Crisis resolution teams in the UK and elsewhere.

Wandsworth Crisis and Home Treatment Team, Springfield Hospital, London SW17 7DJ, UK.
Journal of Mental Health (Impact Factor: 1.01). 01/2012; 21(3):285-95. DOI: 10.3109/09638237.2011.637999
Source: PubMed

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; · 1.01 Impact Factor
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    ABSTRACT: BACKGROUND: Crisis resolution teams (CRTs) provide intensive alternative care to hospital admission for patients with mental health crises. The aims of this study were to describe the proportions and characteristics of patients admitted to in-patient wards from CRTs, to identify any differences in admission practices between CRTs, and to identify predictors of admissions from CRTs. METHODS: A naturalistic prospective multicentre design was used to study 680 consecutive patients under the care of eight CRTs in Norway over a 3-month period in 2005/2006. Socio-demographic and clinical data were collected on the patients, and on the organization and operation of the CRTs. Logistic regression analysis for hierarchical data was used to test potential predictors of admission at team and patient level. RESULTS: One hundred and forty-six patients (21.5%) were admitted to in-patient wards. There were significant differences in admission rates between the CRTs. The likelihood of being admitted to an in-patient ward was significantly lower for patients treated by CRTs that operated during extended opening hours than CRTs that operated during office hours only. Those most likely to be admitted were patients with psychotic symptoms, suicidal risk, and a prior history of admissions. CONCLUSIONS: Extended opening hours may help CRTs to prevent more admissions for patients with moderately severe and relapsing mental illnesses. Patients with severe psychosis seem to be difficult to treat in the community by Norwegian CRTs even with extended opening hours.
    BMC Psychiatry 04/2013; 13(1):117. · 2.23 Impact Factor
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    ABSTRACT: There has been a move to community-based mental healthcare for the past half-century: 1 the number of in-patient psychiatric beds in the UK fell from 152 000 in 1954 to 29 802 in 2005. 2 Crisis resolution and home treatment teams (known variously as CRHTTs, CRTs and HTTs; CRT will be used throughout this article) were established in the 1980s, but the first policy, mandated in The NHS Plan, did not come about until 2000. 3 By 2006, 343 teams had been introduced. 2 They were designed as ward 'gatekeepers', providing intensive short-term care to vulnerable patients considered for admission or discharge. 4 Teams of approximately 14 multidisciplinary staff, predominantly nursing, were anticipated to have case-loads of 20-30 and to be available 24 hours a day, 7 days a week, to a wide variety of patients. Potential interventions would include assessment and engagement of patients in crisis, psychological support and education, medication review and administration, and social support and advocacy. Despite these laudable aims, it has been argued that policy was implemented without sufficient evidence. 5,6 To date there has been little direct advice or guidance specifically to CRTs on markers of good care or outcomes. The Royal College of Psychiatrists is attempting to redress this with the recent piloting of the Home Treatment Accreditation Scheme (HTAS) that will, following refine-ment of goals through analysis of data obtained in this pilot, establish national standards for accredited teams. In this context of a questionable research base and the setting up of a national accreditation scheme, and under the spectre of future primary care (de)commissioning of services, we have set out to systematically review the existing evidence for CRTs and to provide a commentary on this. In particular, this review aims to establish: (a) whether CRTs have affected voluntary and/or compulsory admissions; (b) the clinical profiles of patients admitted despite CRTs; (c) whether CRTs are cost-effective; and (d) whether patients are satisfied with the care received.
    Psychiatrist 07/2013; 37(7):232-237.