Objective To evaluate the effectiveness of a crisis resolution team.

One hundred and twenty patients presenting for admission were randomly allocated into two groups. Controls received standard hospital care and after-care. Projects were not admitted if this could be avoided; instead they and their relatives were provided with comprehensive community treatment and a 24-hour crisis service. Patients with a primary diagnosis of alcohol or drug dependence, organic brain disorder or mental retardation were excluded. During the 12 months study period, 96% of controls were admitted, 51% more than once. Of the projects, 60% were not admitted at all and only 8% were admitted more than once. Controls spent an average of 53.5 days in psychiatric hospitals; projects spent an average of 8.4 days. Community treatment did not increase the burden upon the community, was considered to be significantly more satisfactory and helpful by patients and their relatives, achieved a clinically superior outcome, and cost less than standard care and after-care.

CRTs may prevent some admissions and patients prefer them, although other outcomes appear unchanged in the short term.

Deinstitutionalisation is a two-part process: the first involves discharging patients from hospital to the community, which has been done in many countries. The second part—the provision of adequate resources for good community care—has still to materialise almost everywhere. In New South Wales, the inpatient mental hospital population dropped by two-thirds in 20 years, yet the total number of hospital staff increased considerably during this time; on the other hand, in the community, where most of the patients are, there are relatively few staff. This has important consequences: it means that for many patients, their episode of illness has to progress unchecked until it is of sufficient severity for them to be admitted to hospital. When that happens, there will then be enough staff to give them good quality care, so that their symptoms can subside, but afterwards there will again be hardly anyone available to help maintain them and to prevent relapse.

No abstract