Some users of the mental health services experience repeated admissions to hospital, sometimes over many years, and their complex needs mean that a high level of support may be required. In any area served by a crisis resolution team (CRT), there are likely to be some local service users who present in crisis frequently, often out of hours when other mental health services are not available. Consequently, they are likely to be seen many times by the CRT. While this may sometimes reflect gaps in other, more suitable long-term provision (such as assertive outreach teams, or services for people with borderline personality disorder that are sufficiently containing), this is also a group who may benefit considerably from CRT care. Working with the same service users through repeated crises allows the team to develop and refine an effective response to their individual needs, and if the crises are managed well, there is scope for the development of a therapeutic alliance with service users and carers of a strength that is likely to be hard to achieve in a single episode of crisis care. In some cases, it is only after the CRT and service user have worked together in several crises that they develop effective strategies for reducing the frequency of crises or alternative methods of dealing with them.

In this chapter, a case study is used to highlight important aspects of how CRTs can work with repeat service users and how they can engage social systems in crisis management.