An investigation of the association between characteristics of local crisis care systems and service use in a national survey

Background In England, a range of mental health crisis care models and approaches to organising crisis care systems have been implemented, but characteristics associated with their effectiveness are poorly understood. Aims To i) develop a typology of catchment area mental health crisis care systems and ii) investigate how crisis care service models and system characteristics relate to psychiatric hospital admissions and detentions. Methods Data about crisis systems were obtained from a 2019 English national survey. Latent class analyses were conducted to identify discernible typologies, and mixed effects negative binomial regression models were fitted to explore associations between crisis care models and admissions and detention rates, obtained from nationally-reported data. Results No clear typology of catchment area crisis care systems emerged. Regression models suggested that provision of a crisis telephone service within the local crisis system was associated to a 11.6% lower admissions rate and a 15.3% lower detention rate. Provision of a crisis café was associated with a 7.8% lower rate of admissions. The provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with a 12.8% higher rate of admissions. Conclusions The configuration of crisis care systems varies considerably in England, but we could notderive a typology which convincingly categorised crisis care systems. Our results suggest that a crisis phone line and a crisis café may be associated with lower rates of admission, but crisis assessment teams, separate from home treatment teams, may not be associate to reductions in hospital admission and detentions.