Background: Inpatient psychiatric care is unpopular and expensive, and development and evaluation of alternatives is a long-standing policy and research priority around the world. In England, the three main models documented over the past fifty years (teams offering crisis assessment and treatment at home; acute day services; and residential crisis services in the community) have recently been augmented by several new service models. These are intended to enhance choice and flexibility within catchment area acute care systems, but remain largely undocumented in the research literature. We therefore aimed to describe the types and distribution of crisis care models across England through a national survey. Methods: We carried out comprehensive mapping of crisis resolution teams (CRTs) using previous surveys, websites and multiple official data sources. Managers of CRTs were invited to participate as key informants who were familiar with the provision and organisation of crisis care services within their catchment area. The survey could be completed online or via telephone interview with a researcher, and elicited details about types of crisis care delivered in the local catchment area. Results: We mapped a total of 200 adult CRTs and completed the survey with 184 (92%). Of the 200 mapped adult CRTs, there was a local (i.e., within the adult CRT catchment area) children and young persons CRT for 84 (42%), and an older adults CRT for 73 (37%). While all but one health region in England provided CRTs for working age adults, there was high variability regarding provision of all other community crisis service models and system configurations. Crisis cafes, street triage teams and separate crisis assessment services have all proliferated since a similar survey in 2016, while provision of acute day units has reduced. Conclusions: The composition of catchment area crisis systems varies greatly across England and popularity of models seems unrelated to strength of evidence. A group of emerging crisis care models with varying functions within service systems are increasingly prevalent: they have potential to offer greater choice and flexibility in managing crises, but an evidence base regarding impact on service user experiences and outcomes is yet to be established.

中文翻译：

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英国心理健康危机护理的新兴模式和趋势：对危机护理系统的全国调查

背景：住院精神科护理不受欢迎且费用昂贵，替代品的开发和评估是世界范围内长期的政策和研究重点。在英格兰，过去 50 年记录的三种主要模式（在家里提供危机评估和治疗的团队；紧急日间服务；以及社区中的住宅危机服务）最近得到了几种新服务模式的增强。这些旨在增强集水区急性护理系统内的选择和灵活性，但在研究文献中基本上没有记录。因此，我们旨在通过一项全国调查来描述整个英格兰危机护理模式的类型和分布。方法：我们使用以前的调查对危机解决团队 (CRT) 进行了全面的测绘，网站和多个官方数据源。邀请 CRT 的管理人员作为熟悉其服务区域内危机护理服务的提供和组织的关键知情人参与。该调查可以在线完成，也可以通过与研究人员的电话采访完成，并获取有关在当地集水区提供的危机护理类型的详细信息。结果：我们共绘制了 200 个成人 CRT，并以 184 个（92%）完成了调查。在映射的 200 个成人 CRT 中，有 84 名（42%）有本地（即在成人 CRT 集水区）儿童和青少年 CRT，73 名（37%）有老年人 CRT。虽然英格兰除一个卫生区之外的所有地区都为工作年龄的成年人提供 CRT，但在提供所有其他社区危机服务模式和系统配置方面存在很大差异。危机咖啡馆，自 2016 年进行类似调查以来，街道分诊小组和单独的危机评估服务都激增，而急诊室的提供却减少了。结论：集水区危机系统的组成在英格兰各地差异很大，模型的流行似乎与证据强度无关。一组在服务系统中具有不同功能的新兴危机护理模式越来越普遍：它们有可能在管理危机方面提供更多的选择和灵活性，但尚未建立关于对服务用户体验和结果的影响的证据基础。整个英格兰的集水区危机系统的组成差异很大，模型的流行似乎与证据的强度无关。一组在服务系统中具有不同功能的新兴危机护理模式越来越普遍：它们有可能在管理危机方面提供更多的选择和灵活性，但尚未建立关于对服务用户体验和结果的影响的证据基础。整个英格兰的集水区危机系统的组成差异很大，模型的流行似乎与证据的强度无关。一组在服务系统中具有不同功能的新兴危机护理模式越来越普遍：它们有可能在管理危机方面提供更多的选择和灵活性，但尚未建立关于对服务用户体验和结果的影响的证据基础。