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Effectiveness and cost-effectiveness of admissions to women's crisis houses compared with traditional psychiatric wards: pilot patient-preference randomised controlled trial

  • L. Howard (a1), C. Flach (a1), M. Leese (a1), S. Byford (a1), H. Killaspy (a2), L. Cole (a1), C. Lawlor (a2), J. Betts (a2), J. Sharac (a1), P. Cutting (a3), S. McNicholas (a4) and S. Johnson (a1)...

Abstract

Background

Women's crisis houses have been developed in the UK as a less stigmatising and less institutional alternative to traditional psychiatric wards.

Aims

To examine the effectiveness and cost-effectiveness of women's crisis houses by first examining the feasibility of a pilot patient-preference randomised controlled trial (PP–RCT) design (ISRCTN20804014).

Method

We used a PP–RCT study design to investigate women presenting in crisis needing informal admission. The four study arms were the patient preference arms of women's crisis house or hospital admission, and randomised arms of women's crisis house or hospital admission.

Results

Forty-one women entered the randomised arms of the trial (crisis house n = 19, wards n = 22) and 61 entered the patient-preference arms (crisis house n = 37, ward n = 24). There was no significant difference in outcomes (symptoms, functioning, perceived coercion, stigma, unmet needs or quality of life) or costs for any of the groups (randomised or preference arms), but women who obtained their preferred intervention were more satisfied with treatment.

Conclusions

Although the sample sizes were too small to allow definite conclusions, the results suggest that when services are able to provide interventions preferred by patients, those patients are more likely to be satisfied with treatment. This pilot study provides some evidence that women's crisis houses are as effective as traditional psychiatric wards, and may be more cost-effective.

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Copyright

Corresponding author

Louise Howard, Health Service and Population Research Department, Institute of Psychiatry, Box PO29, De Crespigny Park, London SE5 8AF, UK. Email: louise.howard@kcl.ac.uk.

Footnotes

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The study was funded by the Medical Research Council (grant G0401241) and was adopted by the National Institute for Health Research Mental Health Research Network.

Declaration of interest

None.

