Services and improving the quality of care

Acute mental health crisis services are essential for service users and their allies, and they occupy a significant share of mental health resources in many countries. However, acute care was often unpopular and sometimes powerful, and information about optimal models for patient experience and outcomes is surprisingly scarce, in part due to the difficulties of conducting studies with patients in crisis. Evidence on best practices for early assessment and immediate management is particularly limited. However, several creative models, including extended assessment, brief treatments, and various assistive sites and techniques, could be beneficial. For example, acute services were important in the period of intense treatment after a crisis, but new techniques to reduce coercion, treat trauma, diversify therapies and hospital staff, and make decision-making and care collaborative must be created, evaluated and implemented.

Home-based intensive care programs, day intensive care units and community crisis services have shown evidence that they can keep some service users out of hospital: better knowledge of how to apply them in various circumstances and what works best for which service users would benefit. Approaches to crisis management in the voluntary sector were more flexible and informal: these services could complement and provide useful learning for statutory sector services, particularly for underserved or disengaged communities.

Such approaches often involve professionals who have personal experience of mental health emergencies and potential key roles in improving the quality of acute care across sectors. Great disparities have occurred in many low- and middle-income countries, exacerbated by a lack of access to high-quality mental health treatment. Responses should be based on current community responses and context-appropriate evidence. In low-resource settings, the need to venture outside of formal systems can lead to broader learning through locally rooted techniques.