p>
|
|
<p>UK, England</p>
|
|
<p>
|
|
<b>Aim of the study</b>
|
|
</p>
|
|
<p>To explore the experiences of AMHPs including social workers, of carrying out a Mental Health Act assessment</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=12 Approved Mental Health Professionals with varying backgrounds</p>
|
|
<p>n=5 social worker Approved Mental Health Professionals</p>
|
|
<p>n=5 nurse Approved Mental Health Professionals</p>
|
|
<p>n=2 occupational therapist Approved Mental Health Professionals.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Data collection:</b>
|
|
</p>
|
|
<p>Semi-structured interviews and a “Rich Picture”</p>
|
|
<p>
|
|
<b>Data analysis:</b>
|
|
</p>
|
|
<p>Transcripts were coded and themes were generated</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Negative aspects of case management and what doesn’t work well</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng216er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng216er4.ref12" rid="niceng216er4.ref12">Wickersham 2020</a>
|
|
</p>
|
|
<p>General qualitative inquiry</p>
|
|
<p>UK, England</p>
|
|
<p>
|
|
<b>Aim of the study</b>
|
|
</p>
|
|
<p>To explore factors the might help or hinder detention minimisation</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=11 mental health professionals with varying backgrounds</p>
|
|
<p>n=4 Approved Mental Health Professionals</p>
|
|
<p>n=4 Section 12 (Mental Health Act) Doctors</p>
|
|
<p>n=3 Approved Mental Health Professional service managers</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Data collection:</b>
|
|
</p>
|
|
<p>Semi-structured interviews and focus group</p>
|
|
<p>
|
|
<b>Data analysis:</b>
|
|
</p>
|
|
<p>Thematic analysis</p>
|
|
</td><td headers="hd_h_niceng216er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Negative aspects of case management and what doesn’t work well</div></li><li class="half_rhythm"><div>Positive aspects of case management and what works well</div></li><li class="half_rhythm"><div>Practitioner satisfaction with case management and care planning</div></li><li class="half_rhythm"><div>Responding to an escalation of need among people with mental health problems</div></li></ul>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">AMHP: Approved mental health professional; ASW: Approved social worker; HTP: Home treatment professional; MHA: Mental Health Act</p></div></dd></dl></dl></div></div></div></article><article data-type="fig" id="figobniceng216er4fig1"><div id="niceng216er4.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Theme%20map.&p=BOOKS&id=588603_niceng216er4f1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK588603/bin/niceng216er4f1.jpg" alt="Figure 1. Theme map." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Theme map</span></h3></div></article><article data-type="table-wrap" id="figobniceng216er4tab5"><div id="niceng216er4.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Evidence synthesis (effectiveness and qualitative data)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588603/table/niceng216er4.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng216er4.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng216er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Qualitative Themes</th><th id="hd_h_niceng216er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Overall confidence in the findings</th><th id="hd_h_niceng216er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Effectiveness evidence</th><th id="hd_h_niceng216er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th><th id="hd_h_niceng216er4.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Explanatory contribution of qualitative findings on effectiveness results</th></tr></thead><tbody><tr><td headers="hd_h_niceng216er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<i>D1.1: Alternative treatments to compulsory detention</i>
|
|
</p>
|
|
<p>Data from 2 studies (<a class="bibr" href="#niceng216er4.ref5" rid="niceng216er4.ref5">Allen 2020</a>, <a class="bibr" href="#niceng216er4.ref12" rid="niceng216er4.ref12">Wickersham 2020</a>) suggested that social work practitioners do not have enough time or resources to try less restrictive alternative options to compulsory detention during a mental health crisis. The studies also suggested there was a lack of alternative treatments for mental illness such as psychotherapeutic, holistic and social methods leading practitioners to choose detention instead.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng216er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>
|
|
<i>Outcome: Hospital admissions; measured by number of involuntary admissions via apprehension.</i>
|
|
</p>
|
|
