The landscape of mental health crisis care in Dundee is undergoing a significant transformation, moving away from the traditional model where acute hospital admission was the default response to emotional distress. At the heart of this evolution is the integration of specialized crisis teams, community-based hubs, and home treatment protocols designed to intervene early and de-escalate situations before they require inpatient care. This multi-faceted approach prioritizes the "least restrictive" options, ensuring that individuals receive support in their own environments whenever possible, thereby reducing the trauma often associated with hospitalization.
The current operational framework involves a complex interplay between the Crisis Resolution and Home Treatment Team (CRHTT), located at the Carseview Centre, and the proposed Community Wellbeing Hub (CWH). These services are designed to function as a single point of entry for those experiencing a mental health crisis or significant emotional distress. The overarching goal is to create a safety net that is accessible 24 hours a day, seven days a week, ensuring that help is available regardless of the time of day or the severity of the situation.
This shift represents a paradigm change in how mental health crises are managed in Dundee. Instead of funneling every distressed individual into an acute hospital like Ninewells, the system is being re-engineered to provide community-based assessments and interventions. The Carseview Centre, situated within the grounds of Ninewells Hospital but operating as a distinct mental health unit managed by NHS Tayside, serves as a critical node in this network. However, the ultimate vision includes a standalone Community Wellbeing Hub that will be "always open," operating independently of acute hospital infrastructure. This hub is intended to be the primary access point, featuring a single phone number for both emergency and non-emergency support, effectively streamlining the referral process and reducing confusion for families and patients alike.
The integration of these services is not merely administrative; it is a strategic response to local needs identified through multi-agency suicide reviews and the Strategic Housing Investment Plan (SHIP). By analyzing data on suicide risk and community needs, planners aim to site these facilities in locations that are accessible to those with the greatest need while deliberately avoiding areas with the highest risk factors for suicide. This data-driven approach ensures that resources are allocated where they will have the most significant impact on community safety and wellbeing.
The Crisis Resolution and Home Treatment Team (CRHTT)
The Crisis Resolution and Home Treatment Team (CRHTT) is a specialized service based at the Carseview Centre, located at 4 Tom McDonald Avenue in Dundee. This team is specifically designed to handle emergency presentations that require an assessment within four hours. The service operates on the principle of providing the "least restrictive option of support," meaning that hospitalization is avoided whenever safe and feasible.
The CRHTT functions as a rapid response unit for individuals in acute mental health distress. The team's mandate is to provide immediate intervention, which may include Distress Brief Intervention (DBI) or referrals to third-sector support services. The operational model relies heavily on the ability to assess patients in their home environments, thereby maintaining continuity of care and minimizing disruption to the patient's daily life. This home-based approach is central to the philosophy of the service, recognizing that for many individuals, a crisis can be resolved without the need for acute inpatient beds.
Referral protocols for the CRHTT are strictly defined to ensure that resources are used appropriately. The service is intended for patients who have not been previously open to the Community Mental Health Team (CMHT) or those who are already open to P&K CMHTs but require emergency assessment. For patients already under the care of a CMHT, emergency referrals during office hours are directed to the CMHT Duty Worker, while referrals outside of those hours are directed to the CRHTT.
The geographical scope of the CRHTT extends to Angus and Dundee City. Anyone in these regions experiencing an urgent problem or crisis can access the service. This includes individuals experiencing problems with children, families, or those requiring community care services. The team also offers support for young people aged 12 to 18 who are at risk of suicide, self-injury, or emotional distress, and provides family support for parents, siblings, and carers.
The operational hours of the CRHTT are critical for understanding its role in the broader crisis network. During office hours (0900-1600 for Angus, 0900-1530 for Perth City), emergency referrals for patients already open to CMHTs are managed by the respective CMHT Duty Worker. However, outside of these hours, and specifically for patients not already open to the CMHT, the CRHTT becomes the primary contact. For Angus GP practices, the protocol dictates that all emergency mental health referrals in-hours are managed by the locality CMHTs, while referrals after 1600 hours must be made directly to the CRHTT. In Perth and Kinross, the protocol is similar, with specific hours for the North, South, and City CMHTs, after which the CRHTT takes over.
A critical aspect of the CRHTT's function is the ability to decline referrals that do not meet the criteria for emergency assessment within four hours. If a referral does not constitute a crisis requiring immediate attention, the team may decline it following a discussion with the referrer. This gatekeeping function ensures that the team's limited resources are reserved for the most urgent cases, preventing the dilution of crisis care.