Footnotes

References

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1 Johnson, S, Gilburt, H, Lloyd-Evans, B, Osborn, DPJ, Boardman, J, Leese, M, et al. In-patient and residential alternatives to standard acute psychiatric wards in England. Br J Psychiatry 2009; 194: 456–63.
2 Department of Health. Women-Only and Women-Sensitive Mental Health Services. Department of Health, 2003.
3 Johnson, S, Bingham, C, Billings, J, Pilling, S, Morant, N, Bebbington, P, et al. Women's experiences of admission to a crisis house and to acute hospital wards: a qualitative study. J Ment Health 2004; 13: 247–62.
4 Killaspy, H, Dalton, J, McNicholas, S, Johnson, S. Drayton Park, an alternative to hospital admission for women in acute mental health crisis. Psychiatr Bull 2000; 24: 101–4.
5 Meiser-Stedman, C, Howard, L, Cutting, P. Evaluating the effectiveness of a women's crisis house: a prospective observational study. Psychiatr Bull 2006; 30: 324–6.
6 Torgerson, DJ, Sibbald, B. Understanding controlled trials. What is a patient preference trial? BMJ 1998; 31: 360.
7 King, M, Nazareth, I, Lampe, F, Bower, P, Chandler, M, Morou, M, et al. Impact of participant and physician intervention preferences on randomized trials: a systematic review. JAMA 2005; 293: 1089–99.
8 Howard, LM, Thornicroft, G. Patient preference randomised controlled trials in mental health research. Br J Psychiatry 2006; 188: 303–4.
9 Howard, LM, Leese, M, Byford, S, Killaspy, H, Cole, L, Lawlor, C, et al. Methodological challenges in evaluating the effectiveness of women's crisis houses compared with psychiatric wards; findings from a pilot patient preference RCT. J Nerv Ment Dis 2009; 197: 722–7.
10 Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J. The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976; 33: 766–71.
11 Overall, JE, Gorham, DR. BPRS. Brief Psychiatric Rating Scale. In ECDEU Assessment Manual for Psychopharmacology. US Department of Health, Education and Welfare, 1976.
12 Priebe, S, Huxley, P, Knight, S, Evans, S. Application and results of the Manchester Short Assessment of QoL (MANSA). Int J Soc Psychiatry 1999; 45: 712.
13 Brooks, R, EuroQol Group. EQ–5D: the current state of play. Health Policy 1996; 37: 3–2.
14 Phelan, M, Slade, M, Thornicroft, G, Dunn, G, Holloway, F, Wykes, T, et al. The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry 1995; 167: 589–95.
15 Ruggeri, M, Dall'Agnola, R. The development and use of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS) for measuring expectations and satisfaction with community-based psychiatric services in patients, relatives and professionals. Psychol Med 1993; 23: 511–23.
16 Gardner, W, Hoge, S, Bennett, N, Roth, L, Lidz, C, Monahan, J, et al. Two scales for measuring patients' performance perceptions of coercion during hospital admission. Behav Sci Law 1993; 20: 307–21.
17 Ritsher, JB, Otilingam, PG, Grajales, M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res 2003; 121: 3149.
18 Byford, S, Fiander, M, Torgerson, DJ, Barber, JA, Thompson, SG, Burns, T, et al. Cost-effectiveness of intensive v. standard case management for severe psychotic illness: UK700 case management trial. Br J Psychiatry 2000; 176:537–43.
19 Barrett, B, Byford, S, Crawford, M, Patton, R, Drummond, C, Henry, J, et al. Cost effectiveness of referral to an alcohol health worker in patients attending an accident and emergency department: a decision-making approach. Drug Alcohol Depend 2006; 81: 4754.
20 Kuyken, W, Byford, S, Taylor, RS, Watkins, E, Holden, E, White, K, et al. Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. J Consult Clin Psychol 2008; 76: 966–78.
21 Department of Health. National Health Service Reference Costs. Department of Health, 2007.
22 Finn, W, Hyslop, J, Truman, C. Mental Health, Multiple Needs and the Police. Revolving Doors Agency, 2000.
23 Legal Services Commission. Civil Remuneration Rates. Legal Services Commission, 2004.
24 Curtis, L. Unit Costs of Health and Social Care. Personal Social Services Research Unit, 2006.
25 HM Prison Service. Prison Service Annual Report and Accounts. TSO (The Stationery Office), 2007.
26 British Medical Association, Royal Pharmaceutical Society of Great Britain. British National Formulary. BMJ Books/Pharmaceutical Press, 2007.
27 Koopmanschap, MA, Rutten, FFH. A practical guide for calculating indirect costs of disease. Pharmacoeconomics 1996; 10: 460–6.
28 Efron, B, Tibshirani, RJ. An Introduction to the Bootstrap. Chapman & Hall, 1993.
29 Thompson, SG, Barber, JA. How should cost data in randomised controlled trials be analysed? BMJ 2000; 320: 1197–200.
30 Fenwick, E, Claxton, K, Sculpher, M. Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ 2001; 10: 779–87.
31 Slade, M, Byford, S, Barrett, B, Lloyd-Evans, B, Gilburt, H, Osborn, DPJ, et al. Alternatives to standard acute in-patient care in England: short-term clinical outcomes and cost-effectiveness. Br J Psychiatry 2010 (suppl 53): s149.
32 Howard, LM, Rigon, E, Cole, L, Lawlor, C, Johnson, S. Admissions to women's crisis houses or to psychiatric wards: women's pathways to admission. Psychiatr Serv 2008; 59: 1443–9.
33 Johnson, S, Lloyd-Evans, B, Morant, N, Gilburt, H, Shepherd, G, Slade, M, et al. Alternatives to standard acute in-patient care in England: roles and populations served. Br J Psychiatry 2010 (suppl 53): s613.
34 Preference Collaborative Review Group. Patients' preferences within randomised trials: systematic review and patient level meta-analysis. BMJ 2008; 337: 1864.
35 Gilburt, H, Slade, M, Rose, D, Lloyd-Evans, B, Johnson, S, Osborn, DPJ. Service users' experiences of residential alternatives to standard acute wards: qualitative study of similarities and differences. Br J Psychiatry 2010 (suppl 53): s2631.
36 Johnson, S, Lloyd-Evans, B, Howard, L, Osborn, DPJ, Slade, M. Where next with residential alternatives to admission? Br J Psychiatry 2010 (suppl 53): s524.

Effectiveness and cost-effectiveness of admissions to women's crisis houses compared with traditional psychiatric wards: pilot patient-preference randomised controlled trial

  • L. Howard (a1), C. Flach (a1), M. Leese (a1), S. Byford (a1), H. Killaspy (a2), L. Cole (a1), C. Lawlor (a2), J. Betts (a2), J. Sharac (a1), P. Cutting (a3), S. McNicholas (a4) and S. Johnson (a1)...

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Effectiveness and cost-effectiveness of admissions to women's crisis houses compared with traditional psychiatric wards: pilot patient-preference randomised controlled trial

  • L. Howard (a1), C. Flach (a1), M. Leese (a1), S. Byford (a1), H. Killaspy (a2), L. Cole (a1), C. Lawlor (a2), J. Betts (a2), J. Sharac (a1), P. Cutting (a3), S. McNicholas (a4) and S. Johnson (a1)...
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