We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To evaluate the effects of a crisis resolution and home-based treatment team upon in-patient admission rates. We collected data for 2 years prior and 1 year post-implementation of such a service in Leeds. The chosen time frame allowed the new service to settle in and controlled for seasonal variations.
There were 4353 admissions during the period of the study, with 3325 in the 2 years prior to the service and 1028 in the year after. Generalised linear analysis found a 37.5% reduction in monthly admissions after the introduction of the team (P < 0.0001).
This study shows that in everyday clinical practice crisis resolution and home treatment teams lead to a sustained reduction in in-patient admission rates.
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.
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.
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.
Email your librarian or administrator to recommend adding this journal to your organisation's collection.
Ravimal Galappaththi, Staff Grade Psychiatrist, CRHT and STEP teams
11 June 2007
I read this paper with much interest. My emphases are about how beneficial CRHT input is in patients with serious mental health problems and severe enduring mental illnesses.
Although not clearly substantiated by evidence base in terms of RCTs or meta-analysis, CRHT services are generally accepted to reduce the hospital admissions at least in short term. In a nutshell CRHT is mostly forcussed on clients undergoing time limited periods of instability in reaction to stress. Experience reveals, clients presenting with adjustmentreactions and people with serious mental illnesses presenting in crisis, who have had previous stability in their lives may satisfactorily respond to crisis intervention.
This study and most similar studies do not give precise information about the diagnosis and nature of clients responsible for reduction in admissions, although an overall reduction is apparent. Most studies also do not give information on long term outcome of clients.
In most studies, reduction in admission rate is the main outcome measure. Studies do not analyze the psycho-social functioning of patients in between admissions and following discharge. Lack of this evidence leaves us with difficulty to use stringent criteria in patient selection. On the other hand, effective liaison between CRHT (short term focus), community mental health teams, rehab and recovery (long term focus) as well as GP services are minimal. Unless continuity of care is effectively organized this may well do more harm than good to the above client population. Clients who either suffer severe enduring mental illnesses or serious mental health problems and who present in repeated crisis episodesdo not appear to be offered a satisfactory alternative.
The time has come to research the effectiveness of CRHT services, focussing on patients' quality of life so that we will be equipped with a decent evidence base, which will guide us in select appropriate clients both for crisis intervention and home treatment. I think in addition to reducing admissions, and cost effectiveness strategies, patient’s psychosocial functioning needs to be taken into consideration when commenting on effectiveness of CRHT services. ... More
Conflict of interest: None Declared
Write a replyBack to top
Ahmed S Huda, Locum Consultant Psychiatrist
16 May 2007
The authors report a reduction in the numbers admitted (by a total ofabout 54 admissions "saved" a month). What would be interesting to know ishow many cases were diverted into the new teams in the new period.
If the numbers of cases taken on by the new teams were roughly equivalent to the number of admissions reduced then it is clear that the new teams are reducing admissions efficiently.
If the number of cases diverted to the new teams are much less than the reduction in admissions to the inpatient unit then it suggests that level of need for urgent admission was much lower during the period where the new teams were available(perhaps there was less need for "innappropriate" admissions) and the effect of the new teams was much lessdramatic.
If the number of cases admitted to the new teams was far greater thanthe number of admssions "saved" then this suggests that the new teams are providing increased support and care to large numbers of cases that would not have passed the admission threshold in the past. That is to say the new teams were increasing the numbers of people offered extra resources ofcare. This may or may not be a good thing in itself but it certainly meansan increased cost to the healthcare provider and may not therefore cost less than an "old-fashioned" service without these new teams.
Of course 2 wards were closed in the first month of evaluating the new teams. Bed availablity is obviously a major factor in determining numbers of admissions: if there are no beds then you can't admit anybody. Even if there are only 1 or 2 available cases may not be admitted unless the situation is desperate and so this would further drive down numbers of admissions. You therefore can not say what proportion the effect on reducing numbers of admissions was attributable to the new teams.
This data (particularly numbers diverted to the new teams) should be easily available. ... More
Conflict of interest: None Declared
Write a replyBack to top