The Carseview Centre itself, located at 4 Tom McDonald Avenue, DD4 1NH, serves as the physical base for these operations. The centre is managed by NHS Tayside and acts as a bridge between the hospital environment and the community. It is a mental health unit situated within the grounds of Ninewells Hospital, yet it operates with a distinct focus on crisis resolution and home treatment. This dual positioning allows for rapid access to acute medical resources if needed, while prioritizing community-based care.
The Proposed Community Wellbeing Hub: A Single Point of Entry
The development of a Community Wellbeing Hub (CWH), often referred to as a crisis centre, represents a major step forward in the Dundee Mental Health and Well-being Strategy. This proposed hub is designed to be a "single point of entry" for anyone experiencing a mental health crisis or emotional distress. The core innovation of this hub is its 24/7 availability, ensuring that help is accessible at any time of day or night.
The hub will be led by voluntary sector partners, emphasizing a collaborative approach between the NHS and community organizations. This partnership model leverages the strengths of the third sector in providing compassionate, non-clinical support, while maintaining the clinical oversight necessary for safety. The hub will feature a single phone number, simplifying the process for individuals in crisis. This eliminates the confusion of navigating multiple referral pathways and ensures that callers are directed to the most appropriate service immediately.
The establishment of the CWH is part of a broader progress report to be considered by the Integration Joint Board of the Dundee Health and Social Care Partnership. The location of the hub is being determined using data from the Tayside Multi-agency Suicide Review group. The objective is to site the hub close to the people with the greatest need while avoiding locations that pose the highest risk for suicide. This strategic placement is a direct response to past reviews of crisis and urgent care services conducted over the previous year.
The hub is intended to reduce the burden on acute hospitals like Ninewells. Under the current proposal, people experiencing a crisis will not be required to go to an acute hospital to be assessed. Instead, the hub will provide a dedicated space for assessment and intervention, offering a more supportive and less medicalized environment. This aligns with the principle of the "least restrictive option," ensuring that individuals are not unnecessarily hospitalized.
The CWH is also linked to the Strategic Housing Investment Plan (SHIP), which makes provisions for people with longer-term needs arising from mental health challenges. This integration suggests that the hub will not only address immediate crises but also serve as a gateway to longer-term support, including housing stability and community integration. The cost implications of these developments are being evaluated, but the priority remains on providing a seamless, accessible safety net for the community.
The proposal for the CWH is in keeping with the priorities set out in the Dundee Mental Health and Well-being Strategy commissioning plan. The goal is to open the hub as soon as possible, with updates on progress to be provided to the public. In the interim, the strategy encourages anyone struggling with mental health to reach out and get support, reinforcing the message that "it is okay not to be okay."
Referral Pathways and Operational Protocols
The effectiveness of the crisis system relies heavily on clear and structured referral pathways. Different localities have specific protocols for managing emergency mental health referrals, ensuring that the right patient reaches the right service at the right time.
For Angus GP practices, the protocol distinguishes between in-hours and out-of-hours referrals. During office hours (0900-1600), all emergency mental health referrals are managed by the Angus locality CMHTs. However, after 1600 hours, referrals must be directed to the CRHTT by calling 01382 423053. This ensures that urgent cases are not delayed due to the end of the CMHT's operational day.
In Perth and Kinross, the referral process is similarly segmented. For patients already open to the P&K CMHTs, emergency referrals during office hours (0900-1500 for North and South, 0900-1530 for Perth City) should be directed to the CMHT Duty Worker in the respective locality. Outside of these hours, referrals are directed to the CRHTT. For new patients not already open to the CMHT, referrals should go directly to the CRHTT.
A critical component of the referral process is the requirement for comprehensive information. When making a referral, the following data points are essential to ensure a rapid and accurate assessment:
- Basic demographic information, including a contact number for the patient.
- Description of the presenting problem.
- Existing mental health diagnosis.
- Status of the patient's openness to mental health services.
- Past psychiatric history.
- Physical health issues or disabilities.
- Involvement of other agencies.
- Social setting, circumstances, and child protection concerns.
- Next of kin details and contact number.
- Drug and alcohol use history.
- Current medication and known allergies.
- Risk assessment, including suicide, self-harm, neglect, or risk to others.
