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The aim of this study is to benchmark the impact of the Crisis Resolution Home Treatment Team (CRHTT) on the elderly admission rate as well as the duration of admission

Data were collected for a period of one year before (August 2006 to July 2007) and after (August 2007 to July 2008) the extension of CRHTT input into elderly services.

There was an overall reduction in the number of admissions after CRHTT got involved with the elderly.

This study only considered individuals with functional disorders who were admitted to the in‐patient services or referred to the CRHTT. However, these only make up a proportion of the elderly in‐patients.

The study will help identify areas which may further help in reducing the admissions.

This is an original study that acknowledges the reduction in admission following the introduction of a crisis resolution home treatment team in Trafford, Manchester.

There has been a rapid development and implementation of crisis resolution home treatment teams (CRHTT) in the UK over the past decade. The available research studies of this service provision to date have largely focused on issues related to the “outputs” of CRHTT, for example cost efficacy and the impact on admission rates. There is limited research on the experiences of clinical psychologists within CRHTT. This is despite the fact that it would seem that research exploring the experiences of mental health professionals in CRHTT is important, as working in a new area of service provision may present specific challenges. An understanding of the nature of these challenges is considered important in order to support clinical psychologists in these settings, and to sustain and improve service delivery.

–This study presents a qualitative exploration of clinical psychologists’ experiences of working in a CRHTT. In total, 11 clinical psychologists were interviewed about their perceptions of working within CRHTT, their relationships with other professionals and their experiences of working with service users in “crisis”. The grounded theory approach was employed to analyse participants’ accounts.

–Two themes were identified: psychological and clinical work and teamwork. The emergent themes are compared to the wider literature on clinical psychologists’ experiences of working in teams, and working with service users in “crisis”.

This research demonstrates the value of a clinical psychology perspective in acute mental health settings. It also highlights the value of a clinical psychological perspective in multi-disciplinary team working. It draws attention to the need for clinical psychologists working in CRHTT settings to be able to more clearly articulate their roles in these services. It points to the importance of clinical psychologists considering the interventions they provide to service users with complex presentations. Also, it highlights their need to consider the psychological interventions they provide in CRHTT settings more generally, as this area of work does not closely align with NICE guidelines.

This paper seeks to explore staff experiences of working in Crisis Resolution and Home Treatment (CRHT). There is a paucity of research in the area and a particular lack of in‐depth qualitative accounts of staff experiences with most research focused on output and outcomes of CRHTs, including inpatient admission and bed‐occupancy rates.

Interpretative phenomenological analysis (IPA) was used to investigate participants' experiences of working in this service context. Five CRHT workers were interviewed about their experiences, including the aspects of their work that they found enjoyable and those that they found stressful, and how they coped with challenges related to the work.

Three master themes, each with corresponding subordinate themes, emerged from the analysis. These were: “motivating factors”, “stressors” and “coping”. These findings indicated these subjective experiences emphasised the opportunities to make a difference and help service users and build therapeutic relationships. Perceived stressors were understood in the context of a complex service context, operational issues, responsibility for service users, and supervision and training needs.

The implications of the research for CRHT staff are discussed as well as the limitations of this study.

This study offers a timely development in understanding the experiences of staff working in CRHTs.

The search for alternatives to inpatient mental health care in the UK and further afield has been going on over the last few decades of the previous century. Amongst the range of alternatives that have been developed are community‐based mental health crisis houses that seek to work with people, who may otherwise have been admitted to hospital. Amethyst House is a four‐bed mental health crisis house based in inner city Liverpool and works solely with the local Crisis Resolution Home Treatment Team (CRHTT) to work with people who require support that could not be delivered at home. The purpose of this paper is to report the findings of one element of a service evaluation: the effectiveness of the service in relation to the mental health needs of people admitted.

The paper describes the service model, which integrates the crisis house and the CRHTT, with the latter acting as gatekeepers to the service.

Findings showed improvements in mental health symptomatology and disabilities associated with the crisis between admission and discharge from the service.

The paper describes the profile of the people who used the service over a six‐month period in 2009, their care pathways through the service and their clinical outcomes between admission and discharge.

Families play an instrumental role in helping relatives experiencing mental health issues to stay well. In the context of wider initiatives promoting family and carer needs, this study aims to evaluate the feasibility, acceptability and potential benefits of bespoke training to develop clinicians’ skills in working with families in crisis.

The study was an uncontrolled evaluation of a one-day workshop for home treatment team staff using pre- and post-questionnaires.

