Skip to main content
×
×
Home

Crisis resolution and home treatment teams: an evolving model

  • Sonia Johnson
Summary

Crisis resolution and home treatment teams have been introduced throughout England as part of a transformation of the community mental healthcare system. They aim to assess all patients being considered for acute hospital admission, to offer intensive home treatment rather than hospital admission if feasible, and to facilitate early discharge from hospital. Key features include 24-hour availability and intensive contact in the community, with visits twice daily if needed. This article describes the main characteristics and core interventions of these teams, and reviews the impact of their nationwide introduction. The model has evolved as a pragmatic response to difficulties in the acute care system, and its adaptation continues. Key challenges include achieving close integration with the rest of the mental health system and delivering continuity of care and effective therapeutic relationships despite the involvement of multiple workers in each crisis.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Crisis resolution and home treatment teams: an evolving model
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Crisis resolution and home treatment teams: an evolving model
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Crisis resolution and home treatment teams: an evolving model
      Available formats
      ×
Copyright
Corresponding author
Professor Sonia Johnson, Mental Health Sciences Unit, UCL, Charles Bell House, 67–73 Riding House Street, London W1W 7EY, UK. Email: s.johnson@ucl.ac.uk
Footnotes
Hide All

Declaration of Interest

None.

Footnotes
References
Hide All
Allen, D, Blaylock, W, Mieczkowski, S (2009) Local implementation of the crisis model: the Buckinghamshire community acute service. Psychiatrist 33: 252–4.
Barker, V, Taylor, M, Kader, I et al (2011) Impact of crisis resolution and home treatment services on user experience and admission to psychiatric hospital. Psychiatrist 35: 106–10.
Bindman, JP (2008a) The crisis resolution team within the community mental health system. In Crisis Resolution and Home Treatment in Mental Health (eds Johnson, S, Needle, J, Bindman, JP et al): 8596. Cambridge University Press.
Bindman, JP, Flowers, M (2008b) Practical psychosocial interventions. In Crisis Resolution and Home Treatment in Mental Health (eds Johnson, S, Needle, J, Bindman, JP et al): 137–50. Cambridge University Press.
Birchwood, M, McGorry, P, Jackson, H (1997) Early intervention in schizophrenia. British Journal of Psychiatry 170: 25.
Bracken, P (2001) The radical possibilities of home treatment: post-psychiatry in action. In Acute Mental Health Care in the Community: Intensive Home Treatment (ed Brimblecombe, N) 139–62. Whurr Publishers.
Bridgett, C, Polak, P (2003a) Social systems intervention and crisis resolution. Part 1: Assessment. Advances in Psychiatric Treatment 9: 424–31.
Bridgett, C, Polak, P (2003b) Social systems intervention and crisis resolution. Part 2: Intervention. Advances in Psychiatric Treatment 9: 432–8.
Caplan, G (1964) Principles of Preventive Psychiatry. Basic Books.
Carroll, A, Pickworth, J, Protheroe, D (2001) Service innovations: an Australian approach to community care – the Northern Crisis Assessment and Treatment Team. Psychiatric Bulletin 25: 439–41.
Carse, J, Panton, NE, Watt, A (1958) A district mental health service: the Worthing experiment. Lancet 1: 3941.
Centre for Social Justice (2011) Completing the Revolution: Transforming Mental Health and Tackling Poverty. CSJ.
Cotton, MA, Johnson, S, Bindman, J et al (2007) An investigation of factors associated with psychiatric hospital admission despite the presence of crisis resolution teams. BMC Psychiatry 7: 52.
Crompton, N, Daniel, D (2007) Guidance Statement on Fidelity and Best Practice for Crisis Services. Department of Health/Care Services Improvement Partnership.
Dean, C, Phillips, J, Gadd, EM et al (1993) Comparison of community based service with hospital based service for people with acute, severe psychiatric illness. BMJ 307: 473–6.
Department of Health (2000) The NHS Plan: A Plan for Investment, A Plan for Reform. TSO (The Stationery Office).
Department of Health (2001) Crisis Resolution/Home Treatment Teams: The Mental Health Policy Implementation Guide. Department of Health.
Department of Health (2011) The 2010/11 National survey of Investment in Mental Health Services. Department of Health.
Dibben, C, Saheed, H, Stagias, K et al (2008) Crisis resolution and home treatment teams for older people with mental illness. Psychiatric Bulletin 32: 268–70.
Drake, RE, Bond, G, Essock, SM (2009) Implementing evidence-based practices for people with schizophrenia. Schizophrenia Bulletin 35: 704–13.
Flowers, M, Hoult, J (2008) Planning and implementing a local service. In Crisis Resolution and Home Treatment in Mental Health (eds Johnson, S, Needle, J, Bindman, JP et al): 295306. Cambridge University Press.
Glover, G, Arts, G, Babu, KS (2006) Crisis resolution/home treatment teams and psychiatric admission rates in England. British Journal of Psychiatry 189: 441–5.
Hasselberg, N, Grawe, R, Johnson, S et al (2011) An implementation study of the crisis resolution team model in Norway: are the crisis resolution teams fulfilling their role? BMC Health Services Research 11: 96.
