NHS England recommends the commissioning of intensive support teams (ISTs) to provide effective support to people with intellectual disability (ID) when in crisis. However, there is a paucity of evidence regarding how these services should be organised. This exploratory secondary analysis of data from the IST-ID study aimed to investigate IST characteristics that relate to clinical outcomes. The primary outcome was mean change in the total score on the Aberrant Behavior Checklist and its subscales.

A measure of mental illness severity was the only variable associated with our primary outcome of reduction in challenging behaviour. Accommodation type, affective status and gender were associated with the subdomains of irritability, hyperactivity and lethargy in unadjusted and adjusted analyses.

Our findings indicate that variation in clinical outcomes is influenced by individual rather than organisational factors. Further research on the theoretical fidelity of the IST-ID model is needed.

The study of ideas about death and the mechanisms of their formation in adolescents with suicidal behavior is an important task for both diagnosis and psychotherapy. The parents’ notions of death, and the prohibition on discussing the topic of death in the family, can significantly distort the adolescent’s relationship with death.

Investigate differences in attitudes towards death in parents and adolescents who apply to the crisis care room of a child psychiatric clinic.

The study involved 90 adolescents with their parents who applied to the crisis outpatient care system. The following questionnaires were offered: Death Attitude Profile-Revised, Death Anxiety Scale, Experiences in Close Relationships-Revised, Multidimensional Scale of Perceived Social Support, GAD-7.

Significant differences were found for most of the scales in the samples of adults and adolescents, of particular interest to us were the scales “death avoidance” (W=317,500,z=3,089,p=0,002) and “perception of family support» (W=288,500,z=3,393,p=0,001). For the group of adolescents, there are higher indicators on the scales of anxiety (W=61,000,z=-2,546,p=0,011), anxiety in close relationships (W=83,000,z=-2,549,p=0,011), avoidance of close relationships (W=28,000,z=-3,870,p=0,000), and death as a means of escape (W=54,500,z=-3,076,p=0,002).

In families of adolescents with suicidal behavior, the severity of dysfunctional patterns of building close relationships and the presence of sharply opposite positions in relation to death in children and parents are observed without the possibility of discussing this topic.

No significant relationships.

Internationally, an increasing proportion of emergency department visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units.

This systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units.

We searched EMBASE, Medline, CINAHL and PsycINFO up to March 2021. All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed study risk of bias with Risk of Bias in Non-Randomized Studies – of Interventions and Risk of Bias in Randomized Trials.

Data from twelve studies across six countries (Australia, Belgium, Canada, The Netherlands, UK and USA) and 67 505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared with 49.8% before intervention; difference = 7.8%; P < 0.0001) and increase out-patient follow-up care (χ2 = 37.42, d.f. = 1; P < 0.001). Meta-analysis indicated a significant reduction in length of emergency department stay (by 164.24 min; 95% CI −261.24 to −67.23 min; P < 0.001) and number of in-patient admissions (odds ratio 0.55, 95% CI 0.43–0.68; P < 0.001).

Short-stay mental health crisis units are effective for reducing emergency department wait times and in-patient admissions. Further research should investigate the impact of units on patient experience, and clinical and social outcomes.

Experience of crisis care may vary across different care models.

To explore the experience of care in standard care and ‘open dialogue’ (a peer-supported community service focused on open dialogue and involving social networks for adults with a recent mental health crisis) 3 months after a crisis.

We conducted semi-structured interviews with 11 participants (6 received open dialogue; 5 received treatment as usual (TAU)) in a feasibility study of open dialogue and analysed the data using a three-step inductive thematic analysis to identify themes that (a) were frequently endorsed and (b) represented the experiences of all participants.

Four themes emerged: (a) feeling able to rely on and access mental health services; (b) supportive and understanding family and friends; (c) having a choice and a voice; and (d) confusion and making sense of experiences. Generally, there was a divergence in experience across the two care models. Open dialogue participants often felt able to rely on and access services and involve their family and friends in their care. TAU participants described a need to rely on services and difficulty when it was not met, needing family and friends for support and wanting them to be more involved in their care. Some participants across both care models experienced confusion after a crisis and described benefits of sense-making.

Understanding crisis care experiences across different care models can inform service development in crisis and continuing mental healthcare services.

Street triage services are now common but the population they serve is poorly understood. We aimed to evaluate a local service to determine the characteristics of those using it and their outcomes in the 90 day period following contact.

We found that there were high levels of service use and that the vast majority of contacts were via telephone rather than in person. Street triage was used by both existing secondary mental health patients and non-patients. Follow-up rates with secondary services were high in the former and low in the latter case.

Services are very busy where they exist and may be replacing traditional crisis services. It is not apparent that they work to increase follow-up among those using them, unless they are already in contact with services. In this service, although there was a joint response model nearly all responses were provided by telephone.