Crisis Card: Control in times of crisis

Lia van der Ham (VU University Amsterdam, The Netherlands)Nel van kempen (Pro Persona, The Netherlands)

Advance directives in mental health care: a qualitative evaluation of experiences with the crisis card

Advance directives

Advance statements

Advance agreements

“a document specifying a person's preferences for treatment, should he or she lose capacity to make such decisions in the future”¹

¹ Campbell & Kisely (2010)

Personal data Contact persons

Physical/ Psychological informationWhat does the crisis look like What (not) to do in crisis

MedicationPractical information

Agreements

Advance directives in mental health care: a qualitative

evaluation of experiences with the crisis card

Crisis CardUK:1989

Netherlands: 1999

Pro Persona, 2008: 90 crisis cards

Advance directives in mental health care: a qualitative evaluation of experiences with the crisis card

• use of the crisis card in crisis• effects of the crisis card• implementation of the crisis card

Interviews with 15 stakeholders:– 4 patients– 1 patient-relative– 6 care providers (3 out-patient/ 2 in-patient)– 1 police representative– 1 ‘GP emergency care centre’ representative– 2 Crisis card workers

Advance directives in mental health care: a qualitative

evaluation of experiences with the crisis card

Use of the crisis card

• Patients: 3 patients out of 4 used the crisis card– Situation: street, supermarket and fun park

• Hulpverleners PP: None

• GP emergency centre: None

• Police: 2 times

Patient“I used it several times; once in a supermarket. I panicked and gave it to an employee. He stayed with me untill I was allright.”

Psychosocial effects

• Insight/Understanding

• Security

• Empowerment/ Autonomy

Effects of the crisis card

Effects of the crisis card

Patient“Having the crisis card makes me feel more secure when I’m on the street.”

Patient relative“It gives more peace of mind. From the outside you can’t see what is going on, but with the crisis card people will know.”

Effects on crisis situation

• Recognizing crisis

• Providing information

• Fast intervention

• Appropriate intervention

Effects of the crisis card

Care provider“I think it is very important to have a brief overview providing all information that is nessecary in a crisis situation. For example; the first signs, symptoms. It also states what someone explicitely doesn’t want in a crisis; that you shouldn’t touch someone, or just talk calmly. . . A lot of things that you can do very wrong if you don’t know somebody.”

Effects on crisis

• Prevent crisis

• Prevent escalation

• Recovery crisis

Effects of the crisis card

Effects of the crisis card

Care provider“I don’t think you can always prevent a crisis, but you can control it sooner. Because you act in an earlier stage, you can prevent it from getting worse.”

Effects on hospitalization

• Prevent hospitalization

• Shorter hospitalization

• Client centered care

Effects of the crisis card

Effects of the crisis card

Patient“First, when I didn’t feel well, I used the TOR-bed (time-out bed) more often, than when I didn’t have the crisis card.”

Implementation of the crisis card

Making a crisis card• Patients positive about process• Process can be confronting for patients• Balancing between patient preferences and

feasibility

Crisis card worker“It’s not about what we want or what the care providers wants; it’s about what the patients wants. Sometimes you have to find a balance between; others have to be able to understand information on the card, but for the patient it is important to state it the way he or she wants it.”

Implementation of the crisis card

Role of the crisis card worker• Personal experience with crisis important• Accessible for patients• Embedding in organisation helps

Patient“What I experience with the crisis card worker, or just people who have experience with a psychiatric condition, is that you don’t have to say as much; it is easier to understand each other.”

Crisis card worker at work

Implementation of the crisis card

Obstacles• Some care providers don’t refer to crisis

card

• Crisis card not widely known

• Embedding crisis card in care?

Care provider“It’s not a conscious decision, maybe it’s my shortcoming that it doesn’t come to my mind; I should think about it more often. Maybe it’s also partly because I don’t know the effect. If I knew the effect I would be more enthusiastic.”

Patient“It would be nice if more people would be familiar with the crisis card. Then, people wouldn’t react in such a strange way.”

Conclusion

• Positive attitude toward crisis card

• Positive experiences; various effects

• Lack of insight in actual use/ effects

• Dillemma: embedding card in care/ card as patient’s choice

Thank you for your attention!

Lia van der Ham (VU University Amsterdam, The Netherlands)E-mail: Lia.van.der.ham@falw.vu.nl

Nel van kempen (Pro Persona, The Netherlands)E-mail: n.van.kempen@propersona.nl