In England, when someone experiences a severe mental health crisis, services can admit them to hospital without their consent under the Mental Health Act (MHA), often referred to as being “sectioned”. Even when such a compulsory detention is intended to keep someone safe, it can be frightening, traumatic and deeply disempowering. As one patient wrote in the BMJ, “For me that meant restraint, injected drugs, and forced tube feeding.”
Compulsory detention under the MHA has been steadily rising over the past decade, becoming a common feature of crisis care. A previous Mental Elf blog by Luke Sheridan Rains (2018) highlighted that detentions in England increased by nearly 50% over ten years.
An uncomfortable truth is that this risk is not shared equally: As an example, Ian Cummins (2019), blogging on a meta-analysis in The Lancet Psychiatry, reported that compulsory detention and readmission are significantly higher for Black and minority ethnic (BAME) populations compared to White British people. Given this backdrop, it is not surprising that reducing compulsory detention has become a major policy priority in the UK. But how do we do it?
One proposed solution is advanced crisis planning, supporting people to identify early warning signs, triggers, what helps, and what they would want from services if they became unwell again. In practice, however, crisis plans are often written once and then not used, meaning they don’t always shape what happens in a future crisis.
FINCH stands for Feasibility trial of an INtervention to reduce Compulsory Hospitalisation, adapting a Zürich-based crisis planning model for the UK. The intervention aimed to make crisis planning an active, ongoing process rather than a document filed away and forgotten. With a trained clinician, participants worked to:
- Understand how their crisis developed;
- Create a personalised crisis plan;
- Record treatment preferences for future crises (an advance statement);
- Identify recovery goals; and
- Receive regular check-ins over a year, so the plan could be revisited and updated.
Before running a large, expensive trial, researchers often need to answer a basic question: Is this actually doable?
Compulsory detention under the Mental Health Act is rising in England and disproportionately affects Black and minority ethnic groups, prompting urgent calls for safer, less coercive crisis care.
Methods
FINCH recruited 80 adults detained under Section 2 or 3 of the Mental Health Act who were assessed as having the capacity to consent, across three NHS Trusts. While the capacity requirement was ethically necessary, it may limit representativeness by excluding the most acutely unwell patients. Recruitment relied partly on ward staff identifying eligible patients, which introduces some potential for selection bias.
Participants were randomised 1:1 using a computer-generated sequence, stratified by site and ethnicity, a methodological strength given known inequalities in compulsory detention. Outcome assessors were blinded where possible, although intervention staff were not, leaving some risk of bias.
Pre-specified progression criteria (recruitment rates, retention, fidelity and data completeness) were set in advance, strengthening transparency and reducing post-hoc interpretation. Analyses were primarily descriptive, which is appropriate for feasibility work.
Overall, the design, randomisation procedures and predefined criteria suggest the methods were broadly robust for answering the feasibility question, though limitations in representativeness, blinding and intervention standardisation should be considered.
Results
Was the study doable?
Yes.
- Recruitment: The team recruited 80 participants in 9 months, meeting their target across three NHS Trusts.
- Equity target: 40 participants (50%) were from ethnic groups at higher risk of compulsory detention, meeting the diversity goal.
- Random allocation (“randomisation”): Participants were randomly placed into one of two groups – like flipping a coin – so there was a 50:50 chance of joining either FINCH (n=38) or Usual care (n=42).
Follow-up and questionnaires
- Main outcome follow-up at 12 months: Data on the primary outcome were available for 69 out of 80 people (86%), which met the team’s target for follow-up.
- Interview-based questionnaires: Fewer people completed the longer interview-style measures with 46/80 (58%) at 6 months and 41/80 (51%) at 12 months.
In plain terms, the trial could track the key outcome well, but it was harder to collect all the extra questionnaire data.
Did people actually receive the planned FINCH intervention?
Partly. This is an important part of feasibility: can the intervention be delivered in real services?
- Of the 38 allocated to FINCH, 32 started
- 25 people (66%) received what the team defined in advance as the minimum meaningful amount (at least three sessions, plus partial development of a crisis plan).
