Evaluation of Crisis Occurrence and Resolution in Patients with Severe and Persistent Mental Illness

Principal: Paul Links
Location: Toronto

The overall aims of this proposal are to examine the Best Practices model for crisis response systems that suggests that pre-crisis and on-going supports such as intensive case management will prevent crises, also that crisis functions should form a graduated response with psychiatric emergency services in hospitals dealing with greater levels of severity and intensity of crisis.

Specifically, the project will compare crisis occurrence and resolution in individual with severe and persistent mental illness (SPMI) randomized to two levels of case management (assertive case management, and brokerage case management). This study will also utilize a prospective cohort design to evaluation the role of ongoing support in predicting crisis occurrence and resolution independent of symptom severity, dangerousness and diagnoses in SPMI subjects presenting to our psychiatric emergency service, Crisis Intervention Team (CIT), St. Michael's Hospital without case management support.

The outcomes of the study are the time to first crisis or hospitalization, frequency, severity and resolution of crisis contacts. As well, the roles and activities of professional during these contacts will be examined. Time series analyses will be used to compare the time to first crisis contact or hospitalization across the two levels of case management. Secondary hypotheses will determine the predictive power of ongoing support to prevent crisis occurrence and the fidelity of our CIT service to the Best Practices model. This proposal will add to the understanding of mental health reform by determining the impact of ongoing case management in preventing and resolving crisis contacts and clarifying the role of the hospital based psychiatric emergency service.