Abstract
BackgroundCrisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users’ satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs.MethodsA systematic review was conducted. MEDLINE, Embase, PsycINFO, CINAHL and Web of Science were searched to November 2013. A further web-based search was conducted for government and expert guidelines on CRTs. We analysed studies separately as: comparing CRTs to Treatment as Usual; comparing two or more CRT models; national or regional surveys of CRT services; qualitative studies of stakeholders’ views regarding best practice in CRTs; and guidelines from government and expert organisations regarding CRT service delivery. Quality assessment and narrative synthesis were conducted. Statistical meta-analysis was not feasible due to the variety of design of retrieved studies.ResultsSixty-nine studies were included. Studies varied in quality and in the composition and activities of the clinical services studied. Quantitative studies suggested that longer opening hours and the presence of a psychiatrist in the team may increase CRTs’ ability to prevent hospital admissions. Stakeholders emphasised communication and integration with other local mental health services; provision of treatment at home; and limiting the number of different staff members visiting a service user. Existing guidelines prioritised 24-hour, seven-day-a-week CRT service provision (including psychiatrist and medical prescriber); and high quality of staff training.ConclusionsWe cannot draw confident conclusions about the critical components of CRTs from available quantitative evidence. Clearer definition of the CRT model is required, informed by stakeholders’ views and guidelines. Future studies examining the relationship of overall CRT model fidelity to outcomes, or evaluating the impact of key aspects of the CRT model, are desirable.Trial registrationProspero CRD42013006415.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0441-x) contains supplementary material, which is available to authorized users.
Highlights
Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital
CRT service characteristics: for quantitative studies comparing two CRT service models, we reported the differences between services being studied; for studies of CRTs versus standard care, we reported characteristics of CRTs identified in statutory guidance for England [2] including 24 hour service, gatekeeping function staffing levels, multi-disciplinary team, medical staffing in team, duration of care and early discharge function to support prompt discharge from hospital
Study characteristics The 69 papers included in the review comprised: 1. Comparisons of two CRT models (Table 1) (n = 5) [31,32,33,34,35]: Natural experiments, three with pre-post comparisons
Summary
Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs. Crisis Resolution and Home Treatment Teams (CRTs) serve adults experiencing an acute mental health crisis who are otherwise likely to require hospital admission. CRTs in England Provision of CRTs in all catchment areas became mandatory in England in 2000 under the National Health Service (NHS) Plan [3] Nationwide introduction of this model was achieved over the few years, but with variable adherence to the Department of Health’s original guidance [4]. CRT availability is no longer mandatory in England, but the model continues to be prominent: national guidance on service delivery strongly recommends CRTs as a central part of acute service pathways [5,6]
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