Short-stay crisis units for mental health service users on crisis care pathways: systematic review and meta-analysis

Background
Internationally, an increasing proportion of Emergency Department (ED) visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Responding to these pressures, healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units.
Aims
This systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units.
Method
We searched Embase, MEDLINE, CINAHL and PsycINFO up to March 2021 in this pre-registered review (PROSPERO: CRD42019151043). All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed risk of bias of included studies using Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) and Risk of Bias in randomized trials (RoB 2).
Results
Data from twelve studies from six countries (Australia, Belgium, Canada, the Netherlands, UK and US) and 67,505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared to 49.8% before intervention; difference = 7.8%; p < 0.0001) and increase outpatient follow-up care (χ2=37.42; d.f.=1, p<0.001). Meta-analysis indicated a significant reduction in length of ED stay of 164.24 minutes (95%CI -261.24 to -67.23 minutes; p<0.001), and number of inpatient admissions, odds ratio=0.55 (95% CI 0.43 to 0.68; p<0.001).
Conclusions
Short-stay mental health crisis units are effective for two important service-defined outcomes; reducing ED wait times and inpatient admissions. Further research should investigate impact of units on patient experience, and clinical and social outcomes.

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