We welcome the letter from Sandor and Orme (Reference Sandor and Orme2000, this issue) and await with interest the results of the study to which they refer. Without access to further information concerning this work it is difficult to comment upon their finding that some crisis services have ceased operating. Our study revealed an enthusiastic support for crisis services (Reference Owen, Sashidharan and EdwardsOwen et al, 2000), and our own experience working in inner-city Birmingham has demonstrated that home treatment is an effective intervention, which is more acceptable to clients than hospital admission and is sustainable over many years.

The suggestion that it is inconsistent to refer to home treatment as both an alternative and an adjunct to hospital admission betrays a common misconception about crisis services. Many people who would otherwise have been admitted to hospital are able to be successfully supported during crisis by home treatment, yet hospital admission remains an essential part of acute psychiatric services. Clients of home treatment services not infrequently require admission to hospital, although the length of stay is often short, with early discharge and community support. It is also important to point out that home treatment makes use of other crisis residential alternatives to hospital, such as crisis houses or family sponsorship schemes, with good effect.

There remains a wider issue concerning the reluctance of psychiatrists to embrace developments in community mental health services despite the evidence of its efficacy and general acceptability (Reference Smyth and HoultSmyth & Hoult, 2000). We strongly recommend that the debate in this area should focus on the opportunities that are becoming available in developing innovative crisis services in the context of the National Service Framework. Our failure to do so would once again result in psychiatry being left behind in the development and implementation of modern systems of psychiatric care.