Crisis resolution and home treatment: stakeholders’ views on critical ingredients and implementation in England

BMC Psychiatry

Research Article

Hannah Istead¹  Nicola Morant²  Kate Fullarton²  Danielle Lamb²  Brynmor Lloyd-Evans²  Beth Paterson²  Sonia Johnson²  David Hindle²  Sarah Fahmy²  Claire Henderson³  Eleanor Brown⁴  Kathleen Kelly⁵  Oliver Mason⁶ 

[1] Anna Freud National Centre for Children and Families, 12 Maresfield Gardens, NW3 5SU, London, UK;Division of Psychiatry, UCL, 149 Tottenham Court Road, W1T 7NF, London, UK;Health Service and Population Research Department P029, King’s College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, SE5 8AF, London, UK;IMPACT SRC, Deakin University, Victoria, Australia;Oxford Health NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, OX3 9DU, Oxford, UK;School of Psychology, University of Surrey, Guildford, GU2 7XH, Surrey, UK;

关键词: Crisis resolution teams;    Home treatment teams;    Acute care;    Qualitative research;    Mental health services;    Implementation research;    Service users;    Carers;    Severe mental illness;   

DOI  :  10.1186/s12888-017-1421-0

 received in 2017-03-07, accepted in 2017-07-05,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCrisis resolution teams (CRTs) can provide effective home-based treatment for acute mental health crises, although critical ingredients of the model have not been clearly identified, and implementation has been inconsistent. In order to inform development of a more highly specified CRT model that meets service users’ needs, this study used qualitative methods to investigate stakeholders’ experiences and views of CRTs, and what is important in good quality home-based crisis care.MethodSemi-structured interviews and focus groups were conducted with service users (n = 41), carers (n = 20) and practitioners (CRT staff, managers and referrers; n = 147, 26 focus groups, 9 interviews) in 10 mental health catchment areas in England, and with international CRT developers (n = 11). Data were analysed using thematic analysis.ResultsThree domains salient to views about optimal care were identified. 1. The organisation of CRT care: Providing a rapid initial responses, and frequent home visits from the same staff were seen as central to good care, particularly by service users and carers. Being accessible, reliable, and having some flexibility were also valued. Negative experiences of some referral pathways, and particularly lack of staff continuity were identified as problematic. 2. The content of CRT work: Emotional support was at the centre of service users’ experiences. All stakeholder groups thought CRTs should involve the whole family, and offer a range of interventions. However, carers often feel excluded, and medication is often prioritised over other forms of support. 3. The role of CRTs within the care system: Gate-keeping admissions is seen as a key role for CRTs within the acute care system. Service users and carers report that recovery is quicker compared to in-patient care. Lack of knowledge and misunderstandings about CRTs among referrers are common. Overall, levels of stakeholder agreement about the critical ingredients of good crisis care were high, although aspects of this were not always seen as achievable.ConclusionsStakeholders’ views about optimal CRT care suggest that staff continuity, carer involvement, and emotional and practical support should be prioritised in service improvements and more clearly specified CRT models.

【 授权许可】

CC BY   
© The Author(s). 2017