The CRHTT may decline a referral if it is deemed inappropriate for the service. This decision is made following a discussion with the referrer. The service is specifically for emergency presentations requiring review within four hours. Non-emergency referrals, or those that do not meet the urgency criteria, are directed elsewhere or declined.
For young people aged 12 to 18 years, there are specific pathways. The service offers crisis support to young people at risk of suicide or self-injury, as well as family support for their parents, siblings, and carers. This ensures a holistic approach that considers the family unit, not just the individual in crisis.
The referral process also accounts for non-emergency referrals. Referrals that require urgent assessment within 72 hours or routine assessments have separate pathways. General practice assessments can be conducted face-to-face or remotely, provided the assessment is adequate and covers all the information required in the primary care referral guide.
The integration of these pathways ensures that the system is responsive to the varying levels of urgency. For example, non-emergency referrals between 2 am and 8 am should leave a message or call back after 8:30 am, ensuring that urgent cases are prioritized while non-urgent cases are handled in a timely manner.
Safety, Risk Management, and Adult Protection
Safety is the paramount concern in any mental health crisis system. The Dundee model places a strong emphasis on risk assessment and management. The CRHTT and the proposed CWH are designed to identify and mitigate risks such as suicide, self-harm, neglect, and risk to others.
In cases where there is a concern about the safety or welfare of an adult, the system provides a clear pathway for reporting. Individuals can contact the Social Work Team to report their concerns. Alternatively, they can talk to a home care worker, nurse, doctor, or police officer. This multi-agency approach ensures that safety is a shared responsibility across different sectors.
The service offers specific support for young people aged 12 to 18 who are at risk of suicide or self-injury. This includes crisis support for the young person and family support for parents, siblings, or carers. The inclusion of family support is a key element in managing risk, as it helps stabilize the home environment and provides a support network for the individual.
The Carseview Centre and the CRHTT are equipped to handle high-risk scenarios. The team is trained to assess the immediate risk and determine the most appropriate level of care. If the risk is too high for home treatment, the team will coordinate with the CMHT or other services to ensure the patient receives the necessary level of protection.
The integration of these services is also guided by the Tayside Multi-agency Suicide Review group. This group's data informs the location and operation of the Community Wellbeing Hub, ensuring that it is sited to best serve those with the greatest need while avoiding high-risk locations. This data-driven approach enhances the safety of the service delivery.
The system also includes a 24-hour phoneline for adult protection and early intervention. This line is available for anyone worried about the safety of an adult. The availability of a 24-hour line ensures that concerns can be reported at any time, facilitating rapid response to potential dangers.
The focus on risk management extends to the information required during referral. The inclusion of drug and alcohol use, medication, and allergies in the referral information allows the team to assess the medical stability of the patient and plan for safe interventions. This comprehensive data collection is crucial for making informed decisions about the level of care required.
Strategic Planning and Community Integration
The development of mental health crisis services in Dundee is not an isolated initiative but part of a broader strategic plan. The Dundee Mental Health and Well-being Strategy provides the framework for these developments. The proposal for the Community Wellbeing Hub is aligned with the priorities set out in the commissioning plan, ensuring that the service meets the long-term needs of the community.
The Strategic Housing Investment Plan (SHIP) plays a vital role in this strategy. It makes provisions for people experiencing longer-term needs arising from mental health challenges. This integration of housing and mental health support recognizes that stable housing is a fundamental component of mental wellbeing. The CWH is expected to serve as a bridge between crisis intervention and longer-term community support, helping individuals transition from crisis to stability.
The location of the proposed hub is determined by data from the Tayside Multi-agency Suicide Review group. This ensures that the hub is sited in an area that is accessible to the people with the greatest need. The strategy also considers the avoidance of locations with the highest risk for suicide, reflecting a proactive approach to safety.
The involvement of voluntary sector partners in leading the hub highlights the collaborative nature of the initiative. This partnership leverages the strengths of the third sector in providing compassionate, non-clinical support, while maintaining the clinical oversight of the NHS. The goal is to create a service that is both supportive and effective.
The proposal for the hub is part of a progress report to be considered by the Integration Joint Board of the Dundee Health and Social Care Partnership. The board will review the progress made in the last year and make decisions on the future of crisis and urgent care services. This ongoing review process ensures that the service remains responsive to the changing needs of the community.
The strategy also emphasizes the importance of community support. The CWH will serve as a single point of entry, reducing the confusion associated with navigating multiple referral pathways. This streamlining is designed to make help more accessible and less intimidating for those in crisis.