Healthcare Commission (2008) The Pathway to Recovery: A Review of Acute Inpatient Mental Health Services. Healthcare Commission.
Hopkins, C, Niemiec, S (2007) Mental health crisis at home: service user perspectives on what helps and what hinders. Journal of Psychiatric and Mental Health Nursing 14: 310–8.
Hoult, J (1991) Home treatment in New South Wales. In The Closure of Mental Hospitals (eds Hall, P, Brockington, IF) 107–14. Gaskell.
Hurcom, C, Parnham, L, Horler, M et al (2008) Briefing Paper: The Role of Psychologists Working in Crisis Resolution Home Treatment (CRHT) Teams. British Psychological Society.
Jethwa, K, Galappathie, N, Hewson, P (2007) Effects of a crisis resolution and home treatment team on in-patient admissions. Psychiatric Bulletin 31: 170–2.
Johnson, S, Nolan, F, Hoult, J et al (2005a) Outcomes of crises before and after introduction of a crisis resolution team. British Journal of Psychiatry 187: 6875.
Johnson, S, Nolan, F, Pilling, S et al (2005b) Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study. BMJ 331: 599.
Johnson, S, Thornicroft, G (2008a) The development of crisis resolution and home treatment teams. In Crisis Resolution and Home Treatment in Mental Health (eds Johnson, S, Needle, J, Bindman, JP et al): 921. Cambridge University Press.
Johnson, S, Needle, J (2008b) Crisis resolution teams: rationale and core model. In Crisis Resolution and Home Treatment in Mental Health (eds Johnson, S, Needle, J, Bindman, JP et al): 6784. Cambridge University Press.
Johnson, S, Lloyd-Evans, B, Morant, N et al (2010) Alternatives to standard acute in-patient care in England: roles and populations served. British Journal of Psychiatry 197 (suppl 53): s613.
Johnson, S, Osborn, DPJ, Araya, R et al (2012) Morale in the English mental health workforce: questionnaire survey. British Journal of Psychiatry 201: 239–46.
Katschnig, H, Cooper, J (1991) Psychiatric emergency and crisis intervention services. In Community Psychiatry: The Principles (eds Bennett, DH, Freeman, HL) 517–42. Churchill Livingstone.
Keown, P, Tacchi, MJ, Niemiec, S et al (2007) Changes to mental healthcare for working age adults: impact of a crisis team and an assertive outreach team. Psychiatric Bulletin 31: 288–92.
Kingdon, D (2011) Transforming mental health services. British Journal of Psychiatry 199: 12.
Lyons, C, Hopley, P, Burton, CR et al (2009) Mental health crisis and respite services: service user and carer aspirations. Journal of Psychiatric and Mental Health Nursing 16: 424–33.
Marks, IM, Connolly, J, Muijen, M et al (1994) Home-based versus hospital-based care for people with serious mental illness. British Journal of Psychiatry 165: 179–94.
McCrone, P, Johnson, S, Nolan, F et al (2009a) Economic evaluation of a crisis resolution team: a randomized controlled trial. Epidemiologia e Psichiatria Sociale 18: 54–8.
McCrone, P, Johnson, S, Nolan, F et al (2009b) Impact of a crisis resolution team on service costs in the UK. Psychiatrist 33: 17–9.
Mezzina, R, Vidoni, D (1995) Beyond the mental hospital: crisis intervention and continuity of care in Trieste. International Journal of Social Psychiatry 41: 120.
Middleton, H, Glover, G, Onyett, S et al (2008) Crisis resolution/home treatment teams, gate-keeping and the role of the consultant psychiatrist. Psychiatrist 32: 378–9.
Mind (2011) Listening to Experience: An Independent Report into Acute and Crisis Mental Healthcare. Mind.
Minghella, E, Ford, R, Freeman, T et al (1998) Open all Hours: 24-hour Response for People with Mental Health Emergencies. Sainsbury Centre for Mental Health.
National Audit Office (2007) Helping People through Mental Health Crisis: The Role of Crisis Resolution and Home Treatment Teams. National Audit Office.
Nelson, T, Johnson, S, Bebbington, P (2009) Satisfaction and burnout among staff of crisis resolution, assertive outreach and community mental health teams. Social Psychiatry and Psychiatric Epidemiology 44: 541–9.
Onyett, S, Linde, K, Glover, G et al (2008) Implementation of crisis resolution/home treatment teams in England: national survey 2005–2006. Psychiatric Bulletin 32: 374–7.
Pelosi, AJ, Jackson, GA (2000) Home treatment – enigmas and fantasies. BMJ 320: 308–9.
Polak, P (1970) Patterns of discord: goals of patients, therapists, and community members. Archives of General Psychiatry 23: 277–83.
Polak, PR, Kirby, MW (1976) A model to replace psychiatric hospitals. Journal of Nervous and Mental Disease 162: 1322.
Querido, A (1935) Community mental hygiene in the city of Amsterdam. Mental Hygiene 19: 177–95.
Ramsey, S, Shaw, W (2008) Recruiting, training and retaining an effective crisis team. In Crisis Resolution and Home Treatment in Mental Health (eds Johnson, S, Needle, J, Bindman, JP et al): 307–18. Cambridge University Press.
Rose, D (2001) Users' Voices: The Perspectives of Mental Health Service Users on Community and Hospital Care. Sainsbury Centre for Mental Health.
Scott, D, Starr, I (1985) A 24-hour family orientated psychiatric and crisis service. Journal of Family Therapy 3: 177–86.
Smyth, M, Hoult, J (2000) The home treatment enigma. BMJ 320: 305–8.
Stein, LI, Test, MA (1980) Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry 37: 392–7.
Winness, MG, Borg, M, Kim, HS (2010) Service users' experiences with help and support from crisis resolution teams: a literature review. Journal of Mental Health 19: 7587.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Crisis resolution and home treatment teams: an evolving model

