CRIMSON [CRisis plan IMpact: Subjective and Objective coercion and eNgagement] protocol: a randomised controlled trial of joint crisis plans to reduce compulsory treatment of people with psychosis.
BACKGROUND
The use of compulsory treatment under the Mental Health Act (MHA) has continued to rise in the UK and in other countries. The Joint Crisis Plan (JCP) is a statement of service users' wishes for treatment in the event of a future mental health crisis. It is developed with the clinical team and an independent facilitator. A recent pilot RCT showed a reduction in the use of the MHA amongst service users with a JCP. The JCP is the only intervention that has been shown to reduce compulsory treatment in this way. The CRIMSON trial aims to determine if JCPs, compared with treatment as usual, are effective in reducing the use of the MHA in a range of treatment settings across the UK.


METHODS
This is a 3 centre, individual-level, single-blind, randomised controlled trial of the JCP compared with treatment as usual for people with a history of relapsing psychotic illness in Birmingham, London and Lancashire/Manchester. 540 service users will be recruited across the three sites. Eligible service users will be adults with a diagnosis of a psychotic disorder (including bipolar disorder), treated in the community under the Care Programme Approach with at least one admission to a psychiatric inpatient ward in the previous two years. Current inpatients and those subject to a community treatment order will be excluded to avoid any potential perceived pressure to participate. Research assessments will be conducted at baseline and 18 months. Following the baseline assessment, eligible service users will be randomly allocated to either develop a Joint Crisis Plan or continue with treatment as usual. Outcome will be assessed at 18 months with assessors blind to treatment allocation. The primary outcome is the proportion of service users treated or otherwise detained under an order of the Mental Health Act (MHA) during the follow-up period, compared across randomisation groups. Secondary outcomes include overall costs, service user engagement, perceived coercion and therapeutic relationships. Sub-analyses will explore the effectiveness of the JCP in reducing use of the MHA specifically for Black Caribbean and Black African service users (combined). Qualitative investigations with staff and service users will explore the acceptability of the JCPs.


CONCLUSIONS
JCPs offer a potential solution to the rise of compulsory treatment for individuals with psychotic disorders and, if shown to be effective in this trial, they are likely to be of interest to mental health service providers worldwide.


BACKGROUND
Current Controlled Trials ISRCTN11501328.
Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK. graham.thornicroft@kcl.ac.uk
Graham
G
Thornicroft
Simone
S
Farrelly
Max
M
Birchwood
Max
M
Marshall
George
G
Szmukler
Waquas
W
Waheed
Sarah
S
Byford
Graham
G
Dunn
Claire
C
Henderson
Helen
H
Lester
Morven
M
Leese
Diana
D
Rose
Kim
K
Sutherby
D000328:Adult; D016223:Advance Directives / Q000331:legislation & jurisprudence; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D003419:Crisis Intervention / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D004739:England; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D028642:Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence / Q000523:psychology*; D009937:Organizational Objectives; D010347:Patient Care Planning / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D057240:Patient Preference; D012008:Recurrence; D012107:Research Design; D016037:Single-Blind Method; D013997:Time Factors