Crisis resolution and home treatment teams (CRTs or CHTTs) represent a significant evolution in mental health care, particularly in the UK and other countries, where they have been implemented to provide rapid, intensive care to individuals in mental health crises. These teams aim to prevent unnecessary hospital admissions by offering support and treatment in the patient’s home environment. This approach aligns with the principles of trauma-informed care, as it seeks to reduce the stress and instability of hospital settings during vulnerable moments. The integration of patient feedback into the design and delivery of these services has further emphasized the importance of individualized care, emotional regulation, and improved patient satisfaction.
The development and implementation of CRTs and CHTTs are supported by a growing body of evidence, including systematic reviews and qualitative studies that highlight their effectiveness in reducing hospital admissions, improving recovery outcomes, and enhancing patient experiences. These models also reflect broader shifts in mental health policy, such as the emphasis on community-based care and the recognition of the value of continuity, consistency, and staff reliability in crisis care. This article explores the structure, outcomes, and patient-centered features of these services, drawing on current research and policy developments to provide a comprehensive understanding of their role in modern mental health care.
Origins and Evolution of Crisis Resolution and Home Treatment Teams
The concept of crisis resolution and home treatment teams emerged in response to the need for more flexible, community-based mental health services. According to the Department of Health (2001), these teams were designed to offer rapid assessment and intensive care as an alternative to hospital admission during mental health crises. The introduction of CRTs and CHTTs across England was mandated by the NHS Plan (2000), which marked a significant shift in mental health care policy. By 2011, these teams had been established in every NHS trust in the country, with substantial investment increasing from £38 million in 2002 to £268 million by 2011 (Department of Health, 2011).
The policy driving their implementation was characterized by its prescriptive nature and the emphasis on performance management, including nationwide reporting of activity levels and adherence to centrally set targets. This approach aimed to standardize care delivery and ensure that mental health services met the growing demand for crisis interventions. The expansion of CRTs and CHTTs was not limited to the UK; similar models have been developed in other countries, including Norway and the United States, where the goal of providing timely, accessible care during mental health crises remains a shared objective (Hubbeling & Bertram, 2012).
Structure and Function of Crisis Resolution and Home Treatment Teams
Crisis resolution and home treatment teams operate with a multidisciplinary structure, typically including psychiatrists, nurses, social workers, and psychological therapists. Their primary functions include the rapid assessment of mental health crises, the provision of intensive home-based treatment, and the coordination of care with other mental health services. The model emphasizes the importance of early intervention and personalized care, allowing for the development of individualized treatment plans that address the specific needs of each patient (Health Do, 2001).
The home treatment component of these teams is particularly significant, as it enables patients to receive care in a familiar and stable environment. This approach aligns with trauma-informed care principles, which recognize the importance of minimizing stress and promoting safety in therapeutic settings. Research indicates that home treatment can be as effective as inpatient care in many cases, with the added benefit of reducing the emotional and logistical burdens associated with hospitalization (Khalifeh et al., 2009).
Key Components of Service Delivery
Several key components have been identified as critical to the success of CRTs and CHTTs. These include:
- Rapid Response: The ability to respond quickly to mental health crises is essential for preventing deterioration and reducing the need for hospitalization.
- Multidisciplinary Team Approach: Collaboration among different mental health professionals ensures that patients receive comprehensive care that addresses both their mental health and social needs.
- Home-Based Care: Providing care in the patient’s home environment supports emotional regulation and reduces the stress associated with hospital settings.
- Continuity and Consistency: Patients often express a need for consistent contact with the same team members, which fosters trust and improves treatment outcomes.
- Patient Feedback: Incorporating patient perspectives into service design and delivery helps to refine care models and enhance patient satisfaction (Lloyd-Evans et al., 2018).
These components are supported by evidence from both qualitative and quantitative studies. For example, a systematic review by Toot et al. (2011) found that home treatment services were associated with lower rates of hospital admission and higher patient satisfaction compared to traditional inpatient care. Similarly, a national survey of CRTs in England revealed that patients valued the flexibility and personalized nature of home-based care, particularly when it allowed them to remain in their communities (Middleton et al., 2011).
