In Devon – a predominantly rural area of the UK covering a large geographical patch with dispersed centres of population – we have noticed some encouraging preliminary results with the intensive crisis resolution/home-treatment team (CRHT) in averting admissions. The in-patient CRHT consultant works as an ‘osmotic agent’.

To explain this metaphor one should consider mental health teams as having ‘semipermeable membranes’, rather than being watertight compartments. Consider an in-patient team and a crisis resolution team as being separated by such a membrane. The pores are large enough to let some particles (i.e. patients) pass freely while the passage of others is inhibited. This two-way process is analogous to the teams’ functions of gatekeeping and promoting early discharge. Within this model, the consultant provides supervision and leadership (a key role in monitoring, allowing and facilitating the osmosis) to both the CRHT and the in-patient team.

With this approach the bed occupancy rate in the Mid Devon County area has dropped by 35% over the past 10 months. We registered a decreased number of involuntary hospital admissions and a lower prevalence of antipsychotic polypharmacy when compared with previous approaches.

The new approach is substantially in line with the final report New Ways of Working for Psychiatrists, issued in the UK by the National Steering Group, co-chaired by the National Institute for Mental Health in England (NIMHE) and the Royal College of Psychiatrists (Department of Health, 2005).

Our preliminary experience suggests that the new model and the review of the in-patient CRHT consultant's role might affect positively the utilisation of specialty mental health services, thus achieving a pragmatic balance between community and hospital care.