Implementation of crisis resolution/home treatment teams in England: national survey 2005–2006

Onyett, Steve; Linde, K; Glover, Gyles; Floyd, Siobhan; Bradley, Steven; Middleton, Hugh

doi:10.1192/pb.bp.107.018366

Cited by 45 publications

(70 citation statements)

References 5 publications

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“…We also controlled for the availability of CRHT teams that provide alternative home care in an emergency and play a 'gatekeeping' role in admissions to hospital. 25,54,55 Data on CRHTs were collected as part of the Mental Health Services Mapping Data between 2000 and 2009 at the level of 'local implementation teams' (LITs) which partly cover the geography of local authority social services. 56 There is an almost one-to-one correspondence between LITs and the approximately 150 commissioning organisations in England at that time, primary care trusts (PCTs).…”

Section: Data Sets Used To Generate Other Covariatesmentioning

confidence: 99%

Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data

Jacobs

Gutacker

Mason

et al. 2015

Health Services and Delivery Research

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BackgroundSerious mental illness (SMI) is a set of chronic enduring conditions including schizophrenia and bipolar disorder. SMIs are associated with poor outcomes, high costs and high levels of disease burden. Primary care plays a central role in the care of people with a SMI in the English NHS. Good-quality primary care has the potential to reduce emergency hospital admissions, but also to increase elective admissions if physical health problems are identified by regular health screening of people with SMIs. Better-quality primary care may reduce length of stay (LOS) by enabling quicker discharge, and it may also reduce NHS expenditure.ObjectivesWe tested whether or not better-quality primary care, as assessed by the SMI quality indicators measured routinely in the Quality and Outcomes Framework (QOF) in English general practice, is associated with lower rates of emergency hospital admissions for people with SMIs, for both mental and physical conditions and with higher rates of elective admissions for physical conditions in people with a SMI. We also tested the impact of SMI QOF indicators on LOS and costs.DataWe linked administrative data from around 8500 general practitioner (GP) practices and from Hospital Episode Statistics for the study period 2006/7 to 2010/11. We identified SMI admissions by a mainInternational Classification of Diseases, 10th revision (ICD-10) diagnosis of F20–F31. We included information on GP practice and patient population characteristics, area deprivation and other potential confounders such as access to care. Analyses were carried out at a GP practice level for admissions, but at a patient level for LOS and cost analyses.MethodsWe ran mixed-effects count data and linear models taking account of the nested structure of the data. All models included year indicators for temporal trends.ResultsContrary to expectation, we found a positive association between QOF achievement and admissions, for emergency admissions for both mental and physical health. An additional 10% in QOF achievement was associated with an increase in the practice emergency SMI admission rate of approximately 1.9%. There was no significant association of QOF achievement with either LOS or cost. All results were robust to sensitivity analyses.ConclusionsPossible explanations for our findings are (1) higher quality of primary care, as measured by QOF may not effectively prevent the need for secondary care; (2) patients may receive their QOF checks post discharge, rather than prior to admission; (3) people with more severe SMIs, at a greater risk of admission, may select into practices that are better organised to provide their care and which have better QOF performance; (4) better-quality primary care may be picking up unmet need for secondary care; and (5) QOF measures may not accurately reflect quality of primary care. Patient-level data on quality of care in general practice is required to determine the reasons for the positive association of QOF quality and admissions. Future research should also aim to identify the non-QOF measures of primary care quality that may reduce unplanned admissions more effectively and could potentially be incentivised.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Data Sets Used To Generate Other Covariatesmentioning

confidence: 99%

Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data

Jacobs

Gutacker

Mason

et al. 2015

Health Services and Delivery Research

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“…It seems that despite these guidelines and the implementations of CRHT, the input people receive from CRHT remains inconsistent as evidenced by the experiences of the people in this study. It seems that some CRHT teams continue to be under resourced in order to provide services that adhere to the model suggested by the DOH, for example providing out of hours support (Onyett, et al, 2008). In view of the nature of these people's difficulties, they need someone to turn to when difficulties arise, particularly at night when they feel most alone as voiced by Marie talking about how desperate she felt at night.…”

Section: Links To Previous Researchmentioning

confidence: 99%

“…A national survey of CRHT in 2006 reported that many were under resourced to meet the demands of out of hours assessments and just over half offered out of hours services and only 8% of teams had a psychologist despite these being national guidelines (Onyett et al, 2008).…”

Section: Crisis Resolution/home Treatmentmentioning

confidence: 99%

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What is the Lived Experience of Being Discharged From a Psychiatric Inpatient Stay?

Redding

Maguire

Johnson

et al. 2017

Community Ment Health J

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The first part of this thesis contains a narrative review of the literature relating to how people with mental illness cope with stigma. The majority of the research has focussed on models of stigma, the impact of stigma on individuals and campaigns to combat stigma. There is limited research exploring how people cope with stigma and the effectiveness of these strategies. The review highlights the need for further research in this area to inform interventions.The second part of the thesis contains a qualitative research study, which aimed to provide an understanding of how individuals with a mental illness described their experiences of being discharged from psychiatric inpatient stays. Suicide rates post-discharge remain high despite discharge planning and discharge interventions, yet little is known about why discharge can be so difficult for individuals. Interpretative Phenomenological Analysis (IPA) was used to analyse interviews from eight individuals who had been discharged within the last three years. The analysis highlighted five superordinate themes: the hospital experience, the experience of discharge, the outside world, the journey to health and self-beliefs/identity.The results are discussed in relation to previous findings and implications for future research and clinical practice.

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“…The principles are spelled out, but the details need to be worked out on a local basis. On a practical level, access to psychotherapy services is limited by a number of factors that include, together with lack of adequate service provision (Centre for Economic Performance's Mental Health Policy Group, 2006), the referral path and the length of waiting lists. There are also reports of increased levels of stress among GPs (Royal College of General Practitioners, 2005), who have to deal in more complex ways with more difficult patients and limited funding.…”

Section: Discussionmentioning

confidence: 99%

Psychological therapies provision: views from primary care

Ward¹,

Polizzi

Milovanovic

2008

Psychiatr. bull.

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Aims and MethodRecent National Health Service (NHS) policy and guidelines support the increased provision of psychological therapies. As secondary care providers of psychological therapies, we carried out a questionnaire study of how our services were perceived by local general practitioners (GPs). All GPs in the borough of Southwark were included.ResultsGeneral practitioners value secondary care psychotherapeutic input across a spectrum of complex diagnostic groups and are interested in further training/education. They also consistently complain about long waiting times and confusion about accessing the various services.Clinical ImplicationsWith increasing interest in and willingness to fund the delivery of psychological therapies, there is the potential for working more effectively across the primary–secondary care divide. However, improved communication between primary and secondary care is essential if the increased commitment at government level is to be translated into a locally effective service.

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Implementation of crisis resolution/home treatment teams in England: national survey 2005–2006

Cited by 45 publications

References 5 publications

Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data

Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data

What is the Lived Experience of Being Discharged From a Psychiatric Inpatient Stay?

Psychological therapies provision: views from primary care

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