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Re-referral after the end of CRHT care

Paul Bowers

Crisis Resolution/Home Treatment and Liaison Psychiatry Manager 

South Staffordshire and Shropshire NHS FT

The idea of self-referral (or perhaps more accurately self re-referral in this case) can be a challenging one for many CRHT teams, throwing up a plethora of 'what if's' and generating a real sense of anxiety about the effect of a perceived open door policy on 'core' business. As a way to test out in a graded way what might happen if we set off on this journey and supported by the recommendation  of a serious untoward incident investigation following a death shortly after CRHT intervention ended, a decision was taken that where a service user was discharged from the CRHT service (with an onward referral to secondary mental health services) and that person unexpectedly relapsed into crisis before the first face to face contact with the identified care co-ordinator took place, the CRHT service would take that person back onto its caseload without the need for further assessment in primary care. This approach was felt to be beneficial not only to service users and their carers and families but also to GP colleagues in primary care who we would historically have been asked to assess the person first, before the CRHT service was despatched. This invariably lead to understandable arguments between professionals, especially out of hours, so we had to ask ourselves what was to be gained by insisting GP's reviewed the person's mental health in the first instance, when we had already decided as a team that their needs were best met in secondary mental health services. 

It's not the biggest service development or the most awe-inspiring but to us it has improved the service we offer to people and it has improved partnership working with both GP and community mental health team colleagues too.