Press Release - Helping people through mental health crisis:
The role of Crisis Resolution and Home Treatment services
7 December 2007
Crisis Resolution Home Treatment teams are having a positive
impact on local acute mental health services, providing an
alternative to hospital admission for people experiencing a
short-term mental health crisis.
But a report out today by the National Audit Office found that
services are being limited by a lack of input from specialist
health and social care professionals, variations in staffing levels
across the country and too few admissions to hospital being
assessed by CRHT teams.
Crisis Resolution Home Treatment (CRHT) teams help people though
short-term mental health crises by providing intensive treatment
and support outside hospital, ideally in their own homes. Used
appropriately and safely, CRHT brings clinical benefits and
increased patient satisfaction. Today’s report looked at whether
the Department of Health is delivering on its aims for CRHT
services.
Mental illness costs the economy £47 billion per year, including
over £15 billion in lost employment and £10 billion in benefits
payments. In 2006 – 07, the NHS spent more than £8 billion on
mental health services, more than on any other area of
healthcare.
The report found that CRHT services have been implemented across
most areas of the country, and where they are working they are
making a significant impact. CRHT teams have reduced pressure on
beds and the teams have been successful in reaching many service
users who would otherwise have needed admission to hospital. CRHT
teams are also supporting people in early discharge from
hospital.
The report highlights that the Department met its target of
establishing 335 teams in England by 2005. It did not meet the
national target of providing 100,000 home treatments a year by
2005, but by 2006-07 had reached 95,000 treatments a year.
The report also found wide variations between areas in the
extent to which teams are staffed and resourced. Only three regions
achieved the Department’s estimate for a full functioning service
of 14 or more whole-time-equivalent CRHT staff per 150,000
population. Staffing in the least well resourced region (North
West) is 25 per cent lower than that in the best (South Central)
and the national headcount for staff is only 90 per cent of the
number estimated by the Department as required.
Department guidelines specify that teams should be
multi-disciplinary with input from a variety of health and social
care professionals. Yet almost a third of teams received no
dedicated consultant psychiatrist input at all and fewer than half
reported having dedicated input from approved social workers.
One of the key aims of the CRHT service is for CRHT teams and
inpatient staff to assess all service users prior to admission, to
identify if they are appropriate candidates for CRHT. But, in a
sample of 500 admissions, the NAO found that this was happening in
only half of cases. A cautious estimate of savings of around £12
million a year could be achieved through greater use of CRHT
services in appropriate cases.
The NAO concludes that there is still more to do. To maximize
the impact of CRHT and improve value for money the Department and
the NHS need to ensure that CRHT teams are properly resourced,
fully functional and integrated within local mental health
services. The Department needs to take the lead in improving
national data on services, and encouraging better use of feedback
and data at the local level. Local NHS organizations need to
improve links between CRHT teams and other mental health services,
and Mental Health Trusts should enforce written policies and
procedures requiring every inpatient admission to be preceded by a
CRHT assessment.
Sir John Bourn, head of the National Audit Office, said
today:
"Crisis Resolution Home Treatment teams are really beginning to
prove their worth in the NHS. They are providing significant
benefits and increased satisfaction for service users and reducing
pressure on hospital beds.
"However, a lack of resources and a lack of multi-disciplinary
support are limiting what these teams can do. And not all of those
who would benefit from this service are being considered for it.
These issues need to be addressed if the service is to
improve."
Notes for Editors:
- The introduction of CRHT services was one of the key elements
in the 1999 National Service Framework for mental health. The NHS
Plan (2000) made the provision of CRHT services a national priority
and the Department of Health’s 2002 Public Service Agreement
included targets both for the number of teams and the number of
people treated.
- Press notices and reports are available from the date of
publication on the NAO website, which is at www.nao.org.uk. Hard
copies can be obtained from The Stationery Office on 0845 702
3474.
- The Comptroller and Auditor General, Sir John Bourn, is the
head of the National Audit Office which employs some 850 staff. He
and the NAO are totally independent of Government. He certifies the
accounts of all Government departments and a wide range of other
public sector bodies; and he has statutory authority to report to
Parliament on the economy, efficiency and effectiveness with which
departments and other bodies have used their resources.
Press Notice 58/07
All enquiries to Donna Watson, NAO Press Office:
Tel: 020 7798 7038
Mobile: 07917 555 388