<p>Data from 1 study (<a class="bibr" href="#niceng216er4.ref3" rid="niceng216er4.ref3">Semple 2021</a>) showed that crisis outreach and support team had an important benefit over general patrol without social worker input in terms of number of involuntary admissions to hospital via apprehension.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW (1 prospective cohort study)</td><td headers="hd_h_niceng216er4.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The reduction in number of hospital admissions by apprehension under the Mental Health Act could be attributed to the availability of alternative treatments, as suggested by the qualitative evidence. The qualitative data suggests that practitioners chose detention because there was a lack of alternative treatments such as holistic and social methods. In <a class="bibr" href="#niceng216er4.ref3" rid="niceng216er4.ref3">Semple 2021</a>, people were connected to other community resources when they contacted the crisis outreach team, and the availability of these other alternative methods could explain the reduction in involuntary admissions via apprehension.</td></tr><tr><td headers="hd_h_niceng216er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<i>D1.2: Understanding of mental illness</i>
|
|
</p>
|
|
<p>Data from 3 studies (<a class="bibr" href="#niceng216er4.ref5" rid="niceng216er4.ref5">Allen 2020</a>, <a class="bibr" href="#niceng216er4.ref6" rid="niceng216er4.ref6">Buckland 2016</a>, <a class="bibr" href="#niceng216er4.ref7" rid="niceng216er4.ref7">Hall 2017</a>) suggested that a lack of understanding about mental health problems, and the classification as an illness in the MHA, established a relationship between mental health and medical treatments. This could result in negative consequences, for example enforced medication.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng216er4.tab5_1_1_1_3" rowspan="3" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>
|
|
<i>Outcome: Access to care and support in a crisis measured by contact with services or health or social care practitioners; measured by number of people registered to a general practitioner.</i>
|
|
</p>
|
|
<p>Data from 1 study (<a class="bibr" href="#niceng216er4.ref4" rid="niceng216er4.ref4">Timms 2016</a>) showed that outreach by specialist homeless services, followed by a Mental Health Act assessment and detention by an approved mental health professional, had a benefit over pre-intervention in terms of number of people registered with a GP.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab5_1_1_1_4" rowspan="3" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW (1 retrospective cohort study)</td><td headers="hd_h_niceng216er4.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The increase in GP registration post intervention could be explained by the qualtitative evidence which suggests classification of mental health problems as illness, as in the MHA, could lead to a relationship between mental health and medical treatments. Following a diagnosis of mental illness or treatment under the Mental Health Act, people may require - or be expected to require - ongoing medical care as well as medication management. Registration with a GP could be a way of ensuring this is fulfilled.</td></tr><tr><td headers="hd_h_niceng216er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<i>D2.1: What helps decision making in MHA assessments</i>
|
|
</p>
|
|
<p>
|
|
<i>D2.1.1: Considering wider support network</i>
|
|
</p>
|
|
<p>Data from 1 study (<a class="bibr" href="#niceng216er4.ref12" rid="niceng216er4.ref12">Wickersham 2020</a>) suggested that practitioners valued having up to date notes and risk assessments to help increase understanding of a person’s background, and help them make decisions in MHA assessments.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng216er4.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">As the qualitative evidence suggests practitioners value up to date notes to ensure they have an understanding of a person’s background, we might expect that practitioners encourage people who have been assessed under the MHA to register with a GP. A benefit of registration could be ensuring that medical records are up to date with information being accessible if future incidents occur.</td></tr><tr><td headers="hd_h_niceng216er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<i>D2.2: What helps minimise detentions</i>
|
|
</p>
|
|
<p>Data from 2 studies (<a class="bibr" href="#niceng216er4.ref12" rid="niceng216er4.ref12">Wickersham 2020</a>, <a class="bibr" href="#niceng216er4.ref10" rid="niceng216er4.ref10">Stone 2019</a>) suggested that a MHA assessment itself could lead to more engagement.</p>
|
|
</td><td headers="hd_h_niceng216er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng216er4.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The qualitative evidence here suggests that an increase in general practitioner registration could be a direct result of the MHA assessment encouraging engagement with health services.</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">GP: General practitioner; MHA: Mental Health Act</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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