Controlled comparison of two crisis resolution and home treatment teams

Abstract

Aims and methodTo compare an existing crisis resolution service with a new crisis resolution team (CRT) in Wales. The impact of the new team was measured by changes in bed days and admissions. A random sample of patients from each service was assessed for service satisfaction, social functioning and quality of life after first presentation.ResultsThe total number of bed days was reduced following the introduction of the new CRT (27.3%). The frequency and duration of compulsory admissions increased by 31% in the CRT between the first and second years and by 7% in the control service, offset by a greater reduction in informal admissions in the CRT (23.5%) compared with the control group (13.3%); overall bed usage was unchanged. Service satisfaction, social functioning and quality of life showed no important differences between the services.Clinical implicationsCrisis resolution teams may reduce informal admissions in the short term but at the cost of more compulsory admissions later.

Impact of crisis resolution and home treatment services on user experience and admission to psychiatric hospital

“…Our findings reflect an overall reduction in admissions and are in stark contrast to the finding by Tyrer et al that introduction of CRHT reduced informal admissions but was accompanied by increased numbers of compulsory admission. 11 Our results replicated the finding of Johnson et al that there was a reduction in compulsory admissions with the introduction of CRHT but that this was not significant. 8 Tyrer et al hypothesised that the work of CRHT teams maintains patients in the community, preventing informal admissions, but results in some patients' condition deteriorating to such a point that compulsory admission is eventually necessary.…”

“…11 In contrast to this, our CRHT teams covered a wide and socially diverse geographic area, which may account for some of the differences in findings and may indicate that our results are more generalisable to services in other, larger catchment areas.…”

“…Jethwa et al 7 performed an evaluation of the long-term effects of the introduction of CRHT in Leeds and demonstrated a significant reduction in admission rates of 37.5% in the first year. In contrast, a study by Tyrer et al 11 found only a 7.7% reduction in admissions and no significant reduction in length of in-patient stay after the introduction of CRHT in Cardiff.…”

Variation in compulsory psychiatric inpatient admission in England: a cross-classified, multilevel analysis

“…This phenomenon has been observed previously, forwith the introduction of Assertive Outreach and Crisis Resolution services across the UK. 23,24 We found several statistically significant associations at patient and local-area levels. Black pPatients of Black ethnicity were almost three times more likely to be admitted compulsorily than White patients, in keeping with evidence from elsewhere, 25 and after adjusting for areaand Provider Trust-level characteristics.…”

Crisis teams: systematic review of their effectiveness in practice

“…A study of a CRT in Wales 15 found overall bed usage unchanged, attributed to a reduction in informal admissions coinciding with compulsory admissions increasing. Similarly, another study, in England, found no differences, although it lacked statistical power.…”