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CRHTT

Roles and ResponsibilitiesHome Treatment Team StructureWorking practicesInterventionsReferrals. Over View. Key Policy Guidance and Reports. National Service Framework for Mental Health: Modern standards and Service Models (DoH 1999)NHS Plan (DoH 2000)Mental Health Policy Implementation G

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CRHTT

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    1. CRHTT Crisis Resolution and Home Treatment Team

    2. Roles and Responsibilities Home Treatment Team Structure Working practices Interventions Referrals Over View

    3. Key Policy Guidance and Reports National Service Framework for Mental Health: Modern standards and Service Models (DoH 1999) NHS Plan (DoH 2000) Mental Health Policy Implementation Guide: Crisis Resolution /Home Treatment Teams. (DoH 2001) Guidance Statement on Fidelity and Best Practice for Crisis Services (DoH 2006)

    4. Who is CRHT for? The MHPIG (DoH 2001 p11) states ‘Commonly adults (16 to 65 years old) with severe mental illness (e.g. schizophrenia, manic depressive disorders, severe depressive disorder) with an acute psychiatric crisis of such severity that, without the involvement of a crisis resolution/home treatment team, hospitalisation would be necessary……… Including people with a diagnosis of personality disorder (DoH 2003, Personality disorder no longer a diagnosis of exclusion).

    5. And who should be signposted on to other services This service is not usually appropriate for individuals with: Mild anxiety disorders Primary diagnosis of alcohol or other substance misuse Brain damage or other organic disorders including dementia Learning disabilities Recent history of self harm but not suffering from a psychotic illness or severe depressive illness • Crisis related solely to relationship issues’ (MHPIG (DoH 2001 p11)

    6. Mental Health Policy Implementation Guide: Crisis Resolution /Home Treatment Teams. 24/7 service Least restrictive environment Gate-keeper to in-patient beds Rapid response following referral Intensive intervention and support in the early stages of crisis Maintaining the individuals social system Time limited intervention

    7. Roles and Responsibilities Key Tasks. Home Treatment as an alternative to hospital admissions. Gate Keeping all acute admissions. Facilitate early discharge from the hospital. (Discharge at a time earlier than would happen if intensive home treatment was not available and is still part of an acute episode of care.)

    8. CRHTT Team Structure Integrated Team Manager; Urgent Care Services (CRHT, AMHP,ADTT,MHLT) Lead Nurse Multidisciplinary Team: Mental Health Nurses Social workers Doctors: Consultant Psychiatrist Staff grade, Specialty grade, Trainees. (Guidance Statement on Fidelity and Best Practice for Crisis Services - DoH 2006)

    9. Working Practices 7 days per week 8. 30 am – 10 pm Senior nurse practitioners 9pm – 9am 2 shifts with 2 hand over meetings; 9:00am ARM and a short allocation meeting 2:00pm Shift longer clinical handover

    10. Referrals To CRHT January – June 2008

    11. Who can refer? Self referrals and carer referrals are excluded. GP referrals are screened by Access / CMHT prior to referral to CRHT. The most common referral points are: Community mental health teams (CMHTs / Access and Recovery services / outpatients), Early Intervention in Psychosis service, acute psychiatric inpatient wards (for early discharge), Drug and Alcohol / Dual diagnosis services, Approved Mental Health Professionals (following Mental Health Act Assessments) and MHLT (A&E). 90% of mental health presentations to A&E do not require home treatment

    12. SMILES / CRHT pathway ( in hours)

    13. SMILES / CRHT pathway ( out of hours)

    14. Core CRT Interventions Comprehensive initial assessment – Risks Symptoms Social circumstances/relationships Substance misuse Physical assessment Engagement Symptom management Medication management Practical help

    15. Core CRT Interventions 2 Opportunities to talk through problems and brief interventions Education about mental health problems for patients and social network Identification of triggers Relapse prevention work Discharge planning

    16. Quarterly Referrals & Admissions Dec – Mar 2008/09

    17. Admissions Over Three Months Period

    18. Average - Length of Stay In Days

    19. References Department of Health. 1999. A National Service Framework for Mental Health: Modern standards and Service Models. London: Department of Health Department of Health. 2000. The NHS Plan. London: The Stationery Office Department of Health. 2001. Mental Health Policy Implementation Guide: Crisis Resolution /Home Treatment Teams. London: Department of Health

    20. References Department of Health. 2006. Guidance Statement on Fidelity and Best Practice for Crisis Services National Audit Office. 2007. Helping people through mental health crisis: The role of Crisis Resolution and Home Treatment services

    21. Thank You……..

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