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

Morant, Nicola, Lloyd-Evans, Brynmor, Lamb, Danielle, Fullarton, Kate, Brown, Eleanor, Paterson, Beth, Istead, Hannah, Kelly, Kathleen, Hindle, David, Fahmy, Sarah, Henderson, Claire, Mason, Oliver, Johnson, Sonia and CORE Service User and Carer Working groups 2017, Crisis resolution and home treatment: stakeholders' views on critical ingredients and implementation in England, BMC psychiatry, vol. 17, pp. 1-13, doi: 10.1186/s12888-017-1421-0.

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Title Crisis resolution and home treatment: stakeholders' views on critical ingredients and implementation in England
Author(s) Morant, Nicola
Lloyd-Evans, Brynmor
Lamb, Danielle
Fullarton, Kate
Brown, Eleanor
Paterson, Beth
Istead, Hannah
Kelly, Kathleen
Hindle, David
Fahmy, Sarah
Henderson, Claire
Mason, Oliver
Johnson, Sonia
CORE Service User and Carer Working groups
Journal name BMC psychiatry
Volume number 17
Article ID 254
Start page 1
End page 13
Total pages 13
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2017-07-17
ISSN 1471-244X
Keyword(s) acute care
carers
crisis resolution teams
home treatment teams
implementation research
mental health services
qualitative research
service users
severe mental illness
adult
caregivers
catchment area (health)
continuity of patient care
crisis intervention
England
female
focus groups
health plan implementation
home care services
male
mental disorders
program evaluation
quality of health care
CORE Service User and Carer Working groups
science & technology
life sciences & biomedicine
psychiatry
Summary BACKGROUND: Crisis 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.

METHOD: Semi-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.

RESULTS: Three 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.

CONCLUSIONS: Stakeholders' 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.
Language eng
DOI 10.1186/s12888-017-1421-0
Field of Research 1103 Clinical Sciences
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30108996

Document type: Journal Article
Collections: Faculty of Health
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.