Joint crisis plans and inpatient care: a qualitative study

Abstract

Background: Patients suffering from a severe mental illness (SMI) are likely to face relapse and psychiatric readmission. Although joint crisis plans (JCP) are clinical relevant aids to avoid coercion, this complex intervention is prone to implementation and sustainability barriers. The effectiveness of JCPs is evaluated in robust quantitative studies, but the process of establishing a JCP seems to be under researched. Aim: To gain insight in the beneficial and impeding factors in the process of establishing a JCP with a SMI patient. Method: A generic qualitative study was conducted using semi-structured interviews. Twelve healthcare professionals were selected, having experiences in the process of establishing JCPs on an inpatient ward of a psychiatric hospital in the Netherlands, in 2017. The interview findings were recorded, transcribed, content-analysed and thematised. In the second stage, these findings were made available for peer review and member check. Results: Three core themes were identified as influencing factors: the validation of the JCP, the engagement of the patient and the patient-centered support. The successful validation of the JCP is associated with the shared decision-making in the triad: patient, healthcare professional and carer. The engagement of the patient depends on the level of motivation, the symptom profile and corresponding abilities. The patient-centered support depends on the abilities of the healthcare professional during the process and the collaboration between the healthcare professionals. Conclusion: This study revealed three themes serving both as beneficial and impeding factors. The combination of engagement of the patient and patient-centered support leads to the validation of the JCP: the key concept to make the process work. Recommendations: Further research should focus on the use of JCPs once the patient is discharged to a community based context.