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McGlynn (2006) CRHT: A Practical Guide
Size and structure of a CRHT team
The ideal size for a CRHT team depends on:
• the population of the catchment area to be covered
• the level of need in the catchment area
• the number of inpatient admissions from the catchment area prior to the CRHT team commencing operation
• the number of staff needed to maintain an adequate rota, allowing for periods of leave and sickness
• the need for good communication between team members.
The policy implementation guidelines (DH, 2001a) state that there should be 14 clinical staff (not including medical staff ) per 150,000 population but acknowledges that local circumstances mean a team may require a variation from this. Inner city areas may generate far more people in crisis for a given population size than do rural areas because the people living there tend to have more problems and fewer social supports. There is an argument therefore for inner city teams being larger or the population covered being smaller. There are some areas - especially rural areas with small populations - where to follow the guidelines would result in a team with too few staff for an adequate rota. With fewer than 10 or 11 staff a team becomes vulnerable to the effects of holidays and study leave plus unexpected sickness, with the possibility of having only one worker for a particular shift - a situation which could be dangerous.
From the experience of the early teams, a team of 14 can deal with an area that produces about 400 hospital admissions per annum before the team's commencement.
In some areas of the country there are teams that are quite large, with more than 30 staff covering a population of around 350,000. This can create potential problems with staff communication; team handovers need to be handled with firmness and skill, for example, to ensure that they do not take an inordinate amount of time. Nevertheless some of the larger teams have produced good outcomes, so it is too early to say whether they should be recommended or not. (p.14)