An investigation of the association between characteristics of local crisis care systems and service use in a national survey

Background In England, a range of mental health crisis care models and approaches to organising crisis care systems have been implemented, but characteristics associated with their effectiveness are poorly understood. Aims To i) develop a typology of catchment area mental health crisis care systems and ii) investigate how crisis care service models and system characteristics relate to psychiatric hospital admissions and detentions. Methods Data about crisis systems were obtained from a 2019 English national survey. Latent class analyses were conducted to identify discernible typologies, and mixed effects negative binomial regression models were fitted to explore associations between crisis care models and admissions and detention rates, obtained from nationally-reported data. Results No clear typology of catchment area crisis care systems emerged. Regression models suggested that provision of a crisis telephone service within the local crisis system was associated to a 11.6% lower admissions rate and a 15.3% lower detention rate. Provision of a crisis café was associated with a 7.8% lower rate of admissions. The provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with a 12.8% higher rate of admissions. Conclusions The configuration of crisis care systems varies considerably in England, but we could notderive a typology which convincingly categorised crisis care systems. Our results suggest that a crisis phone line and a crisis café may be associated with lower rates of admission, but crisis assessment teams, separate from home treatment teams, may not be associate to reductions in hospital admission and detentions. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted by the NIHR Policy Research Unit (PRU) in Mental Health. NS'research is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King's College Hospital NHS Foundation Trust. NS is a member of King's Improvement Science, which offers co-funding to the NIHR ARC South London and is funded by King's Health Partners (Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust), and Guy's and St Thomas' Foundation. The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or its arm's length bodies, or other government departments. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors