XClose

The Core Study

Menu

Item 11

Comprehensive assessments

Target

a) A structured assessment is carried out documenting: i) circumstances of the presenting problem and potential triggers for the crisis; ii) mental state examination; iii) symptoms; iv) current medication and adherence; v)family and social network;  vi) social functioning including difficulties with employment, housing and finances; vii) substance misuse; viii) risks and safety; ix) strengths, goals and treatment preferences; x) personal and psychiatric history (or reference to where it is already accessible in patient records);  xi) involved carers' views; xii) religion/spirituality and religious needs.

b) The CRT uses assertive engagement strategies to assess service users in person if there are difficulties making initial contact.

Why this is important

A thorough assessment at the point of entry to a CRT can ensure all problems and risks are identified. It can help locate sources of support and service users' own strengths and capabilities and inform treatment plans. Many service users may have reservations about accepting support from mental health services or be hard to contact/engage: if the CRT is to avert as many hospital admissions as possible, strategies to work with hard-to-engage service users are needed.

In the video below, Beth, Carer & Researcher, explains how distress can often be multifaceted, and the importance of capturing this when conducting assessments. 

In the video below, a carer explains the importance of ensuring service users are assertively engaged

Ways of doing this well

Comprehensive assessments

CRHTs in Sussex Partnership Trust use the following structured assessment. Adur, Arundel and Worthing CRHT scored highly on this item as they used this assessment tool to carry out a comprehensive initial assessment with service users they support. The assessment tool encourages staff to include service uses strengths, goals and treatment preferences and involved carers' and families views at initial assessment to ensure that from the outset support is individualised and aims to meet the needs of service users and their support networks. 

The following documents are also good examples of assessment tools and checklists: 

Assertive engagement 

Strategies to work with hard-to-engage service users may include: enlisting help from a family member or other involved staff to arrange an appointment; being as flexible as possible about the time and location of meetings; conducting an unannounced visit. Bromley HTT have devised clear guidelines for staff regarding appropriate engagement strategies to use if a service user is not engaging with the team.

Examples of good practice

In our fidelity review survey of 75 crisis teams in 2014, the following teams achieved excellent model fidelity, and can be contacted for advice about how they achieved this:

  • West South Staffordshire (Stafford) CRT, South Staffordshire & Shropshire Healthcare NHS Foundation Trust
  • North Somerset Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
  • Pontypool CRHTT, NHS Wales
  • West Gwent CRHTT, NHS Wales
  • Northamptonshire South CRHTT, Northamptonshire Healthcare NHS Foundation Trust
  • West Suffolk HTT, Norfolk & Suffolk NHS Foundation Trust
  • South Gwent CRHTT, NHS Wales
  • Northamptonshire North (Kettering) CRHTT, Northamptonshire Healthcare NHS Foundation Trust
  • Gateshead CRT, Northumberland, Tyne and Wear NHS Foundation Trust
  • South Tyneside Initial Response Team, Northumberland, Tyne and Wear NHS Foundation Trust
  • Bromley HTT, Oxleas NHS Foundation Trust
  • Dudley CRT, Dudley and Walsall Mental Health Partnership NHS Trust
  • Waltham Forest HTT, North East London NHS Foundation Trust
  • Tower Hamlets HTT, East London NHS Foundation Trust
  • Adur, Arundle & Worthing CRHTT, Sussex Partnership NHS Foundation Trust
  • Eastbourne CRT, Sussex Partnership NHS Foundation Trust
  • Manchester North, Manchester Mental Health and Social Care Trust
  • Brighton & Hove CRHTT, Sussex Partnership NHS Foundation Trust
  • Sandwell CRHTT, Black Country Partnership NHS Foundation Trust
  • South Essex West (Basildon) CRHTT, South Essex Partnership University NHS Foundation Trust 
  • South East Kent (Canterbury) CRHTT, Kent and Medway NHS and Social Care Partnership Trust
  • Bath Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
  • North Devon CRHTT, Devon Partnership NHS Trust
  • East and Mid Devon CRHTT, Devon Partnership NHS Trust
  • Taunton and Bridgewater CRHTT, Somerset Partnership NHS Foundation Trust 
  • Chichester CRHTT, Sussex Partnership NHS Foundation Trust
  • Edinburgh IHTT, NHS Lothian
  • Wolverhampton CRHTT, Black Country Partnership NHS Foundation Trust

Relevant reading

Bridgett & Polak, Social systems intervention and crisis resolution Part 1: Assessment (2003)

Need for CRTs to use 'social systems assessment' (p. 428)

Thus, in contrast to the usual practice of interviewing the patients before any other action is taken, the crisis and social systems approach is facilitated by time spent finding out more about a referral before the first interview with the patient. This might reveal that it would be very useful to have present at the first assessment others particularly familiar with the issues involved. (p. 429)