***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Compulsory admission to psychiatric hospitals may be distressing , disruptive to patients and families , and associated with considerable cost to the health service . Improved patient experience and cost reductions could be realised by providing cost-effective crisis planning services . Methods Economic evaluation within a multi-centre r and omised controlled trial comparing Joint Crisis Plans ( JCP ) plus treatment as usual ( TAU ) to TAU alone for patients aged over 16 , with at least one psychiatric hospital admission in the previous two years and on the Enhanced Care Programme Approach register . JCPs , containing the patient 's treatment preferences for any future psychiatric emergency , are a form of crisis intervention that aim to mitigate the negative consequences of relapse , including hospital admission and use of coercion . Data were collected at baseline and 18-months after r and omisation . The primary outcome was admission to hospital under the Mental Health Act . The economic evaluation took a service perspective ( health , social care and criminal justice services ) and a societal perspective ( additionally including criminal activity and productivity losses ) . Findings The addition of JCPs to TAU had no significant effect on compulsory admissions or total societal cost per participant over 18-months follow-up . From the service cost perspective , however , evidence suggests a higher probability ( 80 % ) of JCPs being the more cost-effective option . Exploration by ethnic group highlights distinct patterns of costs and effects . Whilst the evidence does not support the cost-effectiveness of JCPs for White or Asian ethnic groups , there is at least a 90 % probability of the JCP intervention being the more cost-effective option in the Black ethnic group . Interpretation The results by ethnic group are sufficiently striking to warrant further investigation into the potential for patient gain from JCPs among black patient groups . Trial Registration Current Controlled Trials IS RCT BACKGROUND Psychiatric emergency situations ( PES ) are of high importance to the German prehospital physician-based emergency medical system . So far , however , no prospect i ve studies regarding the incidence of PES have been performed , neither have effects of training programs on diagnostic and therapeutic accuracy been studied . METHOD The protocol s of two emergency medical services ( EMS ) were collected and analyzed prospect ively .  Emergency physicians ( EPs ) in Kaiserslautern ( KL ) attended a st and ardized educational program and underwent daily supervision .  EPs in Homburg ( HOM ) had not been informed about the study . In KL , sociodemographic variables were collected . An investigator who was not involved in the individual EMS mission assessed the correct classification of PES . RESULTS Among all calls for an EP , 11.8 % were classified as PES . There was no difference between the two centers . Correct classification of PES in KL was significantly higher than that in HOM ( 94.3 % vs. 80.6 % ) . Documentation of suicidal behavior was deficient in both centers . EPs in KL gave verbal crisis intervention significantly more often , administered less medication overall , and dispensed more specific drugs in psychotic disorders and significantly less drugs in substance abuse disorders . Patients were more often treated at the scene and were less often transported to a hospital . Some sociodemographic variables were associated with psychiatric morbidity of treatment . CONCLUSION Accounting for 12 % of all missions , psychiatric emergencies are a frequent reason for calls for EPs , equaling trauma-related and neurological emergencies . The most frequent reasons for calls were alcohol intoxication , states of agitation and suicidal behavior . The diagnostic and therapeutic accuracy of EPs may be improved with a concise st and ardized teaching program 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 r and omised controlled trial ( PP- RCT ) design ( IS RCT N20804014 ) . 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 r and omised arms of women 's crisis house or hospital admission . RESULTS Forty-one women entered the r and omised 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 ( r and omised 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 Background : A&E departments are key points of contact for many people with mental health problems . Various models of care have been developed in A&E departments for delivering mental health services , but few have been assessed for effectiveness . The present study aim ed to assess the impact of a dedicated A&E psychiatric nurse service on several outcomes relevant to patients and clinicians . Methods : A crossover design was used to introduce a  dedicated psychiatric nurse service ( comprising four experienced community psychiatric nurses ) into two busy UK A&E departments . St and ardised assessment s were completed for each patient , and a r and om sample of these independently assessed for quality . Data were also collected on the number of patients assessed , psychiatric nurse time employed , waiting times , onward referrals , repeat attendances , patient satisfaction , and staff views . Results : A&E staff referred about a third of patients judged to have mental health problems to the psychiatric nurse service ; approximately half of those assessed had a psychiatric history . On average , assessment s took 60 min and over 90 % of the formulated management plans were judged appropriate by independent assessors . The psychiatric nurse intervention had little impact on waiting times or satisfaction levels for mental health patients , although there was evidence of a change in onward referral patterns . Comment : Psychiatric nurse assessment services have been introduced in many A&E departments , although the evidence base for the effectiveness of this development is not well established . This study presents evidence that psychiatric nurses can provide an accurate assessment and referral service with advantages for patient care Background Mental health patients can feel anxious about losing the support of staff and patients when discharged from hospital and often discontinue treatment , experience relapse and readmission to hospital , and sometimes attempt suicide . The benefits of peer support in mental health services have been identified in a number of studies with some suggesting clinical and economic gains in patients being discharged . Methods This pilot r and omised controlled trial with economic evaluation aim ed to explore whether peer support in addition to usual aftercare for patients during the transition from hospital to home would increase hope , reduce loneliness , improve quality of life and show cost effectiveness compared with patients receiving usual aftercare only , with follow-up at one and three-months post-discharge . Results A total of 46 service users were recruited to the study ; 23 receiving peer support and 23 in the care-as-usual arm . While this pilot trial found no statistically significant benefits for peer support on the primary or secondary outcome measures , there is an indication that hope may be further increased in those in receipt of