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Implementation of crisis resolution/home treatment teams in England: national survey 2005–2006

  • Steve Onyett (a1), Karen Linde (a2), Gyles Glover (a3), Siobhan Floyd (a4), Steven Bradley (a5) and Hugh Middleton (a6)...

Abstract

Aims and Method

To describe implementation of crisis resolution/home treatment (CRHT) teams in England, examine obstacles to implementation and priorities for development. We conducted an online survey followed by a telephone or face-to-face interview among 243 teams.

Results

Considerable progress has been made in implementation with a subset of teams demonstrating strong fidelity to the Department of Health's guidance, particularly in urban settings. However, only 40% of teams described themselves as fully established. Many teams reported a high assessment load, understaffing, limited multidisciplinary input and patchy fulfilment of their gate-keeping role.

Clinical Implications

Successful implementation of the CRHT teams as alternatives to hospital admission requires resources for home treatment out of hours, effective systems working among local services, stronger local understanding and advocacy of the teams' role.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

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Dean, C., Phillips, J., Gadd, E., et al (1993) Comparison of a community-based service with a hospital-based service for people with acute, severe psychiatric illness. BMJ, 307, 473476.
Department of Health (2000) The NHS Plan. HMSO.
Department of Health (2002) Mental Health Policy Implementation Guide: Community Mental Health Teams. Department of Health.
Glover, G., Arts, G. & Babu, K. S. (2006) Crisis resolution/home treatment teams and psychiatric admission rates in England. British Journal of Psychiatry, 189, 441445.
Glover, G. & Johnson, S. (2008) The crisis resolution team model: recent developments and dissemination. In Crisis Resolution and Home Treatment in Mental Health (eds Johnson, S., Needle, J., Bindman, J. P., et al). Cambridge University Press.
Johnson, S., Nolan, F., Hoult, J., et al (2005) Outcomes of crisis before and after introduction of a crisis resolution team. British Journal of Psychiatry, 187, 6875.
Joy, C. B., Adams, C. E. & Rice, K. (2006) Crisis intervention for people with severe mental illnesses. Cochrane Database of Systematic Reviews, 4, CD001087.
Middleton, H., Glover, G., Onyett, S., et al (2008) Crisis resolution/home treatment teams, gate-keeping and the role of the consultant psychiatrist. Psychiatric Bulletin, 32, 378383.
Minghella, E. (1998) Home-based emergency treatment. Mental Health Practice, 2, 1014.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Implementation of crisis resolution/home treatment teams in England: national survey 2005–2006

  • Steve Onyett (a1), Karen Linde (a2), Gyles Glover (a3), Siobhan Floyd (a4), Steven Bradley (a5) and Hugh Middleton (a6)...
Submit a response

eLetters

Survey of Crisis Team Fidelity in the Wessex Deanery

Asif M Bachlani, ST 5 General Adult Psychiatry, Hampshire Partnership Foundation NHS Trust
29 October 2009

We conducted a small scale survey to investigate the management and operational procedures of local Crisis teams within the Wessex Deanery in a similar vein to the 2006 National Survey (Onyett, et al 2008)1. These findings were compared with the Department of Health’s Guidance Statement (2007)2.

Local Crisis Teams were contacted and a senior practitioner or team manager completed a proforma on their respective caseload, staffing, available resources and the service they provide. We were particularly interested to see if other Crisis Teams had day hospital facilities and whether they provided services outside of the 16 – 65 year age group as outlined by Department of Health (DoH 2001)3. These results were further compared to the national picture using the National Survey data.

Six out of the nine teams responded. 100% of the teams provided a 24hour service and gate-keep inpatient beds which was significantly higher than the National Survey (72% Gate-keep and 53% provided a 24hr service).

Only 33% (two teams) provided a service for 16 – 65 year olds, with the rest covering 18 – 65 year olds. Outside this scope 50% (three teams)provide services for LD clients, and only 17% (one team) for Older Persons. Only one team had a day hospital for clients.

There was a wide range of team staffing levels (includes part-time) from 11.7 – 37.5, with patient episodes varying from 284 – 900. Given DoHon staffing (15 per 150,000 population with 300 patient episodes) only 50%of teams had sufficient staffing. This was lower than the reported resultsin the National Survey (88%).

Wessex Crisis Teams' Composition when compared to the National Surveyhad similar input from Nurses (100% vs 98%), higher input from Support Workers (100% vs 70%), Approved Mental Health Professionals (83% vs 49%), OTs (50% vs 30%) and Psychologists (50% vs 8%).

When comparing medical staff input 100% of teams had medical input. The proportion composition found was 8.6% which is higher than the 5.2% reported by Middleton et al, 20084. Of these 100% of teams had consultants of which 83% (five teams) had dedicated consultants with othermedical staff and 50% (three teams) had dedicated non consultant staff.

In conclusion to ensure CRHT Teams are successful in their objectivesas alternatives to hospital admission it is vital to have sufficient staffand resources. From the above data teams in Wessex had higher MDT staff diversity in comparison to the National Survey but only three of the six (50%) had adequate staffing according to the DoH guidance.

1.Onyett S, Linde K, Glover G, et al (2008) Implementation of crisisresolution/home treatment teams in England: national survey 2005–2006. Psychiatric Bulletin, 32: 374 –377.

2.DEPARTMENT OF HEALTH (2007) Guidance Statement on Fidelity and Best Practice for Crisis Services. Department of Health

3.DEPARTMENT OF HEALTH (2001) Mental Health Policy Implentation Guide. Department of Health

4.Middleton H, Glover G, Onyett S, et al (2008) Crisis resolution/home treatment teams, gate-keeping and the role of the consultant psychiatrist. Psychiatric Bulletin, 32: 378 –383
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Conflict of interest: None Declared

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