Nicola Morant1, Michael Davidson2, Jane Wackett3, Danielle Lamb4, Vanessa Pinfold3, Deb Smith3, Sonia Johnson2,5, Brynmor Lloyd-Evans2, David P J Osborn2,5. 1. Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK. n.morant@ucl.ac.uk. 2. Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK. 3. McPin Foundation, 7-14 Great Dover St, London, SE1 4YR, UK. 4. Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK. 5. Camden and Islington NHS Foundation Trust, London, UK.
Abstract
BACKGROUND: Acute Day Units (ADUs) provide intensive, non-residential, short-term treatment for adults in mental health crisis. They currently exist in approximately 30% of health localities in England, but there is little research into their functioning or effectiveness, and how this form of crisis care is experienced by service users. This qualitative study explores the views and experiences of stakeholders who use and work in ADUs. METHODS: We conducted 36 semi-structured interviews with service users, staff and carers at four ADUs in England. Data were analysed using thematic analysis. Peer researchers collected data and contributed to analysis, and a Lived Experience Advisory Panel (LEAP) provided perspectives across the whole project. RESULTS: Both service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within an environment that felt safe. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems. CONCLUSIONS: Multi-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice and effective support within local acute care systems.
BACKGROUND: Acute Day Units (ADUs) provide intensive, non-residential, short-term treatment for adults in mental health crisis. They currently exist in approximately 30% of health localities in England, but there is little research into their functioning or effectiveness, and how this form of crisis care is experienced by service users. This qualitative study explores the views and experiences of stakeholders who use and work in ADUs. METHODS: We conducted 36 semi-structured interviews with service users, staff and carers at four ADUs in England. Data were analysed using thematic analysis. Peer researchers collected data and contributed to analysis, and a Lived Experience Advisory Panel (LEAP) provided perspectives across the whole project. RESULTS: Both service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within an environment that felt safe. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems. CONCLUSIONS: Multi-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice and effective support within local acute care systems.
Entities:
Keywords:
Acute care; Acute day unit; Alternative to admission; Crisis care; Mental health; Psychiatry; Qualitative; Service users; Severe mental illness
Authors: Brynmor Lloyd-Evans; Bethan Paterson; Steve Onyett; Ellie Brown; Hannah Istead; Richard Gray; Claire Henderson; Sonia Johnson Journal: Int J Ment Health Nurs Date: 2017-01-11 Impact factor: 3.503
Authors: Nomi Werbeloff; Chin-Kuo Chang; Matthew Broadbent; Joseph F Hayes; Robert Stewart; David P J Osborn Journal: Lancet Psychiatry Date: 2016-12-13 Impact factor: 27.083
Authors: Danielle Lamb; Michael Davidson; Brynmor Lloyd-Evans; Sonia Johnson; Samira Heinkel; Thomas Steare; Vanessa Pinfold; Scott Weich; Nicola Morant; James Kirkbride; Louise Marston; Alastair Canaway; Jason Madan; David Osborn Journal: BMC Health Serv Res Date: 2019-11-21 Impact factor: 2.655
Authors: Sonia Johnson; Christian Dalton-Locke; John Baker; Charlotte Hanlon; Tatiana Taylor Salisbury; Matt Fossey; Karen Newbigging; Sarah E Carr; Jennifer Hensel; Giuseppe Carrà; Urs Hepp; Constanza Caneo; Justin J Needle; Brynmor Lloyd-Evans Journal: World Psychiatry Date: 2022-06 Impact factor: 79.683
Authors: Danielle Lamb; Thomas Steare; Louise Marston; Alastair Canaway; Sonia Johnson; James B Kirkbride; Brynmor Lloyd-Evans; Nicola Morant; Vanessa Pinfold; Deb Smith; Scott Weich; David P Osborn Journal: BJPsych Open Date: 2021-03-19