Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best ap-proaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision-making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low- and middle-income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low-resource settings may lead to wider learning from locally embedded strategies.

中文翻译：

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急性精神科护理：增加服务范围和改善护理的可及性和质量的方法。

精神卫生危机的紧急服务对于服务使用者及其支持者来说非常重要，并且在许多国家消耗了大量的精神卫生资源。然而，急性护理通常不受欢迎，有时甚至是强制性的，关于哪种模型最适合患者体验和结果的证据仍然令人惊讶地有限，这部分反映了对处于危机中的人进行研究的挑战。关于初始评估和即时管理的最佳方法的证据尤其缺乏，但一些涉及扩展评估、简短干预以及提供支持的多样化环境和策略的创新模型可能会有所帮助。急性病房在危机后的强化治疗阶段仍然是核心，但需要开发新的方法，评估和实施以减少胁迫、解决创伤、多样化治疗和住院人员，以及制定决策和护理协作。强化家庭治疗服务、急性日间病房和社区危机服务在转移一些服务用户住院方面有支持性证据：更好地了解如何在广泛的环境中最好地实施它们，以及哪些服务用户最适合有价值的。志愿部门的危机管理方法更加灵活和非正式：此类服务有可能补充并为法定部门服务提供有价值的学习，特别是对于往往服务不足或脱离接触的群体。这种方法通常涉及具有心理健康危机亲身经历的员工，他们在提高各部门急症护理质量方面具有重要的潜在作用。许多低收入和中等收入国家存在巨大差距，这是由于难以获得优质的精神卫生保健服务。响应需要建立在现有社区响应和上下文相关证据的基础上。在资源匮乏的环境中移出正式系统的必要性可能会导致从本地嵌入策略中更广泛地学习。