The provision of emergency psychiatric intervention within the Barnet region is anchored by the Crisis Resolution and Home Treatment Team (CRHTT). This specialized unit operates as a critical bridge between community-based outpatient care and restrictive inpatient hospitalization, designed specifically for individuals experiencing an acute deterioration in their mental health. The primary clinical objective of the Barnet CRHTT is the delivery of short-term, intensive home treatment, which serves as a therapeutic alternative to hospital admission. By shifting the locus of care from a clinical ward to the patient's own home or other suitable accommodation, the service aims to maintain the individual's social integration and autonomy while providing the high-level monitoring and intervention typically associated with psychiatric wards. This approach is predicated on the understanding that recovery is often more sustainable when achieved within the patient's natural environment, provided that such a setting is deemed safe and appropriate by the multidisciplinary clinical team.
The operational philosophy of the Barnet CRHTT is rooted in a vision of supporting healthy lives and resilient communities through the integration of mental health and community healthcare. This integration ensures that the transition from acute crisis intervention to long-term recovery is seamless. The service is characterized by a commitment to care, compassion, and respect, utilizing a collaborative model that involves not only the service user but also their families, friends, and broader support networks. This systemic approach recognizes that mental health crises do not occur in isolation and that the involvement of a support system is paramount for stabilizing the patient and preventing future relapses.
Multidisciplinary Clinical Composition and Service Delivery
The Barnet CRHTT does not operate through a single lens of care but utilizes a multidisciplinary team (MDT) approach. This ensures that every patient receives a holistic assessment that covers biological, psychological, and social dimensions of their crisis.
- Psychiatrists: These medical professionals provide the diagnostic expertise and pharmacological management necessary to stabilize acute symptoms. They oversee the clinical safety of home-based treatment and determine the necessity of medication adjustments.
- Nurses: Specialized mental health nurses provide the frontline clinical monitoring and bedside care. They are responsible for the daily implementation of the care plan and the observation of the patient's mental state.
- Psychologists: These practitioners offer evidence-based psychological interventions to help the patient navigate the cognitive and emotional drivers of their crisis, providing coping strategies to prevent further escalation.
- Support Workers: These professionals focus on the social and practical aspects of recovery, assisting with community engagement and the practicalities of daily living during a period of acute distress.
The technical execution of this MDT model involves a tailored approach based on the individual's assessed needs. Rather than a one-size-fits-all protocol, the team provides a spectrum of support including clinical advice, mental health education, and active community engagement. The impact of this diverse staffing model is a comprehensive safety net that allows the team to manage complex cases in the community that would otherwise require the restrictive environment of a hospital.
Eligibility, Demographics, and Access Criteria
The Barnet CRHTT maintains specific eligibility parameters to ensure that the intensity of the service is matched to the needs of the patient population.
| Criterion | Specification | Clinical Notes |
|---|---|---|
| Primary Age Range | 16 to 65 years | General eligibility for the standard crisis service. |
| Extended Age Range | Over 65 years | Discretionary access based on individual circumstances and need for community intervention. |
| Primary Goal | Hospital Avoidance | Intended for those who would otherwise require inpatient admission. |
| Service Availability | 24 hours / 365 days | Continuous availability to address urgent mental health deterioration. |
For individuals over the age of 65, the service applies a discretionary model. This means that while the general focus is on the 16-65 demographic, clinicians will evaluate elderly patients on a case-by-case basis. If an older adult requires an urgent crisis assessment, immediate intervention, or short-term follow-up care within the community, the CRHTT can extend its services to them. This flexibility prevents a gap in care for the elderly population who may experience acute psychiatric episodes.
Referral Pathways and Procedural Requirements
Access to the Barnet CRHTT is governed by a strict set of referral protocols to ensure that resources are allocated to those in the highest state of urgency. The service allows for both external and internal referral streams.
External Referrals: - General Practitioners (GPs): Primary care physicians who identify a patient in crisis. - A&E Doctors: Medical staff in emergency departments who determine that a patient requires a psychiatric crisis team rather than a general medical ward. - Police Doctors: Law enforcement medical personnel responding to mental health emergencies in the community. - Service Users: Individuals who recognize they are in crisis and seek help (self-referral). - Carers and Next of Kin: Family members or legal guardians who initiate the request for intervention on behalf of the patient.
Internal Referrals: - Care Co-ordinators: Professionals already managing the patient's long-term care who identify an acute escalation. - Other Internal Teams: Specialized NHS units that coordinate the transfer of care to the home treatment team.
All referrals are overseen by the Barnet CRHTT to ensure clinical appropriateness. It is a mandatory administrative requirement that no referrals be made via email; this is a safety measure to ensure that urgent crises are not delayed by the latency of email communication.
For immediate access, the primary pathway is through NHS 111. When a caller selects "option 2" for mental health, they are connected directly to the NLFT (North London Foundation Trust) crisis service. Specially trained staff then conduct an initial screening to address urgent needs and provide support based on the presenting symptoms.
