A randomised trial is testing whether a simple written plan can keep people with psychosis out of compulsory detention. Compulsory admissions under the Mental Health Act are rising in England, despite policy commitments to treat people in the least restrictive way. The Joint Crisis Plan (JCP) is the only structured intervention shown to reduce compulsory treatment so far. It is a document created by a service user with staff and an independent facilitator, listing early warning signs of relapse, medication preferences, and treatment choices. The CRIMSON study is a multi-site randomised controlled trial comparing JCPs with usual care for people with a history of relapsing psychotic illness. If the JCP works, it could reduce the number of people forcibly detained, lower costs to the NHS, and improve patients’ sense of control and engagement with services. The trial also explicitly measures whether the plan reduces compulsory treatment for black service users, who are disproportionately affected by the Mental Health Act. Success would mean a low-cost, scalable tool that shifts mental health care toward genuine patient choice without requiring new drugs or technology.
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Background: Mental health policy in England emphasises that service users should exercise choice and be treated in the least restrictive way. Despite this, use of compulsory admissions under the Mental Health Act continues to rise. The Joint Crisis Plan (JCP) is so far the only structured intervention shown to reduce compulsory treatment. It aims to empower the holder and to help early detection and treatment of relapse of mental illness. Study design: A multi-site randomised controlled trial of Joint Crisis Plans compared with treatment as usual for people with a history of relapsing psychotic illness. The intervention: The JCP is developed by a mental health service user in collaboration with staff and an independent facilitator. The plan contains information including early warning signs of relapse, details of medication and treatment preferences. Outcomes assessed: (i) Proportion of service users admitted or detained under an order of the Mental Health Act during the follow-up period; (ii) Costs; (iii) Perceived coercion. (iv) Engagement with mental health services; (v) Therapeutic relationship; and (vi) reduced use of the Mental Health Act for the black service users.
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