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From home treatment to crisis resolution: the impact of national targets

  • Judy Harrison (a1), Sheethal Rajashankar (a1) and Simon Davidson (a1)
Abstract
Aims and method

The home treatment service in central Manchester was established in 1997 to provide an alternative to in-patient care: referrals were only taken from secondary care services. In order to meet national crisis resolution and home treatment (CRHT) activity targets, referral routes were extended to primary care from 2008. To examine the impact of these changes, details of all referrals to the service were collected for a 6-month period in 2008/2009. Referral sources, demographic details and diagnosis were compared with similar data from 2005.

Results

There was a marked increase in the number of individuals accepted by the service in 2008/2009 with a corresponding reduction in duration of contact. Primary care referrals were not accepted in 2005 but accounted for 20% of people treated in 2008/2009. This was mirrored by a change in diagnostic profile, with the proportion of individuals with mild to moderate illness increasing from 25 to 50%. In 2005, 70% of individuals treated had complex care needs compared with 39% in 2008/2009.

Clinical implications

The strict imposition of numerical activity targets can have a significant impact on service delivery. Although more individuals have been treated under the new arrangements, the emphasis has shifted away from the intensive care of those with severe mental illness.

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Copyright
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.
Corresponding author
Judy Harrison (judy.harrison@mhsc.nhs.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Department of Health. The NHS Plan. HMSO, 2000.
2 Department of Health. Mental Health Policy Implementation Guide: Community Mental Health Teams. Department of Health, 2002.
3 National Audit Office. Helping People through Mental Health Crisis: The Role of Crisis Resolution and Home Treatment Services. TSO (The Stationery Office), 2007.
4 Johnson, S, Nolan, F, Hoult, J, White, IR, Bebbington, P, Sandor, A, et al. Outcomes of crises before and after introduction of a crisis resolution team. Br J Psychiatry 2005; 187: 6875.
5 Glover, G, Arts, G, Babu, KS. Crisis resolution/home treatment teams and psychiatric admission rates in England. Br J Psychiatry 2006; 189: 441–5.
6 Harrison, J, Poynton, A, Marshall, J, Gater, R, Creed, F. Open all hours: extending the role of the psychiatric day hospital. Psychiatr Bull 1999; 23: 400–4.
7 Harrison, JA, Marshall, S, Marshall, P, Marshall, J, Creed, F. Day hospital versus home treatment: a comparison of illness severity and costs. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 541–7.
8 Harrison, J, Allam, N, Marshall, J. Home or away: which patients are suitable for a psychiatric home treatment service? Psychiatr Bull 2001; 25: 310–3.
9 World Health Organization. The ICD–10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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From home treatment to crisis resolution: the impact of national targets

  • Judy Harrison (a1), Sheethal Rajashankar (a1) and Simon Davidson (a1)
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