Outcomes and Efficacy of Crisis Resolution and Home Treatment Teams
The effectiveness of CRTs and CHTTs has been extensively studied, with the majority of evidence suggesting that these teams contribute to improved outcomes for individuals in mental health crises. One of the primary goals of these teams is to reduce the need for hospital admission, and several studies have demonstrated that this objective is often achieved. For instance, a study by Johnson et al. (2005) found that the introduction of a crisis resolution team led to a significant reduction in hospital admissions compared to the period before the team was established. Similarly, a systematic review by Carpenter et al. (2018) concluded that crisis teams were associated with lower rates of hospital admission and shorter lengths of stay when inpatient care was necessary.
In addition to reducing hospital admissions, CRTs and CHTTs have been linked to improvements in symptom recovery and functional outcomes. A randomized controlled trial by Pilling et al. (2002) found that patients treated by a crisis resolution team experienced greater functional improvement compared to those receiving standard care. These findings suggest that the early and intensive intervention provided by CRTs can help individuals stabilize more quickly and return to their normal activities sooner. Furthermore, qualitative research has highlighted the importance of the therapeutic relationship between patients and team members, with many participants reporting that the support and understanding they received during home visits played a crucial role in their recovery (Klevan et al., 2017).
Patient Perspectives and Service Satisfaction
Patient satisfaction is another important measure of the effectiveness of CRTs and CHTTs. While these teams have generally received positive feedback, some challenges have been identified. For example, a study by Faulkner and Blackwell (2008) found that while patients appreciated the availability of crisis teams, they also expressed concerns about the inconsistency of service delivery and the lack of continuity in care. These issues can undermine the therapeutic benefits of home-based treatment and may lead to dissatisfaction or disengagement from the care process.
To address these concerns, service providers have increasingly emphasized the importance of incorporating patient feedback into the design and delivery of crisis services. For instance, the Home Treatment Accreditation Scheme (HTAS), developed by the Royal College of Psychiatrists, includes standards that require teams to engage with service users and incorporate their feedback into service improvement (Baugh, 2019). This approach has been shown to enhance patient satisfaction and improve the overall quality of care. For example, a study by Hubbeling and Bertram (2014) found that patients who received care from teams that actively sought and acted on their feedback reported higher levels of satisfaction and felt more involved in their treatment.
Challenges and Limitations of Crisis Resolution and Home Treatment Teams
Despite the benefits associated with CRTs and CHTTs, several challenges and limitations have been identified in the literature. One of the primary challenges is the variability in service delivery across different regions. While some teams have been highly effective in reducing hospital admissions and improving patient outcomes, others have struggled to meet their goals. This variability may be due to differences in staffing, training, and resource allocation. For example, a national survey of CRTs in England found that while most teams were able to provide rapid assessment and treatment, some teams faced difficulties in maintaining consistent staffing levels and ensuring that patients received the same level of care over time (Lloyd-Evans et al., 2018).
Another limitation is the potential for CRTs and CHTTs to become overburdened, particularly in areas with high demand for crisis services. This can lead to delays in response times and a reduction in the quality of care. To address this issue, some teams have implemented strategies such as increasing the number of staff, improving training programs, and expanding collaboration with other mental health services. However, these strategies require additional funding and resources, which may not always be available.
Additionally, while CRTs and CHTTs have been effective in reducing hospital admissions for many individuals, they may not be appropriate for all patients. For example, individuals with severe mental health conditions that require more intensive or specialized care may still need to be admitted to hospital. In these cases, CRTs can play a supportive role by providing care before and after hospitalization, but they may not be able to fully replace inpatient services. This highlights the importance of ensuring that CRTs are part of a broader mental health care system that includes a range of services tailored to different levels of need (Rhodes & Giles, 2014).
Future Directions for Crisis Resolution and Home Treatment Services
Given the evolving nature of mental health care and the increasing focus on patient-centered approaches, there are several potential directions for the future development of CRTs and CHTTs. One key area is the continued integration of patient feedback into service design and delivery. As highlighted in recent studies, incorporating patient perspectives can lead to improvements in care quality and patient satisfaction. For example, service users have emphasized the importance of staff punctuality, consistency, and communication in their overall experience of crisis services. By addressing these concerns and ensuring that teams are responsive to patient needs, CRTs and CHTTs can further enhance their effectiveness and relevance in the mental health care landscape (Lloyd-Evans et al., 2018).
