Crisis teams: systematic review of their effectiveness in practice

Rebecca A Carpenter,Thomas P White,Derek K Tracy,Jara Falkenburg

doi:10.1192/pb.bp.112.039933

Rebecca A Carpenter, Thomas P White + Show 2 more

Open Access

https://doi.org/10.1192/pb.bp.112.039933

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Abstract

Aims and methodCrisis resolution and home treatment teams (variously abbreviated to CRTs, CRHTTs, HTTs) were introduced to reduce the number and duration of in-patient admissions and better manage individuals in crisis. Despite their ubiquity, their evidence base is challengeable. This systematic review explored whether CRTs: (a) affected voluntary and compulsory admissions; (b) treat particular patient groups; (c) are cost-effective; and (d) provide care patients value.ResultsCrisis resolution teams appear effective in reducing admissions, although data are mixed and other factors have also influenced this. Compulsory admissions may have increased, but evidence that CRTs are causally related is inconclusive. There are few clinical differences between ‘gate-kept’ patients admitted and those not. Crisis resolution teams are cheaper than in-patient care and, overall, patients are satisfied with CRT care.Clinical implicationsHigh-quality evidence for CRTs is scarce, although they appear to contribute to reducing admissions. Patient-relevant psychosocial and longitudinal outcomes are under-explored.

Highlights

Crisis resolution teams are cheaper than in-patient care and, overall, patients are satisfied with CRT care
Crisis resolution teams were implemented in the UK based on projected reductions on hospital admissions - both rates and durations - and compulsory detentions, improved patient satisfaction and cost savings, but without adequate evidence that they would be effective in meeting these aims
This systematic review illustrates an overall trend of falling admission rates that is massively confounded by national changes in in-patient bed numbers, rates fell more so for areas that had a CRT,[17] and the evidence overall supports a modest positive effect in reducing admission rates and duration

Summary

Results

Voluntary admission rates and duration The NHS Plan[3] stated that CRTs should produce a 30% reduction of both rate and length of admission. Other work[36,37] investigated cost-effectiveness using previously collected data.[9,10] Over a 6-month follow-up period CRT patients cost £2438 less than in-patients.[36] In the prospective controlled trial[37] the finding that a CRT patient costs less per 6 months than an in-patient was only significant when patients who had any CRT contact were compared with those that had no contact, rather than comparing pre- or post-CRT groups Thirteen studies addressed this question (see online Table DS4 for characteristics of included studies): two systematic reviews,[7,8] one RCT,[9] six quantitative analyses,[9,10,30,39,40,41] three qualitative analyses,[42,43,44] and two using both.[11,45] Some studies[15,27] attempted to collect patient satisfaction data as secondary analyses, but had response rates considered too low to report given the issue of response bias. These problems were not universal, and most patients accepted the ending of CRT care as long as they were given sufficient warning, explanation and details when changes were going to occur, and a specific plan for what they should do if a crisis were to occur again

Method

Discussion