title: What service users with psychotic disorders want in a mental health crisis or relapse: thematic analysis of joint crisis plans.
abstract: OBJECTIVE
  Recent legislation and guidance in England emphasises the importance of service user choice in care planning. However, it is not obvious how best to facilitate choices in care planning, and some clinicians are concerned that service users may make 'unwise' decisions. This study aimed to examine mental health service users' preferences and priorities in the event of a future mental health crisis or relapse.
  
  
  METHODS
  Thematic analysis of 221 joint crisis plans (JCP) developed by service users and their clinical team as part of the CRIMSON randomised controlled trial. Participants had a diagnosis of a psychotic disorder, at least one psychiatric admission in the past 2 years, contact with a community mental health team, and complex care needs.
  
  
  RESULTS
  Two major categories of preferences were identified: first the manner in which crisis care would be delivered; and second, specific treatment interventions. Most service users requested full involvement in decisions about their care, clear and consistent treatment plans, access to familiar clinicians who knew them well, and to be treated with respect and compassion. Some service users requested hospitalisation, but the majority preferred alternatives. The most frequently preferred intervention was care by a home treatment team. Just under half made a treatment refusal, the majority being for specific medications, alternatives were offered.
  
  
  CONCLUSIONS
  Joint crisis planning resulted in service users making choices that were clinically reasonable. The technique employed by JCPs appeared to empower service users by engaging them in a productive dialogue with their clinicians.
authors.affiliation: Section of Community Mental Health, Box PO29, Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK, simone.farrelly@kcl.ac.uk.
authors.forename: Simone
authors.initials: S
authors.lastname: Farrelly
authors.forename: Gill
authors.initials: G
authors.lastname: Brown
authors.forename: Diana
authors.initials: D
authors.lastname: Rose
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Doherty
authors.forename: R Claire
authors.initials: RC
authors.lastname: Henderson
authors.forename: Max
authors.initials: M
authors.lastname: Birchwood
authors.forename: Max
authors.initials: M
authors.lastname: Marshall
authors.forename: Waquas
authors.initials: W
authors.lastname: Waheed
authors.forename: George
authors.initials: G
authors.lastname: Szmukler
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D004739:England; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008603:Mental Health; D008605:Mental Health Services; D057240:Patient Preference; D010817:Physician-Patient Relations; D011618:Psychotic Disorders / Q000175:diagnosis / Q000628:therapy*; D012008:Recurrence