Impact of a Crisis Assessment and Treatment Service on Admissions into an Acute Psychiatric Unit

Adesanya, Adesina

doi:10.1080/j.1440-1665.2005.02176.x

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…Outcomes assessed were admission rates, health status at discharge, and service user and carer satisfaction. CRTs versus standard care (Additional file 3 : Table DS3) (n = 16) [ 8 , 9 , 12 , 13 , 36 - 47 ]: Two studies were randomised controlled trials, three were non-randomised (naturalistic) two-group comparison studies; and 11 were naturalistic pre-post comparison studies. Two studies were Australian, one German, one American, and 12 British; studies were published between 1993 and 2011.…”

Section: Resultsmentioning

confidence: 99%

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review

Wheeler¹,

Lloyd‐Evans²,

Churchard³

et al. 2015

BMC Psychiatry

136

132

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BackgroundCrisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users’ satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs.MethodsA systematic review was conducted. MEDLINE, Embase, PsycINFO, CINAHL and Web of Science were searched to November 2013. A further web-based search was conducted for government and expert guidelines on CRTs. We analysed studies separately as: comparing CRTs to Treatment as Usual; comparing two or more CRT models; national or regional surveys of CRT services; qualitative studies of stakeholders’ views regarding best practice in CRTs; and guidelines from government and expert organisations regarding CRT service delivery. Quality assessment and narrative synthesis were conducted. Statistical meta-analysis was not feasible due to the variety of design of retrieved studies.ResultsSixty-nine studies were included. Studies varied in quality and in the composition and activities of the clinical services studied. Quantitative studies suggested that longer opening hours and the presence of a psychiatrist in the team may increase CRTs’ ability to prevent hospital admissions. Stakeholders emphasised communication and integration with other local mental health services; provision of treatment at home; and limiting the number of different staff members visiting a service user. Existing guidelines prioritised 24-hour, seven-day-a-week CRT service provision (including psychiatrist and medical prescriber); and high quality of staff training.ConclusionsWe cannot draw confident conclusions about the critical components of CRTs from available quantitative evidence. Clearer definition of the CRT model is required, informed by stakeholders’ views and guidelines. Future studies examining the relationship of overall CRT model fidelity to outcomes, or evaluating the impact of key aspects of the CRT model, are desirable.Trial registrationProspero CRD42013006415.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0441-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review

Wheeler¹,

Lloyd‐Evans²,

Churchard³

et al. 2015

BMC Psychiatry

136

132

View full text Add to dashboard Cite

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“…However, nurses portrayed a level of competency in their ability to assess and manage risks within a positive framework whilst fulfilling the requirements of their gatekeeping role in reducing admission rates. A reduction in hospital admissions is evidenced through a documented sustained decline in admission rates over the years (Bridgett & Polak , Adesanya , Johnson et al . , Jethwa et al .…”

Section: Discussionmentioning

confidence: 99%

Nurses experiences of working in Crisis Resolution Home Treatment Teams with its additional gatekeeping responsibilities

Begum

Riordan

2016

Psychiatric Ment Health Nurs

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It is evident through nurse's experiences of working within CRHTT and gatekeeping that their roles were very dynamic and challenging. A positive risk-taking approach contributed towards the success of CRHTT as gatekeepers. Family members played a significant role in ensuring gatekeeping remained a priority consistent with Government targets. Clinical Implications and recommendations for future research are discussed.

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“…A regional/rural crisis assessment and treatment service (CAT) was trialed in rural Western Australia in a before and after study measuring its impact on inpatient admissions to an acute adult psychiatric facility [7]. While there was a non-significant trend in this study towards fewer and more appropriate admissions, policy makers and state governments have historically been unwilling to commit significant resources to these areas despite the clear need.…”

Section: Discussionmentioning

confidence: 99%

Perceived Differences in the Management of Mental Health Patients in Remote and Rural Australia and Strategies for Improvement: Findings from a National Qualitative Study of Emergency Clinicians

Jelinek

Weiland

Mackinlay

et al. 2011

Emergency Medicine International

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Introduction. We aimed to describe perceptions of Australian emergency clinicians of differences in management of mental health patients in rural and remote Australia compared with metropolitan hospitals, and what could be improved. Methods. Descriptive exploratory study using semi-structured telephone interviews of doctors and nurses in Australian emergency departments (EDs), stratified to represent states and territories and rural or metropolitan location. Content analysis of responses developed themes and sub-themes. Results. Of 39 doctors and 32 nurses responding to email invitation, 20 doctors and 16 nurses were interviewed. Major themes were resources/environment, staff and patient issues. Clinicians noted lack of access in rural areas to psychiatric support services, especially alcohol and drug services, limited referral options, and a lack of knowledge, understanding and acceptance of mental health issues. The clinicians suggested resource, education and guideline improvements, wanting better access to mental health experts in rural areas, better support networks and visiting specialist coverage, and educational courses tailored to the needs of rural clinicians. Conclusion. Clinicians managing mental health patients in rural and remote Australian EDs lack resources, support services and referral capacity, and access to appropriate education and training. Improvements would better enable access to support and referral services, and educational opportunities.

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Impact of a Crisis Assessment and Treatment Service on Admissions into an Acute Psychiatric Unit

Cited by 9 publications

References 15 publications

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review

Nurses experiences of working in Crisis Resolution Home Treatment Teams with its additional gatekeeping responsibilities

Perceived Differences in the Management of Mental Health Patients in Remote and Rural Australia and Strategies for Improvement: Findings from a National Qualitative Study of Emergency Clinicians

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