Another important direction is the expansion of crisis services to address the unique needs of different populations. For instance, there is growing recognition of the importance of providing specialized care for individuals with perinatal mental health concerns, as these individuals may have distinct needs and challenges during a mental health crisis. Research has shown that tailored treatment approaches that consider the specific context of perinatal care can improve patient outcomes and strengthen the therapeutic relationship between patients and service providers (Lloyd-Evans et al., 2018). Similarly, there is a need to develop crisis services that are culturally competent and inclusive, ensuring that they meet the needs of diverse populations.
Finally, the future development of CRTs and CHTTs will likely be influenced by broader changes in mental health policy and funding. As governments and healthcare systems continue to prioritize cost-effective and patient-centered care, there may be increased investment in community-based services and a greater emphasis on the integration of mental health care with other areas of public health. This could lead to the expansion of CRTs and CHTTs to new regions or populations, as well as the development of new models of care that build on the principles of crisis resolution and home treatment.
Conclusion
Crisis resolution and home treatment teams have emerged as a vital component of modern mental health care, offering a flexible and patient-centered approach to managing mental health crises. These teams have been shown to reduce hospital admissions, improve recovery outcomes, and enhance patient satisfaction when implemented effectively. Their success is closely tied to the principles of trauma-informed care, emotional regulation, and individualized treatment planning. However, challenges such as variability in service delivery, resource limitations, and the need for specialized care for certain populations highlight the importance of ongoing evaluation and improvement.
As mental health care continues to evolve, the role of CRTs and CHTTs will likely expand to include a greater emphasis on patient feedback, cultural competence, and integration with broader health services. By addressing the challenges and limitations associated with these teams and building on their strengths, mental health providers can continue to improve the quality and accessibility of crisis care for individuals in need.
Sources
- Department of Health (2001) Crisis Resolution/Home Treatment teams: the Mental Health policy implementation guide. Department of Health
- Department of Health (2011) NHS Plan. Department of Health
- Faulkner A, Blackwell H (2008) Mixed blessings: service user experience of crisis teams. Crisis Resolution home treat mental health. 177
- Faulkner A, Blackwell H (2008) Mixed blessings: service user experience of crisis teams
- Health Do (2001) Crisis Resolution/Home Treatment teams: the Mental Health policy implementation guide. Department of Health
- Hubbeling D, Bertram R (2012) Crisis resolution teams in the UK and elsewhere. J Mental Health 21(3):285–295
- Hubbeling D, Bertram R (2014) Hope, happiness and home treatment: a study into patient satisfaction with being treated at home. Psychiatr Bull 38:265–269
- Khalifeh H, Murgatroyd C, Freeman M, Johnson S, Killaspy H (2009) Home Treatment as an alternative to Hospital Admission for Mothers in a Mental Health Crisis: a qualitative study. Psychiatric Serv 60(5):634–639
- Lloyd-Evans B, Lamb D, Barnby J, Eskinazi M, Turner A, Johnson S (2018) Mental health crisis resolution teams and crisis care systems in England: a national survey. BJPsych Bull 42(4):146–151
- Lloyd-Evans B, PB, Onyett S, Brown E, Istead H, Gray R, Henderson C, Johnson S (2018) National implementation of a mental health service model: a survey of Crisis Resolution teams in England. Int J Ment Health Nurs 27(1):214–226
- Rhodes P, Giles SJ (2014) Risky Business: a critical analysis of the role of crisis resolution and home treatment teams. J Mental Health 23(3):130–134
- Toot S, Devine M, Orrell M (2011) The effectiveness of crisis resolution/home treatment teams for older people with mental health problems: a systematic review and scoping exercise. Int J Geriatr Psychiatry 26(12):1221–1230
- Tobitt S, Kamboj S (2011) Crisis resolution/home treatment team workers’ understandings of the concept of crisis