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McGlynn (2006) CRHT: A Practical Guide

Gatekeeping to hospital beds

We can see no evidence of CRHT teams, nationally or internationally, being effective in achieving reductions in hospital bed use if they do not have the right to gatekeep, i.e. to assess most or all referrals prior to hospital admission. This issue has probably resulted in more friction than anything else between teams and between professional groups, but is one of the most critical for CRHT teams. It therefore has to be addressed, however uncomfortable the process may appear. It is logical to assume that if a CRHT team is expected to reduce the pressure on acute inpatient units by 30%, as suggested in the NHS Plan (DH, 2000a), the team must focus on those who would have been admitted to hospital if it had not existed. To do so the team has to target anyone at risk of hospitalisation. Without the gatekeeping role, other professionals may continue admitting as before, and few cases may be referred to the CRHT team.

All users of mental health services who are at risk of hospitalisation should have the right to assessment for treatment at home and for this reason gatekeeping should be absolute and extend to all assessments for hospital admission, including Mental Health Act assessments and assertive outreach cases. It is recognised, however, that on occasion the team may be unable to carry out an assessment because of the timescales involved, and in such cases the involvement of the CRHT team should not hold up the process. (p.15)