- Staff described practical barriers in services (like limited time) that got in the way.
What happened at 12 months?
The primary outcome was repeat compulsory detention under the Mental Health Act within 12 months. (This is the main outcome the study focused on). Among the 69 participants with outcome data, 49 (71%) were not compulsorily detained again.
- Usual care: 23/34 (67.6%) avoided detention
- FINCH: 26/35 (74.3%) avoided detention
That’s an absolute difference of 6.7 percentage points in favour of FINCH. The statistical estimate (odds ratio 1.38, 95% CI 0.48 to 3.96) was uncertain and not statistically significant, which is to be expected in a feasibility study.
What about people from higher-risk ethnic groups?
In the subgroup of participants from ethnic groups at higher risk of detention, the pattern was similar and slightly stronger, but should be treated as exploratory (a “possible signal”, not a firm conclusion).
- Usual care: 10/17 (58.8%) avoided detention
- FINCH: 12/17 (70.6%) avoided detention
That’s an absolute difference of 11.8 percentage points in favour of FINCH. The estimated NNT in this subgroup was about 9 (odds ratio 1.68, 95% CI 0.41 to 6.96). Again, the study wasn’t powered to confirm effectiveness, especially not within subgroups.
Safety and costs
- Serious adverse events: Mostly hospital admissions, not thought to be caused by the study, and similar in both groups.
- Costs: Average total 12-month costs (including the intervention) were:
- £41,840 in usual care
- £35,962 in FINCH
- Difference: £5,872 lower with FINCH (95% CI −£22,204 to £9,781), not statistically significant.
What did the interviews suggest?
Interviews with 8 service users and 9 clinicians suggested FINCH was generally acceptable. People particularly valued crisis planning and the therapeutic relationship, while staff highlighted challenges delivering FINCH within tight time and capacity limits.
FINCH could be delivered and evaluated in the NHS, with a good 12-month follow-up (86%), and results leaned towards fewer repeat detentions.
Conclusions
FINCH does not show that supported crisis planning definitely reduces compulsory detention, and this study was never designed to answer that. Feasibility trials are mainly about one question: can we run a bigger, definitive study successfully? On that front, FINCH performed well. The team showed they could:
- Recruit participants across multiple NHS sites,
- Include groups who are disproportionately affected by detention,
- Randomise people fairly,
- Deliver the intervention (although service constraints limited full uptake), and
- Retain most participants for the main outcome at 12 months.
The outcomes also hinted at potential benefit (fewer repeat detentions in the FINCH group), but these findings should be treated as early signals, not proof, especially because feasibility studies are too small to reliably test effectiveness.
Overall, FINCH looks possible to implement, acceptable to participants and clinicians, and promising enough to justify a larger, fully powered trial that can properly test whether it reduces repeat compulsory detention.
FINCH doesn’t yet prove effectiveness, but shows that supported crisis planning can be delivered and studied in NHS settings, and is promising enough to justify a larger trial.
Strengths and limitations
Strengths:
- One major strength of FINCH was its co-production approach. People with lived experience were involved in designing the intervention, increasing its relevance and acceptability.
- The study successfully recruited 80 participants within the planned timeframe, including 50% from ethnic groups known to be at higher risk of compulsory detention. This is important given longstanding inequalities in detention rates.
- The primary outcome, repeat compulsory admission, was based on routine data, reducing reliance on self-report and increasing objectivity.
- The intervention itself addressed a known implementation gap: crisis plans are often written once and then forgotten. FINCH attempted to make crisis planning an active, ongoing process supported over time.
Limitations:
However, several methodological concerns limit how far we can interpret the findings.
