Crisis resolution and home treatment teams: an evolving model

Johnson, Sonia

doi:10.1192/apt.bp.107.004192

Cited by 102 publications

(101 citation statements)

References 34 publications

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“…Unlike the other service models mandated in England by the NHS Plan in 2000 (Assertive Community Treatment Teams and Early Intervention Services for psychosis), and despite the trial evidence for the effectiveness of the CRT model, CRT implementation has not been widespread elsewhere in the UK or internationally (Johnson ). Other than in England, CRTs have been implemented nationally only in Norway (Hasselberg et al .…”

Section: Introductionmentioning

confidence: 99%

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

Lloyd‐Evans

Paterson

Onyett

et al. 2017

Int J Mental Health Nurs

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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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Section: Introductionmentioning

confidence: 99%

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

Lloyd‐Evans

Paterson

Onyett

et al. 2017

Int J Mental Health Nurs

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“…In addition to these specifi c psychosis services, in the UK, crisis resolution home treatment teams have been created that care for people when they are in crisis or require hospital admission but may benefi t from intensive support at home rather than in the hospital (Johnson 2013 ). While the vision with the number of different teams that care for a person is aimed at reducing hospital admissions, it does cause fragmentation of care as people are cared for by a number of staff and therefore continuity of care can become an issue.…”

Section: Current Service Models For Individuals With Psychosismentioning

confidence: 99%

Integrated Pathways of Care for Psychosis: An Overview

Rathod

Pinninti

2016

Brief Interventions for Psychosis

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“…[172][173][174] The risk of suicide in the transition from inpatient care is now firmly established 175 and there is some suggestion that this risk has been transferred from inpatient to crisis resolution and home treatment services. 168,176 Harm to others is a much rarer event but, nevertheless, is likely to have significant negative consequences for the victim, the individual with mental health problems and the wider system, including individual workers, such that risk-averse practice is common. 177 The pressure to ensure safety and avoid blame appears to be omnipresent in mental health services.…”

Section: Safety and Riskmentioning

confidence: 99%

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

Simpson

Coffey

Hannigan

et al. 2017

Health Serv Deliv Res

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BackgroundMental health service users in acute inpatient wards, whether informal or detained, should be involved in planning and reviewing their care. Care planning processes should be personalised and focused on recovery, with goals that are specific to the individual and designed to maximise their achievements and social integration.Objective(s)We aimed to ascertain the views and experiences of service users, carers and staff to enable us to identify factors that facilitated or acted as barriers to collaborative, recovery-focused care and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving 19 mental health wards in six NHS sites in England and Wales included a metanarrative synthesis of policies and literature; a survey of service users (n = 301) and staff (n = 290); embedded case studies involving interviews with staff, service users and carers (n = 76); and a review of care plans (n = 51) and meetings (n = 12).ResultsNo global differences were found across the sites in the scores of the four questionnaires completed by service users. For staff, there was significant difference between sites in mean scores on recovery-orientation and therapeutic relationships. For service users, when recovery-orientated focus was high, the quality of care was viewed highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Across all sites, staff’s scores were significantly higher than service users’ scores on the scale to assess therapeutic relationships. Staff across the sites spoke of the importance of collaborative care planning. However, the staff, service user and carer interviews revealed gaps between shared aspirations and realities. Staff accounts of routine collaboration contrasted with service user accounts and care plan reviews. Definitions and understandings of recovery varied, as did views of the role of hospital care in promoting recovery. ‘Personalisation’ was not a familiar term, although there was recognition that care was often provided in an individualised way. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.ConclusionsOur results suggest that there is positive practice taking place within acute inpatient wards, with evidence of widespread commitment to safe, respectful, compassionate care. Although ideas of recovery were evident, there was some uncertainty about and discrepancy in the relevance of recovery ideals to inpatient care and the ability of people in acute distress to engage in recovery-focused approaches. Despite the fact that staff spoke of efforts to involve them, the majority of service users and carers did not feel that they had been genuinely involved, although they were aware of efforts to keep them safe.Future workFuture research should investigate approaches that increase contact time with service users and promote personalised, recovery-focused working; introduce shared decision-making in risk assessment and management; and improve service user experiences of care planning and review and the use of recovery-focused tools during inpatient care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Crisis resolution and home treatment teams: an evolving model

Cited by 102 publications

References 34 publications

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

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

Integrated Pathways of Care for Psychosis: An Overview

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

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