Impact of a crisis resolution team on service costs in the UK

McCrone, Paul; Nolan, Fiona; Sandor, Andrew; Hoult, John; Pilling, Stephen; White, Ian R.; Bebbington, Paul; McKenzie, Nigel

doi:10.1192/pb.bp.107.018648

Cited by 21 publications

(15 citation statements)

References 2 publications

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“…Besides, flexibility within each locality is acceptable [41]. Reported outcome include: reduce hospital admission subsequently saving cost and better user satisfaction [40][41][48][49]. The success of this service has been attributed to it being a mobile service, home based and its strong emphasis on the importance of family and social network helping in the recovery process [41].…”

Section: Crisis Resolution Home Treatment (Crht)mentioning

confidence: 99%

Typology of Psychiatric Emergency Services in the United Kingdom: A narrative literature Review

Odejimi

Bagchi

Tadros

2020

Preprint

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Background Mental health crisis requiring emergency access to psychiatric service can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 hours. Presently, several PESs are available in the United Kingdom (UK) with the aim of providing prompt and effective assessment, management and in some cases treatment and/or referral. Therefore, this study aims to provide a detailed narrative literature review of Psychiatric Emergency Service (PES) currently available in the UK Method Electronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was conducted. Studies were included if it described a service that provides immediate response in mental health crisis within the first 24 hours. Excluded studies did not describe a PES, non-English, and were not conducted in UK. Results Nine PESs were found. Amongst the 9 services, more papers described crisis resolution home treatment. Majority of the papers reported services within England than other countries within the UK. Conclusion All forms of PES are beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of all models of PES. This may help inform researchers, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PES meet the needs as well as aid recovery during crisis.

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Section: Crisis Resolution Home Treatment (Crht)mentioning

confidence: 99%

Typology of Psychiatric Emergency Services in the United Kingdom: A narrative literature Review

Odejimi

Bagchi

Tadros

2020

Preprint

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“…Two health economic assessments have shown lower health-care costs when CRTs are available. 19,20 There is also some evidence that service user satisfaction with acute care is higher when CRTs are available. 15,18 Little is known about the views of carers regarding the current UK model of CRTs.…”

Section: Synopsis Backgroundmentioning

confidence: 99%

“…The main substantial UK studies of the last decade regarding CRTs involved members of the CORE programme team, including a naturalistic investigation of the intervention's impact on a range of social and clinical outcomes, 15 the only randomised trial, 18 health economic studies, 19,20 an investigation of patient factors associated with being admitted rather than treated at home, 55 a workforce study 21 and the CRT national survey. 24 Thus, the current project is the next step in a continuing programme of investigation of community acute alternatives to hospital admission.…”

Section: The Core Programmementioning

confidence: 99%

Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs

Lloyd‐Evans

Christoforou

Osborn

et al. 2019

Programme Grants Appl Res

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Background Crisis resolution teams (CRTs) seek to avert hospital admissions by providing intensive home treatment for people experiencing a mental health crisis. The CRT model has not been highly specified. CRT care is often experienced as ending abruptly and relapse rates following CRT discharge are high. Aims The aims of CORE (Crisis resolution team Optimisation and RElapse prevention) workstream 1 were to specify a model of best practice for CRTs, develop a measure to assess adherence to this model and evaluate service improvement resources to help CRTs implement the model with high fidelity. The aim of CORE workstream 2 was to evaluate a peer-provided self-management programme aimed at reducing relapse following CRT support. Methods Workstream 1 was based on a systematic review, national CRT manager survey and stakeholder qualitative interviews to develop a CRT fidelity scale through a concept mapping process with stakeholders (n = 68). This was piloted in CRTs nationwide (n = 75). A CRT service improvement programme (SIP) was then developed and evaluated in a cluster randomised trial: 15 CRTs received the SIP over 1 year; 10 teams acted as controls. The primary outcome was service user satisfaction. Secondary outcomes included CRT model fidelity, catchment area inpatient admission rates and staff well-being. Workstream 2 was a peer-provided self-management programme that was developed through an iterative process of systematic literature reviewing, stakeholder consultation and preliminary testing. This intervention was evaluated in a randomised controlled trial: 221 participants recruited from CRTs received the intervention and 220 did not. The primary outcome was re-admission to acute care at 1 year of follow-up. Secondary outcomes included time to re-admission and number of days in acute care over 1 year of follow-up and symptoms and personal recovery measured at 4 and 18 months’ follow-up. Results Workstream 1 – a 39-item CRT fidelity scale demonstrated acceptability, face validity and promising inter-rater reliability. CRT implementation in England was highly variable. The SIP trial did not produce a positive result for patient satisfaction [median Client Satisfaction Questionnaire score of 28 in both groups at follow-up; coefficient 0.97, 95% confidence interval (CI) –1.02 to 2.97]. The programme achieved modest increases in model fidelity. Intervention teams achieved lower inpatient admission rates and less inpatient bed use. Qualitative evaluation suggested that the programme was generally well received. Workstream 2 – the trial yielded a statistically significant result for the primary outcome, in which rates of re-admission to acute care over 1 year of follow-up were lower in the intervention group than in the control group (odds ratio 0.66, 95% CI 0.43 to 0.99; p = 0.044). Time to re-admission was lower and satisfaction with care was greater in the intervention group at 4 months’ follow-up. There were no other significant differences between groups in the secondary outcomes. Limitations Limitations in workstream 1 included uncertainty regarding the representativeness of the sample for the primary outcome and lack of blinding for assessment. In workstream 2, the limitations included the complexity of the intervention, preventing clarity about which were effective elements. Conclusions The CRT SIP did not achieve all its aims but showed potential promise as a means to increase CRT model fidelity and reduce inpatient service use. The peer-provided self-management intervention is an effective means to reduce relapse rates for people leaving CRT care. Study registration The randomised controlled trials were registered as Current Controlled Trials ISRCTN47185233 and ISRCTN01027104. The systematic reviews were registered as PROSPERO CRD42013006415 and CRD42017043048. Funding The National Institute for Health Research Programme Grants for Applied Research programme.

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“…36 In the prospective controlled trial 37 the finding that a CRT patient costs less per 6 months than an in-patient was only significant when patients who had any CRT contact were compared with those that had no contact, rather than comparing pre-or post-CRT groups.…”

Section: Are Crts Cost-effective?mentioning

confidence: 99%

Crisis teams: systematic review of their effectiveness in practice

et al. 2013

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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.

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Impact of a crisis resolution team on service costs in the UK

Cited by 21 publications

References 2 publications

Typology of Psychiatric Emergency Services in the United Kingdom: A narrative literature Review

Typology of Psychiatric Emergency Services in the United Kingdom: A narrative literature Review

Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs

Crisis teams: systematic review of their effectiveness in practice

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