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

Abstract

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.

Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology

“…In particular, critical ingredients outlined in the DoH guidelines (Department of Health, ) such as intensive visits, crisis planning and support for carers were rarely provided at optimal levels, and without these elements one would not expect the model to function as intended (Johnson et al, ). Secondly, while findings from this survey broadly align with those from surveys of CRT managers (Lloyd‐Evans et al, ; Lloyd‐Evans et al, ; Onyett et al, ) on issues relating to the organizational and structural aspects of CRTs, they are discrepant on the content of care (e.g. crisis planning, working with families).…”

“…Table represents the extent to which teams met the recommendations of the original Department of Health guidelines for CRTs (Department of Health, ) and compares these results with the other three available CRT surveys. In addition to the data from the reviews conducted for this survey, data were collected via self‐report questionnaires in 2005/2006 (Onyett et al, ), 2011/2012 (Lloyd‐Evans et al, ), and 2016 (Lloyd‐Evans et al, ). While the survey method used in previous national research into CRTs was quite different to the method described in this study, we believe it is worth considering the trends over time that comparison of this work offers.…”

“…Purposive sampling was used, and CRTs were selected to include urban and rural settings, and to cover England, Scotland and Wales. CRTs have only been implemented nationally in England, with over 200 having been set up (Lloyd‐Evans et al, ), and only a few elsewhere in the UK. It should be noted that the Scottish Government outlined different guidance for CRTs than those in England and Wales (NHS Scotland, 2006).…”

A scoping review of crisis teams managing dementia in older people

“…Current research fails to demonstrate full translation of guidelines for crisis resolution teams into practice 29. Consequently, future research could look to include gray literature, other methods to assess interventions, qualitative work, and service evaluations.…”

Evidence‐based policy strategies: A typology.

“…In 2000, the NHS issued "an unprecedentedly prescriptive policy mandate" to implement three specific types of psychiatric crisis services to reduce the demand for psychiatric admissions (Lloyd-Evans et al, 2018). In 2000, the NHS issued "an unprecedentedly prescriptive policy mandate" to implement three specific types of psychiatric crisis services to reduce the demand for psychiatric admissions (Lloyd-Evans et al, 2018).…”