Southwark CResT Teams

1. Southwark CResT Teams Presentation by Simon Rayner

2. Southwark has two Crisis Resolution Home Treatment Teams (CRT/HTT) North CResT � covering: Borough & Bankside, Walworth, Bermondsey & Rotherhithe. South CResT � covering: Camberwell, Peckham, Nunhead & Peckham Rye, & Dulwich

3. CResT teams are Multi-Disciplinary (Doctors, Nurses, Social Workers, Support Time & Recovery Workers, Bed Managers and Administrators). We are open from 8am until 12 midnight 7 days a week 365 days a year. Psychiatric Liaison Services at A&E is a 24 hour service.

4. We work with any person who lives in Southwark and has a psychiatric crisis. The teams are an alternative to a hospital admission. We gate-keep all possible admissions, to ensure all alternatives to admission have been explored. We provide intensive support in the clients home, rather than them being admitted into hospital.

5. We have an ethos of positive risk taking. We apply social systems interventions to the patients psychiatric crisis. Not afraid of getting our hands dirty (practical interventions) We prioritise those in high need. Service users and carers prefer to be treated at home rather than admission (more humane, and improved services of people who experience mental health services)

6. Vignette 1 A 24 year old female presents at surgery, there is no previous history of contact with mental health services. She reports feeling increasingly anxious over the past month and has been experiencing panic attacks during this time. Sleep and appetite are reported to be poor and she also states that her motivation is low. She has, on occasion experienced fleeting suicidal thoughts but denies any plans or intent to act on these now or in the future. She lives alone since her relationship of 3 years ended recently. Her social circle outside of the relationship had been limited and she describes herself as having always been a shy, timid type of person. She has never worked and is in receipt of benefits. Refer to ABT for: Assessment Anxiety management Treatment of underlying depressive episode Not suitable for CResT as intensive input not indicated & risk to self and others low.

7. Vignette 2 Family member is expressing concern that X has recently began to behave in a bizarre manner, withdrawing from family contact, stating that they are impostors that have replaced his real family. X has also started to neglect his personal hygiene and to dress in several layers of outlandish clothes. When the family member gained access to X�s flat it was in a chaotic state with several pieces of paper pinned to the wall containing unintelligible symbols and words. The family member reports that when X was at university he experienced a �break down� where he was withdrawn and believed that people were after him, which appeared to resolve. X presented with pressured speech and was at times distracted and appeared to be responding to internal stimuli. He reports that he hears a male voice externally telling him that he has been chosen for a special mission. He is unclear what this mission will be but receives commands from the voice that will lead to enlightenment.

8. Cont� X was agitated and at times guarded. He does not feel that anything is wrong with him. He expressed concern that his �real� family have disappeared and believes that his successful completion of his �mission� may lead to their return. He denies any ideas of harm to others, but has thought that his life will not be worth living if he is unable to complete his mission. X is male, single and unemployed. CResT referral and assessment is appropriate. Risk to others - low. Risk to self - moderate. Withdrawn from usual social systems/network. Could be assessed and treated at home with intensive input.

9. The department of Health states that a crisis 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 Exclusive diagnosis of personality disorder Recent history of self harm but not suffering from a psychotic illness or severe depressive illness Crisis related solely to relationship issues. However, this has been superseded by new thinking on personality disorder not being a �diagnosis of exclusion�

10. Referring for a Crisis Assessment Monday to Friday 9am until 5pm Refer all patients to appropriate ABT (CMHT). They will triage all service users and refer to CResT if appropriate. CResT will contact you directly to arrange an assessment. CResT should be able to get to your surgery within the hour. Weekdays after 5pm and Weekends For a Crisis Assessment you can refer directly to CResT. North CResT 020 7188 6991 South CResT 020 7919 3500 Pager (for both) 07659 158 085

11. After the Assessment CResT take on patient. CResT refer patient to CMHT. CResT have patient admitted into hospital. Patient may not need psychiatric services. CResT may advise to refer patient to another service.