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

1. Crisis Resolution &
Home Treatment (CRHT)
IMRAN WAHEED
WWW.BHAMPSYCH.COM
JULY 2011

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. 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. 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. 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. 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. Advantages identified by patients

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).