In total, 83 staff members participated. Overall, there was a strong agreement for the involvement of families, which increased marginally after training. There were significant changes in views about talking to family members without service user consent (p = 0.001) and keeping them informed of their relative’s well-being (p = 0.02). Qualitative feedback indicated that participants enjoyed the interactive elements, particularly role-playing. Training provided an opportunity to practice skills, share knowledge and facilitate the integration of family work into their professional role.

Confident support for families contributes to effective mediation of crisis and continuation of care; factors important in reducing admission rates and protecting interpersonal relationships. Overall, the consistency of responses obtained from participants suggests that this workshop offers a helpful introduction to a family approach at times of a mental health crisis.

This pilot evaluation suggests this new one-day workshop, is a feasible and acceptable training program, which is beneficial in developing clinicians’ skills in working with families in a crisis.

A quarterly reflection on recent research into mental health and social inclusion issues.

This position paper focuses on the current tensions and challenges of aligning inpatient care with innovations in mental health services. It argues that a cultural shift is required within inpatient services. Obstacles to change including traditional perceptions of the role and responsibilities of the psychiatrist are discussed. The paper urges all staff working in acute care to reflect on the service that they provide, and to consider how the adoption of new ways of working might revolutionise the organisational culture. This cultural shift offers inpatient staff the opportunity to fully utilise their expertise. New ways of working may be perceived as a threat to existing roles and responsibilities or as an exciting opportunity for professional development with increased job satisfaction. Above all, the move to new ways of working, which is gathering pace throughout the UK, could offer service users1 a quality of care that meets their needs and expectations.

This review paper will look at internationally existing publications in the English language on mental health shared decision making (SDM) implementation of a variety of interventions, including different methodologies and research methods, age groups and countries. The purpose of this paper is to provide an overview of: process, degree and outcomes of implementation; barriers and facilitators; perspectives on implementation by different stakeholders; analysis of the process of implementation in mental health services through the lenses of the normalisation process theory (NPT).

Following a targeted literature search the data were analysed in order to provide an overview of methodologies and methods applied in the articles, as well as of the variables listed above. Three different types of information were included: a content analysis of key issues, reflective understanding coming out of participating in implementation of an SDM project in the form of two narratives written by two key participants in an SDM pilot project and an NPT analysis of the process of implementation.

Only a minority of mental health SDM research focuses on implementation in everyday practice. It is possible and often desirable to achieve SDM in mental health services; it requires a low level of technology, it can save time once routinized, and it is based on enhancing therapeutic alliance, as well as service users’ motivation. Implementation requires an explicit policy decision, a clear procedure, and regular adherence to the aims and methods of implementation by all participants. These necessary and sufficient conditions are rarely met, due to the different levels of commitment to SDM and its process by the different key stakeholders, as well as due to competing providers’ objectives and the time allocated to achieving them.

The review indicates both the need to take into account the complexity of SDM, as well as future strategies for enhancing its implementation in everyday mental health practice. Perhaps because applying SDM reflects a major cultural change in mental health practice, current value attached to SDM among clinicians and service managers would need to be more positive, prominent and enduring to enable a greater degree of implementation.

The Coventry Community Personality Disorder Service is a new service that has been developed successfully over the past two years, despite several challenges such as real difficulties with recruitment. This is a description of our model, its implementation and some of the emergent issues we encountered along the way.

The purpose of this paper is to evaluate the impact on recovery and personal goal attainment of a transition intervention service for return to the community following exit from an alternative to psychiatric inpatient admission – a residential recovery house. The services seek to facilitate community reintegration, promote recovery and prevent future mental health crisis. The service was funded by the Stone Family Foundation.

This evaluation employed a within groups design: a single case evaluation follow-up. Analysis of Recovery Star and personal goal achievement data collected at service entry and exit points during routine practice (n=181), at four sites in England. The adults had mental illness diagnoses including depression, schizophrenia, bipolar disorder, personality disorder, and anxiety disorder.

There was a significant increase in overall Recovery Star scores with a large effect size, and significant increases in eight of the ten Recovery Star life domains. There were significant increases in the goal scores linked to “Managing mental health”, “Self-care” and “Living skills”.

A transitional intervention service provided by the third sector for return to community following mental health crisis may contribute to recovery and personal goal achievement. A randomised control trial of this transition intervention service is recommended.

This is first outcome evaluation of an alternative to psychiatric inpatient admission transition intervention service and findings indicate the potential positive effect of having this service incorporated into the design of alternative to admission provision.