Crisis Services and Hospital Crises by Dylan Tomlinson Kevin Allen

Author:Dylan Tomlinson, Kevin Allen [Dylan Tomlinson, Kevin Allen]
Language: eng
Format: epub
ISBN: 9781138611634
Barnesnoble:
Publisher: Taylor & Francis
Published: 2018-08-09T00:00:00+00:00

What Next?

Having discussed the limitations of the current approaches to crisis service evaluation, what next? The next logical step may be to carry out a randomised controlled trial of crisis services at a national level where the resources for a more thorough approach can be made available. This need arises from the observation that the research skills required to carry out such a project are not widespread in the primary care and community care settings (Mant, 1997) and because the cost of such a study would be prohibitive in the context of the local initiatives which are characteristic in this field. However, it has to be said that such a development may well be premature because of the relatively underdeveloped state of the service philosophy underpinning crisis services and, following on from this, the relatively diverse pattern of service models which characterise the systems that are currently in operation (Value for Money Unit, 1997; Orme and Hogan, forthcoming). Given such a heterogeneous pattern of services the generalisability of the results from a well designed randomised control trial would be seriously limited.

We cannot avoid the conclusion that what has to happen next is that we need to return to the question of what exactly it is that those who propose and operate crisis services are seeking to achieve. In particular, whether or not the development of such services is designed to provide a new form of service that will provide a therapeutic intervention currently missing from areas without such a service; or an alternative and more cost effective model for the arrangement for primary mental health care, or, indeed, some mixture of the two. Finally, and most important perhaps, who are the intended clients for such a service? Are they to be, as is the case in some areas, long term mental health service users or anyone who is suffering a severe crisis with psychological/psychiatric dimensions?

In order to evaluate a service, as a point of reference, we need a clear set of aims and objectives for that service. It is important, therefore, for crisis services to define what they consider to be a crisis. However, our ongoing survey of crisis services and previous review (Hogan et al., 1997b) suggest this is often not normal practice. It is assumed that a crisis is a known quantity. However, services can be seen to offer services to clients suffering greatly different problems.

Jacobs (1983) defined a crisis as ‘a turning point that precludes the possibility of life going on as usual’ (p. 172). This definition applies to all people whether mental health service users or not. This is important as the work of Caplan (1964), who is often cited as the instigator of the development of crisis intervention services, was directed towards reducing the incidence of mental ill-health in the community before people became service users. It can be seen therefore that the practice of crisis intervention has moved from treating everyone in the community, and the community itself, to treating a distinct group of individuals often with a long and varied psychiatric history (Hogan and Orme, 1997; Hogan et al.

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