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
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.
Available from: informahealthcare.com
- "Using a model similar to community mental health teams in the UK, outpatient clinics ( Institutsambulanzen ) are the single most important service component for patients with SMI (Salize et al., 2007). There has been no comprehensive national roll-out of new community service models on the basis of a national plan as has been the case in, for example, England and Wales (Hubbeling & Bertram, 2012). The provision of mental health services in Germany is highly fragmented. "
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ABSTRACT: The German healthcare system offers comprehensive coverage for people with mental illness including inpatient, day hospital and outpatient services. These services are primarily financed through the statutory health and pension insurances. According to legal regulations, providers are required to base their services on current scientific evidence and to continuously assure the quality of their services. This paper gives an overview of recent initiatives to develop, evaluate and disseminate routine outcome measurement (ROM) in service settings in Germany. A large number of projects have shown outcome monitoring to be feasible, and that feedback of outcome may enhance routine care through an improved allocation of treatment resources. However, none of these initiatives have been integrated into routine care on a nationwide or trans-sectoral level, and their sustainability has been limited. This is due to various barriers in a fragmented mental health service system and to the lack of coordinated national or state-level service planning. The time is ripe for a concerted effort including policy-makers to pick up on these initiatives and move them towards wide-spread implementation in routine care accompanied by practice-oriented research including service user involvement.
International Review of Psychiatry 03/2015; 27(4):1-9. DOI:10.3109/09540261.2015.1014025 · 1.80 Impact Factor
Available from: Penny Rhodes
- "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
Available from: Steve Kisely
- "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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