The Core Study


Item 8

Explanation and direction to other services regarding declined referrals


a) The CRT manager and staff team identify clear care pathways and available sources of support for service users requiring urgent help but not requiring hospital admission or CRT care.  

b) There is all-source agreement that the CRT provides a written response phone or face-to-face contact to referrers for service users assessed in person but not taken on, explaining their decision and identifying appropriate sources of support where needed. 

c) The CRT will refer in person to appropriate sources of support for service users not using other mental health services assessed in person but not taken on. 

d) The CRT monitors referrers for accepted and declined referrals and provides clear guidance about referral thresholds, especially for those who frequently make referrals that are not accepted. 

Why this is important

Providing clear guidance and support around referral pathways will allow the CRT to concentrate on its core remit, and will also ensure that service users receive the appropriate support in a timely fashion. Stakeholders indicated that inappropriate referrals can be a problem for CRTs, and some referrers may require guidance on what the thresholds for CRT care are. Monitoring this will highlight patterns in referral sources and allow action to be taken if necessary. If a referral is inappropriate it is important that a clear care pathway is identified for the service user, so they are provided a prompt service and not just returned to their GP.

In the video below, Danni Lamb, CORE study Deputy Programme Manager, talks about the importance of clearly publicised contact details and referral criteria to ensure teams are open to a range of sources. 

Ways of doing this well

Clear care pathways

Good communication and understanding between the CRT and other community care teams to flag up when prompt sub-acute help is needed. 

Reducing inappropriate referrals 

  • Monitoring referral sources and identifying/addressing frequent referrers of clients not taken on 
  • Clear guidance for referrers (checklist for making referrals, info on where else to go, section on referral form prompting CRT staff to give written reason for why referral declined)
  • Link workers, induction shadowing etc (see item 34, eg. part of staff induction could be spending a short amount of time with other services) 

Clear communication

The Bristol team send a letter to service users and their GPs/care coordinators explaining why they were not taken on to the CRT case load:

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:

  • Wyre Forest, Bromsgrove and Redditch HTT, Worcestershire Health and Care NHS Trust
  • Maidstone CRT, Kent and Medway NHS and Social Care Partnership Trust
  • Northamptonshire North (Kettering) CRHTT, Northamptonshire Healthcare NHS Foundation Trust
  • South Tyneside Initial Response Team, Northumberland, Tyne and Wear NHS Foundation Trust
  • Tower Hamlets HTT, East London NHS Foundation Trust
  • Redbridge HTT, North East London NHS Foundation Trust
  • Walsall CRT, Dudley and Walsall Mental Health Partnership NHS Trust
  • Hastings CRT, Sussex Partnership NHS Foundation Trust
  • Great Yarmouth CMHT, Norfolk & Suffolk NHS Foundation Trust
  • Eastbourne CRT, Sussex Partnership NHS Foundation Trust
  • Taunton and Bridgewater CRHTT, Somerset Partnership NHS Foundation Trust 
  • Edinburgh IHTT, NHS Lothian
  • Gloucester CRT, 2gether NHS Foundation Trust
  • South East Hertfordshire (Ware) CATT, Hertfordshire Partnership University NHS Foundation Trust