title: Pathways through care of severely mentally ill individuals experiencing multiple public crisis events: a qualitative description.
abstract: BACKGROUND
  Patients experiencing severe mental illnesses (SMI) need continuing support and remain vulnerable in many domains. Crisis interventions and compulsory admissions are common, causing a huge burden on police, health workers, the community and patients. The aim of this retrospective case-file study is to determine profiles of SMI-patients and their pathways through care among those experiencing multiple public crisis events.
  
  
  METHODS
  Data from a larger study of 323 SMI-patients in Amsterdam were used. These data were linked to data of the public mental health care (PMHC) in order to identify persons that experienced crisis interventions (CI's) between January 2004 and November 2012. The cut-off point for inclusion in the study population was set on three CI's, resulting in a group of 47 SMI-patients. PMHC and mental health care (MHC) data were linked in order to identify profiles in patterns of care. Qualitative content analysis was used to gather and analyze chronological timelines.
  
  
  RESULTS
  Three profiles were identified: SMI-patients with CI's during continuous MHC, SMI-patients with CI's after discharge and SMI-patients with CI's during unstable MHC. For each profile events prior to, during and after a CI were identified.
  
  
  CONCLUSIONS
  PMHC and MHC can possibly identify cases with a high risk of CI's and predict these events based on the results of this study. CI's seem inevitable for a group of SMI-patients in care but they do not only require acute psychiatric care. The collaboration between MHC, PMHC and police could be further developed in a quick and effective triage in order to tackle the complexity of problems of the SMI-patients.
authors.affiliation: Public Health Service Amsterdam, Department of Epidemiology, Health Promotion, and Care Innovation, Amsterdam, The Netherlands.
authors.forename: Mariëtte J
authors.initials: MJ
authors.lastname: Hensen
authors.affiliation: Arkin Mental Health Care, Research department, Amsterdam, The Netherlands.
authors.forename: Liselotte D
authors.initials: LD
authors.lastname: de Mooij
authors.affiliation: GGZ Ingeest Mental Health Care, Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Theunissen
authors.affiliation: Arkin Mental Health Care, Research department, Amsterdam, The Netherlands.
authors.forename: Jack
authors.initials: J
authors.lastname: Dekker
authors.affiliation: Public Health Service Amsterdam, Department of Public Mental Health Care, Amsterdam, The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Willemsen
authors.affiliation: Arkin Mental Health Care, Department of Emergency Psychiatry, Amsterdam, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Zoeteman
authors.affiliation: Arkin Mental Health Care, Research department, Amsterdam, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Peen
authors.affiliation: Public Health Service Amsterdam, Department of Epidemiology, Health Promotion, and Care Innovation, Amsterdam, The Netherlands. mdwit@ggd.amsterdam.nl.
authors.forename: Matty A S
authors.initials: MA
authors.lastname: de Wit
mesh_terms: D000328:Adult; D003419:Crisis Intervention; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D028642:Persons with Psychiatric Disorders / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Crisis intervention; Mental health care; Pathways through care; Public mental health care; Severe mental illness