Crisis Resolution and Home Treatment


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A presentation by Dr Imran Waheed about Crisis Resolution and Home Treatment in mental health.

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Crisis Resolution and Home Treatment

  1. 1. Crisis Resolution &Home Treatment (CRHT) IMRAN WAHEED WWW.BHAMPSYCH.COM JULY 2011
  2. 2. What is Home Treatment? A 24/7 system for the rapid response and assessment of mental health crisis in the community Offers comprehensive acute psychiatric care at home until the crisis is resolved, usually without hospital admission. Acute care is delivered by a specialist team so as to provide an alternative to hospital admission for individuals with serious mental illness Staffed by nurses, social workers, psychiatrists, OTs, support workers
  3. 3. Why Home Treatment? Interpersonal problems make a major contribution to many psychiatric crises. If people can stay at home at the time of crisis, team members can observe these problems first-hand. Evidence repeatedly shows service users do not like hospitals (SCMH, 1998). Early intervention and treatment prevents deterioration and leads to quicker improvement. Being a psychiatric inpatient carries more social stigma than being treated at home. Home treatment has been shown to cost less than inpatient treatment. Up to 30% of inpatient costs are for hotel services such as cleaning, cooking, linen, etc., not to mention the capital cost of the building. This money is not available for clinical care (Young & Reynolds, 1981)
  4. 4. Who is it for? Commonly adults (16 to 65 years old) With severe mental illness (e.g. schizophrenia, manic depressive disorders, severe depressive disorder) With an acute psychiatric crisis of such severity that, without the involvement of a crisis resolution/home treatment team, hospitalisation would be necessary
  5. 5. Gatekeeping and Rapid Response Act as a „gatekeeper‟ to mental health services, rapidly assessing individuals with acute mental health problems and referring them to the most appropriate service. Screening for the presence of mental health problems which would benefit from involvement of specialist mental health services. Screening possible hospital admissions, so as to minimise these by the provision of Crisis Resolution/Home Treatment team support. No evidence for reduced admissions unless CRHT “gatekeep” all admissions
  6. 6. Early Discharge Facilitation Remain involved with the patient until the crisis is resolved and the service user is linked to ongoing care. If hospitalisation is necessary, be actively involved in discharge planning and provide intensive care at home to enable early discharge. Discharge planning from the point of admission
  7. 7. Advantages identified by patients
  8. 8. What effect do they have? Research evidence suggests that when CRHT teams are shaped around specific service characteristics and principles they: Are likely to reduce the number of admissions to hospital (by between 20% and 40%) and the length of stay for people who are admitted Improve service users‟ experiences of acute mental health care (Minghella et al., 1998).