Crisis resolution teams in the UK and elsewhere
ABSTRACT Crisis resolution and home treatment teams (CRTs) and home treatment teams have been established nationwide in the UK to reduce admissions to psychiatric hospitals. However, the evidence for CRTs was limited at the time of their introduction.
Review of the literature accumulated since the national rollout of CRTs in 2000.
Systematic narrative literature review utilising British Nursing Index, Cinahl, Embase, Medline and PsyINFO.
The search revealed one randomised controlled trial and a number of naturalistic studies. The balance of evidence suggests that CRTs can reduce hospital beds and costs with similar symptomatic outcome and service user satisfaction, but there is no evidence that CRTs are the only way to do so. There is no conclusive evidence that CRTs cause an increase in serious and untoward incidents (SUIs) or compulsory admissions.
Currently, there is no compelling evidence for the widespread implementation of CRTs. In the future, the incidence of compulsory admissions and SUIs needs to be studied at a national level, CRTs have to be compared with other methods to reduce hospital admissions and studies need to specify sample and treatment characteristics with greater detail.
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ABSTRACT: Abstract Background: In 2000, the Department of Health for England recommended the creation of crisis resolution and home treatment teams (CRHTs) in order to reduce the number and length of psychiatric hospital admissions. Central to this was the role of gate-keeping all potential admissions. Aim: To examine the interface between crisis resolution and home treatment and other mental health services. Methods: Semi-structured interviews with mental health professionals (n = 25) at eight sites within one Strategic Health Authority region. Results: Despite wide variation in approach and provision, all teams were confronting common issues related to tensions at both ends of the service user trajectory - on initial assessment and on discharge. Conclusion: The CRHT model is likely to be most effective when there is low staff turnover, flexibility in inter-team working arrangements and senior practitioners have both acute and community experience. Rather than being seen primarily as gatekeeper to the acute service, it would be better to take a system approach and view the CRHT as a resource for clients awaiting discharge or seeking to avoid hospital admission that is equally available to both acute and community services.Journal of Mental Health 03/2014; 23(3). DOI:10.3109/09638237.2014.889284 · 1.01 Impact Factor
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ABSTRACT: Transitional housing programs aim to improve living skills and housing stability for tenuously housed patients with mental illness. 113 consecutive Transitional Housing Team (THT) patients were matched to 139 controls on diagnosis, time of presentation, gender and prior psychiatric hospitalisation and compared using a difference-in-difference analysis for illness acuity and service use outcomes measured 1 year before and after THT entry/exit. There was a statistically significant difference-in-difference favouring THT participants for bed days (mean difference in difference -20.76 days, SE 9.59, p = 0.031) and living conditions (HoNOS Q11 mean difference in difference -0.93, SE 0.23, p < 0.001). THT cost less per participant (I$14,024) than the bed-days averted (I$17,348). The findings of reductions in bed days and improved living conditions suggest that transitional housing programs can have a significant positive impact for tenuously housed patients with high inpatient service usage, as well as saving costs for mental health services.Community Mental Health Journal 10/2013; DOI:10.1007/s10597-013-9654-y · 1.03 Impact Factor
- The Lancet 06/2012; 379(9834):2337–2338. DOI:10.1016/S0140-6736(12)61011-3 · 45.22 Impact Factor