The integration of these services is a key aspect of the Dundee Mental Health and Well-being Strategy. The goal is to provide a seamless, accessible safety net for the community, ensuring that no one falls through the cracks. The emphasis on "it's okay not to be okay" reflects the compassionate, non-judgmental approach that underpins the entire system.
Comparative Overview of Crisis Services in Tayside
To understand the full scope of the crisis system, it is helpful to compare the various teams and their specific roles. The following table outlines the key differences between the Crisis Resolution and Home Treatment Team (CRHTT) and the Community Mental Health Teams (CMHT) in different localities.
| Feature | Crisis Resolution and Home Treatment Team (CRHTT) | Community Mental Health Team (CMHT) |
|---|---|---|
| Primary Function | Emergency assessment within 4 hours; home-based crisis resolution. | Ongoing community mental health care; routine and urgent (72h) assessments. |
| Location | Carseview Centre, 4 Tom McDonald Avenue, Dundee. | Varies by locality (North, South, City). |
| Operating Hours | 24/7 availability (via phone line). | 0900-1500/1530 hrs (varies by locality). |
| Referral Source | GPs, social workers, self-referrals (via single phone number). | GPs, hospitals, self-referrals. |
| Target Population | Acute crisis, suicide risk, self-harm, emotional distress. | Ongoing mental health conditions, routine follow-ups. |
| Contact Number | 01382 423053. | Locality-specific numbers. |
| Service Model | Home treatment, least restrictive care, distress brief intervention. | Community-based therapy, medication management, case management. |
| Geographic Scope | Dundee, Angus, Perth & Kinross. | Localized to specific CMHT areas. |
The CRHTT acts as the safety net for acute emergencies, while the CMHT handles ongoing care. This division of labor ensures that resources are allocated efficiently. The CRHTT's 24/7 phone line ensures that help is available at any time, while the CMHT provides the long-term support necessary for recovery.
The integration of these teams is facilitated by the proposed Community Wellbeing Hub. The hub will serve as a central point of contact, directing callers to either the CRHTT or the CMHT based on the urgency of their needs. This centralized approach reduces the burden on individuals and ensures that they receive the most appropriate level of care.
The system also includes specialized support for young people and families. The CRHTT offers crisis support for young people aged 12 to 18, as well as family support for parents, siblings, and carers. This holistic approach recognizes that mental health crises often affect the entire family unit, and addressing the needs of the family is crucial for the individual's recovery.
The Carseview Centre serves as the physical base for the CRHTT. Located within the grounds of Ninewells Hospital, the centre provides a bridge between acute hospital care and community-based support. This location allows for rapid access to medical resources if needed, while prioritizing the "least restrictive" option of support.
Conclusion
The mental health crisis system in Dundee represents a sophisticated and evolving network designed to provide immediate, compassionate, and effective support. At its core is the Crisis Resolution and Home Treatment Team (CRHTT), which operates from the Carseview Centre to manage emergency situations within four hours. The team's focus on home-based care and the "least restrictive option" ensures that individuals receive help in the most supportive environment possible.
The proposed Community Wellbeing Hub is the next critical step in this evolution. By establishing a 24/7 facility led by voluntary sector partners, the system aims to create a single point of entry for all mental health crises. This hub will reduce the need for acute hospital admissions and provide a dedicated space for assessment and intervention. The strategic placement of the hub, guided by suicide review data, ensures that it serves the population with the greatest need.
The integration of these services is supported by clear referral pathways and a comprehensive data collection process. GPs, social workers, and the public can access these services through a unified phone number, ensuring that help is always available. The system also includes specialized support for young people and families, recognizing the importance of holistic care.
The overall goal of this system is to create a safety net that prevents crises from escalating into hospitalizations. By prioritizing community-based care and leveraging the strengths of the voluntary sector, Dundee is setting a new standard for mental health crisis intervention. The emphasis on "it is okay not to be okay" reflects a culture of compassion and understanding, encouraging individuals to seek help without fear or stigma.
This comprehensive approach, combining immediate crisis resolution, home treatment, and strategic planning, ensures that no one in Dundee or the surrounding regions has to face a mental health crisis alone. The integration of the CRHTT, the proposed CWH, and the existing CMHTs creates a seamless network of support that is both efficient and humane. As the system continues to evolve, it remains committed to providing the highest level of care for those in need.