No abstract

No abstract

No abstract

Innovative and effective approaches to crisis services As a patient, I was recently under the care of a London crisis intervention team. The compassion of the individual staff members was negated by systemic flaws in the way the service was delivered. The experience was very unsettling. Different staff would arrive twice daily at my home because shift patterns would not allow the same workers to see me regularly. Consequently, a constructive, consistent relationship with members of the crisis team was not possible. A stream of strangers entered my small, cramped flat, and the crisis team actually became part of my mental trauma. The problem with the crisis team as an institution is that it is about cost-cutting rather than caring. It felt like a mere sticking plaster on a huge mental wound. While cost-cutting remains the ethos, patients are bound to suffer. The loss of in-patient beds is putting pressure on community services that they cannot sustain. Cost-cutting may masquerade as streamlined efficiency and effectiveness, but it is really a way to hobble and cripple psychiatric provision. Good treatment cannot be delivered without flexibility and variety, both community-based and hospital-based. The crisis team concept is an ineffective halfway (and half-baked!) house between community and hospital.

SummaryThe consensus within psychiatry is that patients' religion/spirituality are legitimate topics in assessment and treatment. Religion/spirituality can help people cope with mental illness, but their use as therapeutic tools is controversial. Despite the publication of position statements by national and international psychiatric organisations, there is no clarity over therapeutic boundaries.Declaration of interestR.P. and R.H. are atheists. C.C.H.C. is an ordained Anglican and a past Chair of the Royal College of Psychiatrists Spirituality and Psychiatry Special Interest Group. He writes here in a personal capacity.