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

backgroundCompulsory admissions to psychiatric hospitals 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 to be the most promising way of reducing compulsory readmissions, but can be challenging to implement.

methodsThe 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.

resultsEighty 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 needed to deliver it.

conclusionsWe were readily able to recruit for this study, including from ethnic groups who are at high risk of compulsory admission, and delivery of our study intervention was feasible at least in a minimum form. Given the high financial and human costs of compulsory admission, there is an ethical and practical requirement for more research in this area: larger-scale research based on a refined version of our intervention has the potential to contribute.

trial registrationISRCTN, ISRCTN11627644. Registered prospectively 25th May 2022,  https://www.isrctn.com/ISRCTN11627644 .