  • Sonia Johnson
Submit a response

eLetters

CRTs and Psychiatric Diagnoses

Dieneke Hubbeling, consultant psychiatrist
15 April 2013

Sir:

Johnson described how crisis resolution and home treatment teams (CRTs) are now an integral part of acute mental health services in the UK.CRTs focus on people with severe mental illness who otherwise would have been admitted to hospital (Johnson 2013). Johnson rightly remarked that further research into the effectiveness of home treatment teams is necessary.

Although not explicitly discussed in the paper, the diagnostic mix ofpatients covered by a CRT is likely to be critical to its effectiveness (Hubbeling 2012). Generally, in CRTs and elsewhere, the treatment providedis determined by the diagnosis, taking into account specific personal circumstances and patient preference. Interventions for someone with a diagnosis of schizophrenia presenting with a psychotic relapse are very different from interventions for someone with a diagnosis of borderline personality disorder (BPD) presenting with self-harm behaviour.

Although there has not been a specific randomised controlled trial ofhome treatment for psychotic relapse, one can assume that the main therapeutic intervention is likely to be taking appropriate medication which can be readily implemented in a home treatment setting. It is much less apparent what type of home treatment should be recommended in response to the crises experienced by individuals with BPD. The database of available studies is limited. There has only been one RCT of crisis intervention with BPD, which evaluated a 3 week Dialectical Behavioural Therapy (DBT) programme (McQuillan 2005). Despite this study purporting toassess the value of DBT for crisis intervention, it can only manage to be indirectly linked to CRT, since the treatment was not administered in the home. The general view is that one would need to offer a consistent long-term approach from a small number of team members (e.g. Davison 2002). This will be difficult to realise in a 24 hour-a-day home treatment team with different members of staff working different shifts.

Future research should concentrate on providing information about thediagnostic case-mix with which the CRT approach is likely to yield the best patient-reported outcomes and treatment experience. Given the investment in CRTs it is imperative for us to identify where the best value may come from for home treatment interventions. We should also thinkabout whether the structure of CRTs, primarily designed for dealing with acute psychosis, may need to be reconsidered for individuals with personality problems.

Dieneke Hubbeling and Robert Bertram

References

Davison SE (2002) Principles of managing patients with personality disorder. Advances in Psychiatric Treatment 8: 1-9.

Hubbeling D, Bertram R (2012) Crisis resolution teams in the UK and elsewhere. Journal of Mental Health 21: 285-95.

Johnson S (2013) Crisis resolution and home treatment teams: an evolving model. Advances in Psychiatric Treatment 19: 115-23.

McQuillan A, Nicastro R, Guenot F, et al. (2005) Intensive Dialectical Behavior Therapy for Outpatients With Borderline Personality Disorder Who Are in Crisis. Psychiatric Services. 56: 193-97.

... More

Conflict of interest: None declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *