The Core Study


Item 34

Working with community services


a) Communication and joint meetings between CRT and involved staff from other community mental health services are evident for at least 80% of service users with involved community services during CRT care.

b) CRT discharge plans and treatment summaries are routinely sent to GPs and involved mental health services promptly (within 3 days) at the end of CRT care (for at least 80% of service users).

c) The CRT has an identified link worker or equivalent for at least one key community mental health service who visits the service at least monthly to discuss joint working issues.

d) CRT and community mental health service managers meet at least every two months to review care pathways and referral protocols and address issues re joint working. 

e) There is all source agreement that there are good working relationships between the CRT and other community teams.

Why this is important

The work of the CRT will often join up with that carried out by other community services. Many service users will already have an involved community service, and others might benefit from this input when they exit CRT care. It is therefore important that the CRT is able to cultivate effective relationships with other community services, both through links at a management level and through frequent joint meetings between workers from the CRT, other services, and the individual service user.

Ways of doing this well

Good working relationships

The CRT in Wales prioritises communication to ensure good working relationships with other services, including the voluntary sector:

The Chichester team use a standard fax form to request information from GPs:

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:

  • South Gloucester CRT, Avon & Wiltshire Mental Health Partnership NHS Trust
  • Wyre Forest, Bromsgrove and Redditch HTT, Worcestershire Health and Care NHS Trust
  • Pontypool CRHTT, NHS Wales
  • West Gwent CRHTT, NHS Wales
  • West Suffolk HTT, Norfolk & Suffolk NHS Foundation Trust
  • Waltham Forest HTT, North East London NHS Foundation Trust
  • Tower Hamlets HTT, East London NHS Foundation Trust
  • Great Yarmouth CMHT, Norfolk & Suffolk NHS Foundation Trust
  • Eastbourne CRT, Sussex Partnership NHS Foundation Trust
  • Mid Surrey (Epsom) HTT, Surrey and Borders Partnership NHS Foundation Trust
  • Sandwell CRHTT, Black Country Partnership NHS Foundation Trust
  • Mendip CRHTT, Somerset Partnership NHS Foundation Trust 
  • South Hams and West Devon CRHTT, Devon Partnership NHS Trust
  • Taunton and Bridgewater CRHTT, Somerset Partnership NHS Foundation Trust 
  • Chichester CRHTT, Sussex Partnership NHS Foundation Trust
  • Edinburgh IHTT, NHS Lothian

Relevant reading

McGlynn (2006) CRHT: A practical guide

'Meet with other CRHT teams

Staff from the team should attend CRHT team forums to exchange information about the good things teams have done, and the hazards teams have faced, to support each other and to unite to take action to deal with threats to their sustainability.' (p.20)

National Audit Office (2008) CRHT: The Service User and Carer Experience

'Continuity between teams - the need for a whole systems approach to the mental health care pathway is a key focus of recent Department of Health policy guidance.  Service users and carers echo the Department's stated need for 'overall service system coordination and coherence' and 'shared values, principles and processes across the whole service system', and feel confused and disappointed when that system appears to break down:

'You're left in limbo, if you're not like familiar with it all, and for someone who is first approached by mental illness it can be a little bit about […] co-ordination. Yes, it's like the right hand doesn't talk to the left hand. And that goes right down to the GP.'

Tiffany (carer)

Source: NAO carer focus group

'I thought, "If he's taken the pills, that's really bad", so I rang the crisis line […] They said, 'Who's the CPN? I'll get in touch with them in the morning'. This was Tuesday

 night. By Friday I hadn't been able to get out of the house. I was in tears. I rang the CPN, and they hadn't even left him a message.'

Mandy (carer)

Source: NAO carer focus group

'When I was discharged, two weeks later, I had an appointment with my consultant who had not had my file back from the Home Treatment team. So Home Treatment had not informed him of my medication […] and I just think it was a shambles.'

Susan (CRHT service user)

Source: NAO service user focus group' (p.23)