Item 10

Focus on core CRT role

Target

a) CRT staff's work involves crisis assessment and home treatment  at least 95% of the time (e.g. not also delivering A&E liaison or  a more general community assessment or continuing care service).

b) At least 70% service users stay with the CRT <6 weeks.

c) At least 90% service users stay with the CRT <6 weeks.

d) There is all-source agreement that the majority of service users accepted for treatment would have otherwise been admitted to hospital. 

e) There is all-source agreement that at least 90% of service users accepted for treatment would have otherwise been admitted to hospital.

Why this is important

Working with less acutely ill people or taking on other types of work would inevitably dilute CRTs' focus on providing intensive home treatment to people who would otherwise be in hospital. Our consultations for the CRT fidelity scale found agreement that CRTs must maintain a clear focus on crisis home treatment to deliver it successfully.

Ways of doing this well

Clear expectations about length of crisis support 

Having clear expectations regarding length of stay. This can involve having a set cut off date for the ending of care, with 6 weeks generally seen as the maximum length of time over which crisis care should be provided.

A clear statement of CRTs' role and responsibilities in operational policy

Automatic review at 6 weeks

Some CRTs have an automatic review if someone has stayed 6 weeks, with an expectation that discharge will be achieved by then unless there are exceptional circumstances, and this kind of procedure can help ensure that the focus of the CRT remains on providing crisis care. 

Focusing on discharge from the outset 

Good communication with continuing care services regarding reasons for referral. As with other items having regular clinically orientated meetings between services can help ensure that this happens. (see item 2, 8, 34)

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:

• Islington CRT, Camden & Islington NHS Foundation Trust
• Bristol Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
• South Gloucester CRT, Avon & Wiltshire Mental Health Partnership NHS Trust
• Greenwich CRT, Oxleas NHS Foundation Trust
• West Gwent CRHTT, NHS Wales
• West Suffolk HTT, Norfolk & Suffolk NHS Foundation Trust
• South Gwent CRHTT, NHS Wales
• Northamptonshire North (Kettering) CRHTT, Northamptonshire Healthcare NHS Foundation Trust
• Shropshire CRT, South Staffordshire & Shropshire Healthcare NHS Foundation Trust
• Surrey Heath HTT (Frimley), Surrey and Borders Partnership NHS Foundation Trust
• Adur, Arundle & Worthing CRHTT, Sussex Partnership NHS Foundation Trust
• North West Sussex (Crawley) CRT, Sussex Partnership NHS Foundation Trust
• East and Mid Devon CRHTT, Devon Partnership NHS Trust
• Chichester CRHTT, Sussex Partnership NHS Foundation Trust
• Edinburgh IHTT, NHS Lothian
• Torbay CRT, Torbay and Southern Devon Health and Care NHS Trust
• South East Hertfordshire (Ware) CATT, Hertfordshire Partnership University NHS Foundation Trust
• Norwich HTT, Norfolk & Suffolk NHS Foundation Trust
• North Camden CRT, Camden & Islington NHS Foundation Trust

Relevant reading