Collaborative and person-centred crisis plans are part of mental health policy in the UK, but little work has investigated take-up of crisis plans or equity in their use by crisis resolution and home treatment teams (CRHTs).Crisis plans may be a useful tool in the prevention of future hospital admissions, and they are especially relevant for CRHTs that perform a central gatekeeping role for people at risk of admission to hospital. Previous evaluations of Aims and method To measure the take-up of formal crisis plans in a specialist home treatment team (HTT) serving an ethnically diverse urban population; and to implement a quality improvement programme and measure its impact on crisis plan completion. Two audits were completed of patients before and after the implementation of a quality improvement programme. Descriptive data are shown by ethnic group, by gender, and for people with multiple hospital admissions.Results At baseline, 16.7% of patients at high risk of admission had an HTT crisis plan, compared with 26.7% of a comparison group. Only 23.1% of the crisis plans for patients with a history of frequent admission mentioned the prevention of future admissions. Crisis plan completion improved following the quality improvement programme, when 80.0% of discharges had an HTT crisis plan; of these, 73.0% mentioned admission prevention. In the follow-up audit, 22.7% of patients in the multiple admission group had been readmitted to hospital at least once. Crisis plan completion did not appear to differ by ethnic group or gender and did not appear to be related to hospital readmission.Clinical implications Crisis plan completion improved with simple practical methods, but completion was unrelated to gender, ethnicity or later readmission.Declaration of interest None.
I fully agree with Dr Hakeem. 1 There seems to be a wrong perception among nursing staff as well as occasionally medical staff that a patient's choice to overeat is a human right. The opposite is the case. There is no 'human right' to eat as much as one wants to. Article 3 of the Human Rights Act 1998 forbids degrading and humiliating treatment (as part of the right to be free of torture), but this relates to seriously degrading practices. It does not at all mean that we need to allow any choices a patient wants to make. It does even allow a degree of institutionalisation as long as it is not deliberately degrading. If it did not, hospitals would not be able to function properly, as certain routines have to be maintained to allow the running of a hospital. Giving unnecessarily large amounts of food to patients could even be seen as a neglect of our duty of care, especially if the patient lacks capacity. If I was diagnosed with schizophrenia and started on clozapine under Section 3 (of the Mental Health Act), I would hope that the people treating me would have enough sense to stop me from eating three times as much as necessary, even if I did ask for it. So, rather than being defensive in anticipatory obedience and the wrong understanding of human rights legislation, we should use our common sense and duty of care, and prevent patients from doing serious harm to themselves by overeating while they are in our care.
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