- Small sample and wide uncertainty
With only 80 participants, the study was not powered to detect statistically significant differences. The apparent benefit, particularly in high-risk ethnic groups, may reflect random variation. - Selection bias
Participants had to consent after a compulsory admission. Those most traumatised or distrustful of services may have declined, potentially skewing the sample toward individuals more open to engagement. - Performance bias
Participants in the intervention group received additional clinician time and structured support. It is difficult to disentangle whether outcomes reflect the crisis plan itself or simply increased therapeutic contact. - Attrition bias
Secondary outcomes such as recovery and quality of life had considerable drop-off by 12 months. This limits conclusions about broader clinical impact beyond detention rates. - Implementation challenges
Only around two-thirds of intervention participants received the minimum planned “dose” (at least three sessions and a crisis plan). Staff turnover and limited protected time made consistent delivery difficult. This raises questions about scalability in routine NHS settings. - Structural confounding
Compulsory detention is shaped by broader systemic factors, including institutional practices and racialised pathways into care. An individual-level crisis planning intervention may reduce risk at the margins, but cannot address structural drivers alone.
Co-produced and equity-focused, FINCH showed strong feasibility, but small sample size, delivery challenges, and wide confidence intervals limit conclusions about effectiveness.
Implications for practice
Should this evidence change practice? Not yet at a system-wide level, but it should influence how crisis planning is conceptualised and delivered. The study highlights a key problem in current services: crisis plans are often written once and not used. FINCH suggests that crisis planning may only be meaningful when it is relational, iterative, and supported over time.
- Crisis planning should be treated as an ongoing process rather than a static document.
- Protected clinician time is crucial if such interventions are to be delivered with fidelity.
- Starting crisis planning earlier during inpatient admission may improve continuity.
- Routine data (e.g., readmissions) may be more reliable than relying solely on interview follow-up.
- Peer workers could potentially deliver parts of the intervention with appropriate support.
Given persistent ethnic inequalities in compulsory detention, interventions showing even preliminary promise in high-risk groups deserve policy attention. However, policymakers should avoid overinterpreting early signals from a feasibility study. Reducing coercion likely requires both relational interventions like FINCH and broader structural reforms addressing service accessibility, trust, and systemic inequities.
Crisis plans may only work when they are active, relational, and revisited over time, requiring protected clinician time and attention to wider structural inequalities.
Statement of interests
As MSc Clinical Mental Health Sciences students at UCL, we want to clarify that while some individuals involved in the discussed research are UCL faculty, we have no direct involvement in the study, its review, or publication. This blog was created independently for our coursework and reflects our interpretation. We have no conflicts of interest beyond our academic relationship with the study.
Contributors
Thanks to the UCL Mental Health MSc students who wrote this blog from the Glover Student Group: Simron Zahoor, Nirjara Sethia, Alice Qian and Jade Ngan.
UCL MSc in Mental Health Studies
This blog has been written by a group of students on the Clinical Mental Health Sciences MSc at University College London. A full list of blogs by UCL MSc students can be found here.
We regularly publish blogs written by individual students or groups of students studying at universities that subscribe to the National Elf Service. Contact us if you’d like to find out more about how this could work for your university.
Edited by
Dafni Katsampa.
Links
Primary paper
Sonia Johnson, Mary Birken, Rafael Gafoor, Patrick Nyikavaranda, Ariana Kular, Jordan Parkinson, Kathleen Lindsay Fraser, Jackie Hardy, Mark Keith Holden, Lizzie Mitchell, Janet Seale, Cady Stone, Valerie Christina White, Louise Blakley, Barbara Lay, Lisa Wood, Nick Freemantle, Henrietta Mbeah-Bankas, Paul McCrone, Fiona Lobban & Brynmor Lloyd-Evans (2025b). Feasibility testing and preliminary trial of a crisis planning and monitoring intervention to reduce compulsory readmissions: the FINCH Study. BMC Medicine, 23(1), 695.
Other references
Anonymous. (2017). What it feels like to be compulsorily detained for treatment. BMJ, 358, j3546.
Cummins, I. (2019, May 29). Compulsory detention under the Mental Health Act: ethnic variations. National Elf Service.
Rains, L. S. (2018, November 20). Mental Health Act detentions are increasing, but why? National Elf Service.
