Accompanying mental health problems at home: Preliminary data from a crisis resolution and home treatment team in Catalonia

Abstract

Accessible SummaryWhat is known on the subject? Home treatment teams help people in a mental health crisis to recover. The staff goes to the person's home, avoiding the need to go to the hospital and providing care in the person's environment. The teams have been created in our country in recent years, becoming part of the mental health care network. What this paper adds to existing knowledge? The paper presents the functioning of a CRHTT, the type of care it provides, and the coordination with the rest of the care network. It also shows the clinical results obtained in the first two years since its creation, supporting the CRHTT's effectiveness in accompanying people with mental health crises and reducing the need for hospital care. The outstanding factors in the team operation were coordination fluidity with referral services (facilitating accessibility), a prolonged care time (about two months), and continuity of care during the CRHTT intervention (the same CRHTT professionals visited the user and the family at home) and upon discharge (CRHTT staff organized joint visits with the professionals who would care for the user and the family after home treatment). The CRHTT followed a person‐centered orientation based on horizontality and dialogue. The CRHTT fostered the inclusion of the family and social network in the treatment and a deep understanding of the crisis considering social determinants. What are the implications for practice? Flexibility, approach to the person's environment, dialogue, shared decision‐making, and the inclusion of the family and social network in the treatment are central factors in CRHTT functioning. It helps the person regain control over their life and enhance their resources to face possible future crises. Training in crisis management, community mental health and family care, and teamwork (which implies joint home visits and co‐responsibility with the rest of the staff, user, and the family) are relevant for CRHTT professionals. AbstractIntroductionCrisis resolution and home treatment teams (CRHTTs) provide intensive home care to people in a mental health crisis, becoming an increasingly widespread alternative to hospital admissions. However, there are wide variations in service delivery, organization, and outcomes, and little literature on how these teams work in clinical practice and different settings.AimTo share the organizational functioning, the therapeutic approach, and the outcomes obtained in a CRHTT in Catalonia, Spain.MethodA descriptive analysis of the functioning of a home treatment team, the characteristics of the people served, and the clinical results from November 2017 to December 2019 are presented.ResultsOne hundred and five people were served, with an average stay of 57 days. And 55.24% were women, and the mean age was 41. Most people could overcome the crisis at home, and 5.71% required hospital admission during home care. A statistically significant improvement was observed in the results of the GAF and HoNOS scales at admission and discharge.DiscussionDespite reduced staff, home care was an alternative to hospital admission for most people treated.Implications for PracticeFlexibility, teamwork, and collaboration with the social network are relevant factors when accompanying the recovery process at home.

Patient-reported outcome, clinician-reported outcome, and patient satisfaction with treatment by crisis resolution teams: a multicenter pre-post study of outcome and associated factors in Norway

“…The nonsignificant change for items 11 and 12 (problems with living conditions, occupation, and activities) was expected for this patient group during crisis treatment for a few weeks. The HoNOS total sum change pre to post was above the outcome measured in a previous pre-post study of Norwegian CRTs [ 10 ] and in line with a UK randomized controlled trial [ 31 ] and two recent pre-post studies from Spain [ 11 , 12 ].…”

“…An earlier pre-post study of CRTs in Norway found moderate improvement in mental health [ 10 ]. Two recent pre-post studies of CRT patients in Spain also found significant improvement in psychiatric problems [ 11 , 12 ], and a recent prospective observational study of CRT patients in Greece found improvement in clinician-rated psychiatric problems pre-post and compared to treatment as usual [ 13 ]. While some studies indicate that CRT home treatment is not associated with an increased risk of violence or suicide, an extensive recent overview of various approaches in acute psychiatric care states that ‘crisis assessment at home is not suitable when someone requires urgent medical tests or treatment (for example, following an overdose or other self‐harm)’ [ 14 ].…”