The Core Study



National Audit Office: Helping people through mental health crisis: The role of Crisis Resolution and Home Treatment Services

'CRHT teams provide acute home treatment for people whose mental health crisis is so severe that they would otherwise have been admitted to an inpatient ward. Users of CRHT are typically suffering from severe mental illness such as psychosis, severe depression or bipolar affective disorder (manic depression).' (p.5)

'1.2 Most people with mental health problems receive treatment in the community, for example from their GP or a Community Mental Health Team. But acute services are also a crucial part of mental health services. Severe psychiatric illnesses are often episodic in nature, with sufferers experiencing both stable phases and periods where their symptoms become more intense. During such periods, they require acute mental health services to provide intensive monitoring and support and help them return to stability. 

1.3 At one time, such services were available only in hospitals, with people in crisis having to be admitted as inpatients to receive the treatment they needed. More recently, and in common with practice in a number of other countries,13 the Department of Health has aimed to ensure that prompt and effective help in times of crisis is provided in an appropriate and safe place as close to home as possible. This aim reflects the development of new clinical techniques and drugs facilitating treatment outside hospital, as well as a growing recognition since the middle of the twentieth century that institutionalisation is the least beneficial option for many users of mental health services.14 Long inpatient stays can mean service users become disconnected from their home and working lives, leading to increased social exclusion, stress and risk of relapse after discharge.' (P. 12-13)

Quote about how CRT could work with more people (currently not always used and people are admitted instead):

'3.22 Both ward and CRHT managers reported instances of patients being admitted even when the managers considered the service user an appropriate candidate for CRHT - ward managers reported this in 16 per cent of the 500 admissions examined. CRHT managers reported that for 20 per cent of the service users referred to them who had subsequently been admitted, the admission would have been better avoided.

3.23 The reasons given why service users had been admitted in these cases varied widely, but included insistence by the Consultant Psychiatrist, accommodation problems or homelessness, patient preference and carers' anxiety about being able to cope. These indicate areas in which strengthening CRHT services and links to other services would provide scope to further reduce admissions in appropriate cases.' (p.24)

'3.26 The broad range of choice for a person in crisis remains quite limited: they can either engage in short‑term intensive home-based treatment, or be admitted to hospital. Indeed, very few alternatives to hospital are available to CRHT teams beyond their own staff providing therapy to service users in service users' homes. Several CRHT managers suggested that access to alternativesto hospital admission could increase their capacity for delivering CRHT: four of the 25 identified a need for short term respite or crisis accommodation, and three identified a need for acute day hospitals.42' (p.25)