Geographic and Administrative Infrastructure
The Barnet CRHTT is integrated into the broader North London NHS Foundation Trust (NLFT), which resulted from the merger of the Barnet, Enfield and Haringey (BEH) and Camden and Islington (CANDI) trusts. This merger allows for a more unified approach to crisis management across North Central London (NCL).
The physical and administrative hub for the Barnet Crisis Team is located at: First Floor, Dennis Scott Unit Edgware Community Hospital Burnt Oak Broadway Edgware HA8 0AD Phone: 020 8702 4040
This facility serves as the operational base from which the home treatment teams are deployed into the community. The phone number provided is directed to a 24-hour Crisis Telephone Service, which can also be reached via the alternative number 0800 151 0023. This redundancy in communication channels ensures that patients and clinicians can always reach the crisis team regardless of the primary line's status.
Integrated Crisis Support Ecosystem
The Barnet CRHTT does not operate in a vacuum but is part of a layered support system that ranges from low-intensity community support to high-intensity emergency medical intervention.
Immediate Emergency Services
For life-threatening emergencies or situations where there is an immediate risk of harm, the following protocols apply: - 999: For medical or police emergencies. - 111 (Option 2): For medical advice and direct connection to the NLFT crisis service. - 0800 151 0023: The direct 24-hour crisis telephone service for the Barnet and Enfield regions.
Specialized Age-Based Services
- Children and Adolescents: For those under the 16-18 transition age, the Barnet, Enfield and Haringey CAMHS (Child and Adolescent Mental Health Services) provides a dedicated 24-hour helpline at 0800 151 0023, staffed by trained mental health advisors.
- Older Adults: While the CRHTT offers discretionary care for those over 65, the Older Adults Home Treatment Team (NLFT) provides specialized support for elderly people in crisis, particularly in the Camden and Islington areas, ensuring age-appropriate geriatric psychiatric care.
Community-Based and Third-Sector Support
For individuals who are not in an acute clinical crisis but require emotional support or preventative care, several alternative options exist: - Sanctuary & Crisis Hubs: These provide immediate emotional support for adults over 18. In Barnet, the hub can be contacted at 020 8343 5704 (Hours: Monday-Friday 4:30pm to 10:30pm, Weekends 12pm to 6pm). - Barnet Wellbeing Service: A "one-stop shop" for non-crisis mental health needs, offering signposting and referrals. This is a non-emergency service available Monday to Friday, 9am to 5pm, via 03333 449088. - Mind in Enfield and Barnet: While not a crisis service, Mind provides broader mental health advocacy and support. - Samaritans: Available 24/7 at 116 123 for those needing a safe place to talk. - SHOUT: A text-based crisis service (Text SHOUT to 85258). - Specialized Charities: CALM (0800 068 4141) for suicide prevention and Child Line (0800 1111) for youth support.
Clinical Comparison of Crisis Interventions
The following table delineates the differences between the various levels of crisis intervention available to residents of Barnet to ensure the correct level of care is accessed.
| Service Type | Provider | Level of Urgency | Primary Delivery Mode | Key Characteristic |
|---|---|---|---|---|
| CRHTT | NLFT | High (Hospital Alternative) | Home-based treatment | Multidisciplinary medical team |
| MHCAS | NLFT | High (Emergency) | 24-hour assessment | Care planning outside A&E |
| Sanctuary Hub | Community/Mind | Moderate (Emotional Distress) | Drop-in/Phone support | Non-clinical emotional support |
| CAMHS Helpline | NLFT | High (Youth Crisis) | 24-hour phone line | Specialist child/adolescent care |
| Wellbeing Service | Local Gov/NHS | Low (Preventative) | Signposting/Referral | General mental health guidance |
Analysis of the Crisis Care Continuum
The structure of the Barnet mental health crisis system is designed to prevent the "revolving door" phenomenon of hospital admissions. By utilizing the Crisis Resolution and Home Treatment Team, the healthcare system implements a strategy of "least restrictive practice." The clinical impact of this is significant: patients who receive intensive treatment at home often experience lower levels of trauma associated with hospitalization and maintain stronger links to their support systems, which accelerates the recovery process.
The integration of the 111 Option 2 pathway represents a modernization of triage, ensuring that the NLFT crisis service is the primary point of contact. This reduces the burden on general Accident and Emergency (A&E) departments by diverting psychiatric crises to specialists who can perform home-based assessments. Furthermore, the inclusion of Approved Mental Health Professionals (AMHPs) within the NCL wider framework allows for the legal execution of the Mental Health Act (MHA), such as sectioning, if the home-treatment approach is deemed insufficient for the patient's safety.
The availability of the service 24 hours a day, 365 days a year, including bank holidays, addresses the reality that mental health crises do not adhere to standard business hours. The collaboration between the CRHTT and the Sanctuary Hubs provides a tiered response: the Hubs manage emotional distress and acute anxiety, while the CRHTT manages clinical psychiatric crises requiring medical intervention. This tiered approach ensures that clinical resources are preserved for those with the highest acuity of illness while still providing a safety net for those experiencing severe distress.