The Core Study



McGlynn (2006) CRHT: A Practical Guide

Twenty-four-hour availability

There is much debate as to the need for teams to be available 24 hours a day. Some say it costs too much to run, others that there is no call for it in their area, but there is a clear rationale for ensuring that this is a core characteristic of CRHT teams. There are two main reasons for providing this. The first is that new referrals can turn up at any hour, not just obligingly during the daytime. At night most referrals will come from A&E and the number will vary according to how busy the department is, but the people who attend will be in some degree of crisis. Failure to gatekeep admissions at night may lead to a disproportionate number of admissions taking place during this period. The second reason is that many of the service users who are supported by the team would otherwise be in hospital. In view of the acute nature of their difficulties, the service users and their carers need someone they can turn to should a difficulty arise, especially in the middle of the night when people feel most alone. If they know they can get immediate help at any time of the day or night they will be more willing to accept home treatment. So while most teams are infrequently or even rarely called out at night, the person on call may get more phone calls from both service users and carers. The team member, having both knowledge of the service user and a home treatment ethos, will often be able to resolve the matter on the phone. The knowledge that staff can be contacted at any time, and if necessary come out, is of great reassurance to service users and carers. It is important to note that a team that does not provide a 24-hour service cannot claim to gatekeep hospital admissions comprehensively. (p.15)

Providing 24-hour, 7-days-a-week service

The ability to respond over a 24-hour period to crisis is much more likely to promote positive risk taking. Practitioners are aware that when they leave a situation after making an assessment, they can easily return, if necessary, as they are often only a phone call and a short journey away. Where longer distances are the norm, for example in some rural areas, decision making must account for that fact. Where community services are only provided between 9 am and 5 pm there is often a 'vacuum' out of hours, where the only options are to go to the local A&E, the local inpatient unit or organise a Mental Health Act assessment. All of these are for the most part unsatisfactory responses. The likelihood, therefore, if faced with these sparse and limited resources, is that decisions will often err on the side of caution and the most restrictive option will be selected. (p.37)