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Helping people through mental health crisis: The role of Crisis Resolution and Home Treatment services

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.

"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."

Sir John Bourn, head of the National Audit Office

Notes for Editors

  1. 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.
  2. Press notices and reports are available from the date of publication on the NAO website, which is at Hard copies can be obtained from The Stationery Office on 0845 702 3474.
  3. 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.

PN: 58/07