peer support . The total cost per case for the peer support arm of the study was £ 2154 compared to £ 1922 for the control arm . The mean difference between costs was minimal and not statistically significant . However , further analyses demonstrated that peer support has a reasonably high probability of being more cost effective for a modest positive change in the measure of hopelessness . Challenges faced in recruitment and follow-up are explored alongside limitations in the delivery of peer support . Conclusions The findings suggest there is merit in conducting further research on peer support in the transition from hospital to home consideration should be applied to the nature of the patient population to whom support is offered ; the length and frequency of support provided ; and the contact between peer supporters and mental health staff . There is no conclusive evidence to support the cost effectiveness of providing peer support , but neither was it proven a costly intervention to deliver . The findings support an argument for a larger scale trial of peer support as an adjunct to existing services . Trial registration Current Controlled Trials IS RCT OBJECTIVE In spite of much effort to create guidelines on the management of violent behavior ( VB ) in emergency departments , little is known about the impact of such guidelines on a real-life emergency environment . The aim of this study is to investigate the impact of a staff educational crisis intervention ( SECI ) on the reduction of VB in patients admitted to emergency departments following drug suicidal attempt . METHOD The impact of a SECI on VB of patient consulting the ER following a drug suicide attempt was assessed by comparing the occurrence of VB before ( 5 months ) and after ( 5 months ) the introduction of a SECI . RESULTS A significant reduction in VB ( from 17.32 % to 7.14 % ) was found with the comparison of two 5-month periods : before ( 254 patients ) and after ( 224 patients ) the introduction of a SECI program ( chi(2)=11.238 ; P=.0008 ) . CONCLUSION These preliminary data suggest the need for further prospect i ve r and omized studies aim ing to prevent VB in emergency departments by developing specific SECI programs Abstract Objective To investigate whether a form of advance agreement for people with severe mental illness can reduce the use of inpatient services and compulsory admission or treatment . Design Single blind r and omised controlled trial , with r and omisation of individual patients . The investigator was blind to allocation . Setting Eight community mental health teams in southern Engl and . Participants 160 people with an operational diagnosis of psychotic illness or non-psychotic bipolar disorder who had experienced a hospital admission within the previous two years . Intervention The joint crisis plan was formulated by the patient , care coordinator , psychiatrist , and project worker and contained contact information , details of mental and physical illnesses , treatments , indicators for relapse , and advance statements of preferences for care in the event of future relapse . Main outcome measures Admission to hospital , bed days , and use of the Mental Health Act over 15 month follow up . Results Use of the Mental Health Act was significantly reduced for the intervention group , 13 % ( 10/80 ) of whom experienced compulsory admission or treatment compared with 27 % ( 21/80 ) of the control group ( risk ratio 0.48 , 95 % confidence interval 0.24 to 0.95 , P = 0.028 ) . As a consequence , the mean number of days of detention ( days spent as an inpatient while under a section of the Mental Health Act ) for the whole intervention group was 14 compared with 31 for the control group ( difference 16 , 0 to 36 , P = 0.04 ) . For those admitted under a section of the Mental Health Act , the number of days of detention was similar in the two groups ( means 114 and 117 , difference 3 , −61 to 67 , P = 0.98 ) . The intervention group had fewer admissions ( risk ratio 0.69 , 0.45 to 1.04 , P = 0.07 ) . There was no evidence for differences in bed days ( total number of days spent as an inpatient ) ( means 32 and 36 , difference 4 , −18 to 26 , P = 0.15 for the whole sample ; means 107 and 83 , difference −24 , −72 to 24 , P = 0.39 for those admitted ) . Conclusions Use of joint crisis plans reduced compulsory admissions and treatment in patients with severe mental illness . The reduction in overall admission was less . This is the first structured clinical intervention that seems to reduce compulsory admission and treatment in mental health services BACKGROUND People with borderline personality disorder frequently experience crises . To date , no r and omised controlled trials ( RCTs ) of crisis interventions for this population have been published . AIMS To examine the feasibility of recruiting and retaining adults with borderline personality disorder to a pilot RCT investigating the potential efficacy and cost-effectiveness of using a joint crisis plan . METHOD An RCT of joint crisis plans for community-dwelling adults with borderline personality disorder ( trial registration : IS RCT N12440268 ) . The primary outcome measure was the occurrence of self-harming behaviour over the 6-month period following r and omisation . Secondary outcomes included depression , anxiety , engagement and satisfaction with services , quality of life , well-being and cost-effectiveness . RESULTS In total , 88 adults out of the 133 referred were eligible and were r and omised to receive a joint crisis plan in addition to treatment as usual ( TAU ; n = 46 ) or TAU alone ( n = 42 ) . This represented approximately 75 % of our target sample size and follow-up data were collected on 73 ( 83.0 % ) participants . Intention-to-treat analysis revealed no significant differences in the proportion of participants who reported self-harming ( odds ratio ( OR ) = 1.9 , 95 % CI 0.53 - 6.5 , P = 0.33 ) or the frequency of self-harming behaviour ( rate ratio ( RR ) = 0.74 , 95 % CI 0.34 - 1.63 , P = 0.46 ) between the two groups at follow-up . No significant differences were observed between the two groups on any of the secondary outcome measures or costs . CONCLUSIONS It is feasible to recruit and retain people with borderline personality disorder to a trial of joint crisis plans and the intervention appears to have high face validity with this population . However , we found no evidence of clinical efficacy in this feasibility study BACKGROUND The CRIMSON ( CRisis plan IMpact : Subjective and Objective coercion and eNgagement ) study is 
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There was evidence of benefits for liaison psychiatry teams in improving service-related outcomes in emergency departments , but this was often limited by potential confounding in most studies .
There was limited evidence regarding models to improve urgent and emergency access to crisis care to guide police officers in their Mental Health Act responsibilities .
There was positive evidence on clinical effectiveness and cost-effectiveness of crisis resolution teams but variability in implementation .
There was a large evidence base on promoting recovery with a range of interventions recommended by NICE likely to be important in helping people  stay well .