Crisis resolution and home treatment: stakeholders’ views on critical ingredients and implementation in England

Abstract

BackgroundCrisis resolution teams (CRTs) can provide effective home-based treatment for acute mental health crises, although critical ingredients of the model have not been clearly identified, and implementation has been inconsistent. In order to inform development of a more highly specified CRT model that meets service users’ needs, this study used qualitative methods to investigate stakeholders’ experiences and views of CRTs, and what is important in good quality home-based crisis care.MethodSemi-structured interviews and focus groups were conducted with service users (n = 41), carers (n = 20) and practitioners (CRT staff, managers and referrers; n = 147, 26 focus groups, 9 interviews) in 10 mental health catchment areas in England, and with international CRT developers (n = 11). Data were analysed using thematic analysis.ResultsThree domains salient to views about optimal care were identified. 1. The organisation of CRT care: Providing a rapid initial responses, and frequent home visits from the same staff were seen as central to good care, particularly by service users and carers. Being accessible, reliable, and having some flexibility were also valued. Negative experiences of some referral pathways, and particularly lack of staff continuity were identified as problematic. 2. The content of CRT work: Emotional support was at the centre of service users’ experiences. All stakeholder groups thought CRTs should involve the whole family, and offer a range of interventions. However, carers often feel excluded, and medication is often prioritised over other forms of support. 3. The role of CRTs within the care system: Gate-keeping admissions is seen as a key role for CRTs within the acute care system. Service users and carers report that recovery is quicker compared to in-patient care. Lack of knowledge and misunderstandings about CRTs among referrers are common. Overall, levels of stakeholder agreement about the critical ingredients of good crisis care were high, although aspects of this were not always seen as achievable.ConclusionsStakeholders’ views about optimal CRT care suggest that staff continuity, carer involvement, and emotional and practical support should be prioritised in service improvements and more clearly specified CRT models.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1421-0) contains supplementary material, which is available to authorized users.

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

“…The results of this survey indicate that priority areas to target for improvement in CRTs include increasing support for carers; planning for future crises; and increasing the frequency of visits to service users. These closely reflect the reported priorities of service users and carers for CRTs (Morant et al, ; Wheeler et al, ). The limitations of care in these areas help explain findings such as that from a government survey (Care Quality Commission, ) that only 14% of service users felt they received the right care from mental health services during a crisis.…”

Continuity of care in a crisis resolution home treatment team

“…1 Local and national data suggest that overall patients and carers prefer home treatment to admission, however, continuity within the care episode is a recognised challenge of the CRHT model. [2][3][4] The Five Year Forward View for Mental Health 5 advises that '24/7 community-based mental health crisis response is available in all areas across England and that services are adequately resourced to offer intensive home treatment as an alternative to an acute inpatient admission.' This is to be delivered through the expansion of crisis resolution and home treatment.…”

“…Evidence from analysis of stakeholder views demonstrates the primary importance of emotional support to patients and carers, and this can only be facilitated through predictable contact of staff and development of the appropriate therapeutic relationship. 3 Service users also report having to repeat themselves with different professionals. 2,3 Continuity of care also has important implications for patient safety: repeated handovers and communication of clinical information between staff increases the potential for incidents.…”

P29 The electronic capture of patient-reported outcomes in trauma research: views from the field

“…1 However, despite the considerable resources required to collect data for national clinical audits, their information is rarely used effectively to improve quality. 2 Barriers lie with the collection, analysis and feedback of these data, as well as with the capability, capacity and motivation of local teams to use them for improvement.…”

“…Aim To explore how Crisis Resolution Teams were discussed on Twitter and compare this with data collected via interviews and focus groups in a related study. 1 Methods Twitter's advanced search function was used to retrieve relevant Tweets on Crisis Resolution Teams (2010-2018). A form of thematic analysis was conducted on 500 relevant randomly selected Twitter posts.…”