The Core Study


Item 1

Responding quickly to new referrals


a) The CRT records and monitors response times to referrals and reviews breaches of response targets.

b) The CRT responds to the referrer within 30 minutes.

c) The  CRT offers an assessment with the service user which takes place within 4 hours for at least 90% of appropriate referrals.

d) The CRT offers a same-day assessment for at least 50% of appropriate referrals made before 6pm.

e) The CRT offers a same-day assessment for at least 90% of appropriate referrals made before 6pm.

f) The CRT provides an immediate mobile response to requests for assessment from emergency services.

Why this is important

Rapid response is crucial for all crisis services to keep people safe and manage crises effectively. Until the CRT team have assessed someone referred to the team, the level of risk and most appropriate service response are not known. Swift access to the CRT was rated as the highest priority of all by stakeholders in the development work for the CORE CRT fidelity scale. Our survey of CRT managers suggests target response times of less than 4 hours from referral to assessment by the CRT are achievable.

Below is a video clip of service users and carers talking about how important quick and easy access to the CRT was to them when they were unwell:

Ways of doing this well

Monitoring response times

Setting formal targets for how quickly the CRT assesses new referrals can help increase focus on rapid response.  Trust policies and the CRT's operating procedures can helpfully reinforce target response times. 

Clear systems to record the time of referrals to the CRT and the time of initial assessment by the CRT are necessary to allow any monitoring of response times. Maidstone CRT, Great Yarmouth CRT and South Wiltshire CRT have all developed systems for monitoring response times to referrals. 

Rapid response

Systems that help Crisis Teams respond rapidly to referrals include being clear about when an assessment for CRT care may be appropriate. Clarity about definitions of a crisis and thresholds for accepting people for CRT care will help with this [See Item 2]. Clear information for referrers about where to access prompt but less acute mental health care will also help [See Item 8].

Ensuring that initial phone referrals are considered by a CRT clinician who is sufficiently experienced to sign-post on referrals which are clearly better suited to other services may also help. 

Sunderland CRHT obtained feedback from service users who reported that they often found it difficult to access crisis support when they needed it,  so the CRHT developed an Initial Response Team to improve accessibility to urgent mental health care. The case study below describes how this change in service delivery impacted positively on service user experience. 

    Examples of good practice

    In our fidelity review survey of 75 crisis teams in 2014, the following teams achieved excellent model fidelity, and can be contacted for advice about how they achieved this:

    • North East Kent CRHTT, Kent and Medway NHS and Social Care Partnership Trust
    • South Tyneside Initial Response Team, Northumberland, Tyne and Wear NHS Foundation Trust

    Relevant reading

    Crisis Resolution and Home Treatment - A Practical Guide, ed. McGlynn (2006)

    Rapid, mobile response

    The sooner a problem can be dealt with and treatment commences, the shorter the period of suffering and the less likely deterioration is to occur. It is thus essential that the team is mobile. There are some people who will not come to a clinic or a centre or an A&E department, despite everyone's efforts to get them there, because they do not believe they need help, or they do not want help. Seeing people in their own environment allows them to be more natural, more of their social network is likely to be involved and staff can evaluate the circumstances in which treatment is to take place. A problem with A&E assessments is that service users and carers sometimes have an expectation that admission to hospital will be the next step, and even if staff do not  think this is warranted, time and effort has to be expended to overcome that view. (p. 16)