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The Core Study

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Item 28

Psychiatric cover

Target

a) Total psychiatric cover is  at least 1.0 full time equivalent (fte) per median CRT caseload size of 30, involving some cover on at least 5 days per week (fully met); at least 0.6 fte per caseload of 30 involving some cover on at least 3 days per week (partially met).

b) Total consultant psychiatrist time is at least 0.6fte per median caseload of 30 involving some cover on at least 3 days per week (fully met); at least 0.3fte per caseload of 30 (partially met). 

c) The CRT can obtain advice and arrange urgent psychiatric assessments within 4 hours for CRT service users from a psychiatrist within the local service system throughout the CRT's opening hours.

Why this is important

Having psychiatrists within the CRT team is the best way to ensure CRT service users can receive medical review or medication prescription promptly when needed. Our review found there is some evidence that CRTs including a psychiatrist were more effective in reducing hospital admissions.

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:

  • Witshire North Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
  • South Wiltshire Intensive Service, Avon & Wiltshire Mental Health Partnership NHS Trust
  • West South Staffordshire (Stafford) CRT, South Staffordshire & Shropshire Healthcare NHS Foundation Trust
  • Sunderland, Northumberland, Tyne and Wear NHS Foundation Trust
  • Wyre Forest, Bromsgrove and Redditch HTT, Worcestershire Health and Care NHS Trust
  • Maidstone CRT, Kent and Medway NHS and Social Care Partnership Trust
  • Northamptonshire South CRHTT, Northamptonshire Healthcare NHS Foundation Trust
  • West Suffolk HTT, Norfolk & Suffolk NHS Foundation Trust
  • Northamptonshire North (Kettering) CRHTT, Northamptonshire Healthcare NHS Foundation Trust
  • Gateshead CRT, Northumberland, Tyne and Wear NHS Foundation Trust
  • Shropshire CRT, South Staffordshire & Shropshire Healthcare NHS Foundation Trust
  • Newham Psychiatric Acute Community Team, East London NHS Foundation Trust
  • South Tyneside Initial Response Team, Northumberland, Tyne and Wear NHS Foundation Trust
  • Bromley HTT, Oxleas NHS Foundation Trust
  • Waltham Forest HTT, North East London NHS Foundation Trust
  • Barking, Dagenham, Havering HTT, North East London NHS Foundation Trust
  • Surrey Heath HTT (Frimley), Surrey and Borders Partnership 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
  • Adur, Arundle & Worthing CRHTT, Sussex Partnership NHS Foundation Trust
  • West Berkshire CRHTT, Berkshire Healthcare NHS Foundation Trust
  • Eastbourne CRT, Sussex Partnership NHS Foundation Trust
  • Hounslow HTT, West London Mental Health NHS Trust
  • Brighton & Hove CRHTT, Sussex Partnership NHS Foundation Trust
  • North West Sussex (Crawley) CRT, Sussex Partnership NHS Foundation Trust
  • Mid Surrey (Epsom) HTT, Surrey and Borders Partnership NHS Foundation Trust
  • Surrey East (Redhill) HTT, Surrey and Borders Partnership NHS Foundation Trust
  • Sandwell CRHTT, Black Country Partnership NHS Foundation Trust
  • South Essex West (Basildon) CRHTT, South Essex Partnership University NHS Foundation Trust 
  • South East Essex (Rochford) CRHTT, South Essex Partnership University NHS Foundation Trust 
  • South East Kent (Canterbury) CRHTT, Kent and Medway NHS and Social Care Partnership Trust
  • Bath Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
  • Mendip CRHTT, Somerset Partnership NHS Foundation Trust 
  • South Hams and West Devon CRHTT, Devon Partnership NHS Trust
  • North Devon CRHTT, Devon Partnership NHS Trust
  • East and Mid Devon CRHTT, Devon Partnership NHS Trust
  • Taunton and Bridgewater CRHTT, Somerset Partnership NHS Foundation Trust 
  • Edinburgh IHTT, NHS Lothian
  • Gloucester CRT, 2gether NHS Foundation Trust
  • Hammersmith CRHTT, West London Mental Health NHS Trust
  • Wolverhampton CRHTT, Black Country Partnership NHS Foundation Trust
  • 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

Relevant reading 

Mental Health Foundation (2012) Take Control: Self-management in care and treatment planning

Medical input - general guidelines:

• Input from psychiatrists is essential for crisis resolution services.

• A consultant psychiatrist should have designated medical responsibility for home based crisis service clients.

• The consultant psychiatrist should be available for a minimum of two weekly sessions to go out and review the cases. In addition, it should also be possible to have access to associate specialists for urgent consultations.' (p. 9)