Published: 26/02/2004, Volume II2, No. 5894 Page 36
Emma Forrest on the rush to establish crisis resolution teams
Crisis resolution teams have existed in one form or another for over 10 years.
But with 335 having to be established by the end of the year (according to Department of Health guidelines), some trusts are struggling.
At a Sainsbury Centre for Mental Health conference held last month, around half of the 105 delegates had already begun establishing teams - but the other half still had to do so.
Pat McGlynn, Sainsbury Centre practice development manager and crisis resolution lead, says the pressure is on to establish the services, but many trusts have concerns over funding. Although the numbers of teams in place is growing, it is doubtful if the target of 335 teams can be met.
Latest figures from Durham University's centre for public mental health show that 135 teams have been established.
'Funding was earmarked for crisis resolution teams but some trusts are saying they are not seeing it come through, ' adds Mr McGlynn.
It is a concern echoed by others.
'No-one is saying that crisis resolution teams should not be established. But the government also wants early intervention teams, male-only and femaleonly areas and gateway workers, for starters, and we are having difficulties providing them all with the money that is available, ' says one manager.
Delegates at the conference said crisis resolution teams were often being funded by the closure of inpatient units. Staff were being transferred to teams as it was hoped the introduction of crisis services would reduce the number of inpatient beds needed.
Pembrokeshire and Derwen trust senior practitioner Jayne Anderson says that with no extra money available for a team, it was funded through opening a 28-bed ward filled with only 14 beds.
She stresses that it was predicted that the service would reduce both the number of beds needed and the rates of bed occupancy, and has done so since being set up. But sacrifices had to be made - a primary care liaison team closed in order to help fund the crisis resolution service.
Mr McGlynn agrees that inpatient staff were often recruited to the new teams after their units closed, but stresses that intensive training was recommended.
'There is no expectation that people will walk off an inpatient ward and straight into a crisis team. Training is a priority, ' he says.
When a team is established, adherence to the suggested model - which includes 24/7 access for service users and a mixture of professions, including medical staff, occupational therapists and social workers - varies.
Over 80 per cent are multidisciplinary, although some teams reported that their psychiatrists were unhelpful or even obstructive to the idea of a crisis resolution service.
But Mr McGlynn notes that not all teams are available 24/7, with around 45 per cent of them having shorter opening hours, either due to local needs or because funding was not available (see box below).
Open house:24-hour access
A lively discussion took place at the Sainsbury Centre for Mental Health conference on crisis resolution over whether a requirement should be imposed for crisis teams available at all times.
While some team leaders asserted that they rarely receive calls after midnight, most felt a 24/7 service to be essential.
But while a 24/7 service was always preferable, added Dr John Hoult, a consultant psychiatrist at Camden and Islington Community trust, local need may dictate that the team follows a different model to guidelines.
Dr Hoult raised eyebrows with the suggestion (disputed by managers in areas that suffered from the BSE and foot and mouth crises in particular) that rural trusts may have less need for an open-all-hours service than towns and cities.
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