Feasibility testing and preliminary trial of a crisis planning and monitoring intervention to reduce compulsory readmissions : the FINCH Study

Background: Compulsory admissions to psychiatric hospital have been rising in England and some other higher income countries. Patients and families often find such admissions distressing, disempowering, and traumatising. Evidence on how to prevent compulsory admissions is still very limited. Collaborative crisis planning currently appears the most promising way of reducing compulsory readmissions, but can be challenging to implement. Methods: The overall aim of the FINCH (Feasibility trial of an INtervention to reduce Compulsory Hospitalisation) study was to develop a crisis planning and monitoring intervention to prevent repeat compulsory admissions, and to investigate the feasibility and acceptability of testing it through a randomised controlled trial. Drawing on a promising intervention developed in Switzerland and on qualitative interviews with service users and carers, a team including researchers, service users, carers and clinicians co-designed an intervention. This included formulating personalised plans for preventing and managing crises, with follow-up contacts over a year to support participants in implementing these. We carried out a feasibility randomised controlled trial of the intervention, with 80 participants recruited towards the end of compulsory hospital admissions in three areas of England. Results: Eighty participants were recruited within our target timeframe, 40 (as planned) from ethnic groups at disproportionately high risk of compulsory admission. Data were obtained for 86% of participants on compulsory admission, identified as a potential primary outcome for a full trial, but only for 51% on secondary outcomes measured at interview. Twenty-five of the 38 experimental group participants (66%) received at least three intervention sessions and developed a crisis plan of some kind. Qualitative data obtained from participating service users and carers suggested the intervention was acceptable and feasible, but that a high level of persistence and flexibility and considerable time were ...