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      Mental health crisis resolution teams and crisis care systems in England: a national survey

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          Abstract

          Aims and method

          A national survey investigated the implementation of mental health crisis resolution teams (CRTs) in England. CRTs were mapped and team managers completed an online survey.

          Results

          Ninety-five per cent of mapped CRTs ( n = 233) completed the survey. Few CRTs adhered fully to national policy guidelines. CRT implementation and local acute care system contexts varied substantially. Access to CRTs for working-age adults appears to have improved, compared with a similar survey in 2012, despite no evidence of higher staffing levels. Specialist CRTs for children and for older adults with dementia have been implemented in some areas but are uncommon.

          Clinical implications

          A national mandate and policy guidelines have been insufficient to implement CRTs fully as planned. Programmes to support adherence to the CRT model and CRT service improvement are required. Clearer policy guidance is needed on requirements for crisis care for young people and older adults.

          Declaration of interest

          None.

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          National implementation of a mental health service model: A survey of Crisis Resolution Teams in England

          Brynmor Lloyd-Evans, Bethan Paterson, Steve Onyett … (2018)
          In response to pressures on mental health inpatient beds and a perceived 'crisis in acute care', Crisis Resolution Teams (CRTs), acute home treatment services, were implemented nationally in England following the NHS Plan in the year 2000: an unprecedentedly prescriptive policy mandate for three new types of functional community mental health team. We examined the effects of this mandate on implementation of the CRT service model. Two hundred and eighteen CRTs were mapped in England, including services in all 65 mental health administrative regions. Eighty-eight percent (n = 192) of CRT managers in England participated in an online survey. CRT service organization and delivery was highly variable. Nurses were the only professional group employed in all CRT staff teams. Almost no teams adhered fully to government implementation guidance. CRT managers identified several aspects of CRT service delivery as desirable but not routinely provided. A national policy mandate and government guidance and standards have proved insufficient to ensure CRT implementation as planned. Development and testing of resources to support implementation and monitoring of a complex mental health intervention is required.
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            Treatment and outcomes of crisis resolution teams: a prospective multicentre study

            Nina Hasselberg, Rolf Gråwe, Sonia Johnson … (2011)
            Background Crisis resolution teams (CRTs) aim to help patients in acute mental health crises without admitting them to hospital. The aims of this study were to investigate content of treatment, service practice, and outcomes of crises of CRTs in Norway. Methods The study had a multicentre prospective design, examining routine data for 680 patients and 62 staff members of eight CRTs. The clinical staff collected data on the demographic, clinical, and content of treatment variables. The service practices of the staff were assessed on the Community Program Practice Scale. Information on each CRT was recorded by the team leaders. The outcomes of crises were measured by the changes in Global Assessment of Functioning scale scores and the total scores on the Health of the Nation Outcome Scales between admission and discharge. Regression analysis was used to predict favourable outcomes. Results The mean length of treatment was 19 days for the total sample (N = 680) and 29 days for the 455 patients with more than one consultation; 7.4% of the patients had had more than twice-weekly consultations with any member of the clinical staff of the CRTs. A doctor or psychologist participated in 55.5% of the treatment episodes. The CRTs collaborated with other mental health services in 71.5% of cases and with families/networks in 51.5% of cases. The overall outcomes of the crises were positive, with a small to medium effect size. Patients with depression received the longest treatments and showed most improvement of crisis. Patients with psychotic symptoms and substance abuse problems received the shortest treatments, showed least improvement, and were most often referred to other parts of the mental health services. Length of treatment, being male and single, and a team focus on out-of-office contact were predictors of favourable outcomes of crises in the adjusted model. Conclusions Our study indicates that, compared with the UK, the Norwegian CRTs provided less intensive and less out-of-office care. The Norwegian CRTs worked more with depression and suicidal crises than with psychoses. To be an alternative to hospital admission, the Norwegian CRTs need to intensify their treatment and meet more patients outside the office.
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              The Impact of Crisis Resolution and Home Treatment Teams on Psychiatric Admissions in England

              R. JACOBS, E Barrenho, R Jacobs (2011)
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                Author and article information

                Journal
                Journal ID (nlm-ta): BJPsych Bull
                Journal ID (iso-abbrev): BJPsych Bull
                Journal ID (publisher-id): BJB
                Title: BJPsych Bulletin
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Print): 2056-4694
                ISSN (Electronic): 2056-4708
                Publication date (Print): August 2018
                Volume: 42
                Issue: 4
                Pages: 146-151
                Affiliations
                [1 ]University College London
                Author notes
                Correspondence to: Brynmor Lloyd-Evans ( b.lloyd-evans@ 123456ucl.ac.uk )
                Author information
                http://orcid.org/0000-0001-9866-788X
                http://orcid.org/0000-0001-6002-1362
                Article
                Publisher Item ID: S2056469418000190 Publisher ID: 00019
                DOI: 10.1192/bjb.2018.19
                PMC ID: 6436049
                PubMed ID: 29792390
                SO-VID: 3fd5da98-c56f-485f-9637-fd881f263ddb
                Copyright © © The Authors 2018
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 November 2017
                Date revision received : 15 February 2018
                Date accepted : 23 February 2018
                Page count
                Tables: 3, Pages: 6
                Categories
                Subject: Original Papers

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