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McGlynn (2006) CRHT: A Practical Guide

Medical input

There is no doubt that doctors have a vital role to play in these services, having traditionally had a central role in gatekeeping hospital beds. It would seem important to optimise the use of this experience in the decision-making processes around admission to hospital. Department of Health guidance into new ways of working for psychiatrists has recognised the challenges to the traditional psychiatrist role brought about by the modernisation of services (including the creation of CRHT teams). The guidance suggests that psychiatrists should be at the forefront of this culture change and it clearly indicates a desire to have a clearer, more focused role for psychiatrists within the context of functional multidisciplinary teams:

" New ways of working are about using the skills, knowledge and experience of consultant psychiatrists to best effect by concentrating on service users with the most complex needs, acting as a consultant to multidisciplinary teams and promoting distributed responsibility and leadership across teams to achieve a cultural shift in services." (DH, 2005) (p.16)

Medication management

In the initial phase, medication can calm disturbed behaviour quickly and, importantly, allow everyone to get a good night's sleep. As in a hospital, its effects need to be monitored in case the initial dose is too high or too low and, as in hospital, it is sometimes necessary to make sure that it is really being taken. Where medication is seen as a key element of an individual's care package, the team may have to monitor compliance closely and, indeed, where situations are chaotic the team may need to take control of dispensing. Disturbed behaviour may have to be controlled quickly if a person is to remain in the community before the social network becomes worn out and neighbours become frustrated. Ensuring that everyone has a good night's sleep is often a big help in de-escalating a crisis situation. Criticism has been made that some CRHT teams offer little more than medication monitoring. This may be due to inadequate staffing of teams. In 1997 the Mental Health Act Commission reported that the amount of direct patient contact by staff on wards is often low (SCMH/MHAC, 1997). CRHT staff must engage properly with people on their caseload. (p.18-19)