Crisis teams: systematic review of their effectiveness in practice

Abstract

Aims and methodCrisis resolution and home treatment teams (variously abbreviated to CRTs, CRHTTs, HTTs) were introduced to reduce the number and duration of in-patient admissions and better manage individuals in crisis. Despite their ubiquity, their evidence base is challengeable. This systematic review explored whether CRTs: (a) affected voluntary and compulsory admissions; (b) treat particular patient groups; (c) are cost-effective; and (d) provide care patients value.ResultsCrisis resolution teams appear effective in reducing admissions, although data are mixed and other factors have also influenced this. Compulsory admissions may have increased, but evidence that CRTs are causally related is inconclusive. There are few clinical differences between ‘gate-kept’ patients admitted and those not. Crisis resolution teams are cheaper than in-patient care and, overall, patients are satisfied with CRT care.Clinical implicationsHigh-quality evidence for CRTs is scarce, although they appear to contribute to reducing admissions. Patient-relevant psychosocial and longitudinal outcomes are under-explored.

The Impact of Integrating Crisis Teams into Community Mental Health Services on Emergency Department and Inpatient Demand

“…The tentative conclusion reached in recent systematic reviews was that CRTs are effective in reducing inpatient admissions (9,10). For this conclusion to be supported in the current study, the reduced emergency response in the community would have needed to have resulted in a meaningful increase in admissions to the inpatient units.…”

Admission to acute mental health services after contact with crisis resolution and home treatment teams: an investigation in two large mental health-care providers

“…They were designed as ward 'gatekeepers', providing intensive short-term care to vulnerable patients considered for admission or discharge 3 . CRTs provide multi-disciplinary interventions, including assessment and engagement of patients in crisis, psychological support and education, medication review and administration, and social support and advocacy 4 . In 2000, only a few areas of the UK were covered by CRTs, but they are now available in most Trusts in the UK 5 , and have similarly become an integral part of community care in a number of settings internationally, for example in Norway 6 and Germany…”

Psychoanalytic Psychotherapy in Contemporary Mental Health Services: Current Evidence, Future Role and Challenges

“…There are undoubted methodological difficulties in undertaking research in this field, and it has long been identified that PP does not lend itself to the scientific gold standard of the double-blind randomized controlled trial. However, this is a problem shared by research in many areas of mental health such as how to reduce suicidal behaviour, and the effectiveness of assertive outreach or crisis and home treatment teams (Carpenter et al, 2013). Furthermore other NICE-recommended psychological (Lynch et al, 2010) and current pharmacological (Caddy et al, 2014, in press;Penn & Tracy, 2012;Sendt et al, 2012) treatments of mental illness are hardly optimal, with outcome data underwhelming and many individuals suffering enduring problems with the indirect costs to the person and society that such difficulties inevitably bring: nevertheless the data, of varying methodological quality and impressiveness, is there in greater numbers than for PP.…”