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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    • "An analysis of national data found no significant differences in admissions between primary care trusts with and without CRHTs, prompting speculation that gate-keeping fidelity might explain the differences (Jacobs & Barrenho, 2011). A recent systematic review concluded that, given the weak evidence base, there was ''no compelling evidence'' of either CRHTs' effectiveness or the assumption that they are the best way of reducing admissions (Hubbeling & Bertram, 2012). The new teams were largely funded through ward closures (Lodge, 2013), and decline in the number of NHS in-patient beds has continued (Buchanan, 2013) to the point that many now believe that the current focus on preventing hospital Correspondence: Penny Rhodes, Centre for Primary Care, Institute for Population Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK. "
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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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    • "Assertive Community Treatment model team (Harvey, Killaspy, Martino & Johnson, 2012), a psychiatric emergency department and a home based mobile acute crisis team (Hubbeling & Bertram, 2012). Further details on mental health services in Queensland are available elsewhere (Harris, Buckingham, Pirkis, Groves & Whiteford, 2012; Siskind et al., 2012). "
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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; 50(5). DOI:10.1007/s10597-013-9654-y · 1.03 Impact Factor
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    • "In 2000, the UK government established CRTs nationally [3], and in 2005, the national health authorities of Norway decided to implement the CRT model at all community mental health centres (CMHCs) [4]. Recent studies, mostly from the UK, indicate that the introduction of CRTs may be associated with a reduction in hospital admissions [5-11], although the evidence is not wholly consistent. Tyrer et al. found that the introduction of CRTs was associated with an increase in involuntary admissions and a decrease in voluntary admissions [12]. "
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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. DOI:10.1186/1471-244X-13-117 · 2.21 Impact Factor
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