A comparison of clinical outcomes, service satisfaction, and well-being in people using Acute Day Units and Crisis Resolution Teams: a cohort study in England

Abstract

AbstractBackgroundFor people in mental health crisis, Acute Day Units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to Crisis Resolution Teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly in comparison to those receiving CRT care alone.AimsTo investigate readmission rates, satisfaction, and wellbeing outcomes for ADU and CRT service users.MethodsA cohort study comparing readmission to acute mental health care during a six-month period for ADU and CRT participants. Secondary outcomes included satisfaction (CSQ), wellbeing (SWEMWBS), and depression (CES-D).ResultsWe recruited 744 participants (ADU: 431, 58%; CRT 312, 42%) across 4 NHS Trusts/health regions. There was no statistically significant overall difference in readmissions; 21% of ADU participants (versus 23% CRT) were readmitted over 6 months (adjusted HR 0.78, 95%CI 0.54, 1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire (CSQ) scores (2.5, 95% CI 1.4 to 3.5, p<0.001) and wellbeing scores (1.3, 95%CI 0.4 to 2.1, p=0.004), and lower depression scores (−1.7, 95%CI −2.7 to −0.8, p<0.001) than CRT participants.ConclusionsService users who accessed ADUs demonstrated better outcomes for satisfaction, wellbeing, and depression, and no significant differences in risk of readmission compared to those who only used CRTs. Given the positive outcomes for service users, and the fact that ADUs are inconsistently provided across the country, their value and place in the acute care pathway needs further consideration and research.