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Providing individualised care
Target
a) Service users' individual needs and goals are recorded in initial assessments or treatment plans.
b) There is agreement from all sources that CRT treatment and support reflects service users' individualised needs and goals.
c) CRT intervention includes some form of intervention in addition to medication review/delivery, risk assessment and referral on to other services.
Why this is important
CRT service users repeatedly advocate holistic CRT care, which offers a range of types of support to meet people's individual needs and preferences. A benefit of home treatment can be that people's existing resources can be utilised and coping strategies relevant to people's day to day life can be developed: CRTs work best when they capitalise on this and provide individualised treatment and support.
In the video below, service users and cares discuss the importance of teams being able to provide a range of interventions to ensure care is tailored to the individual.
Ways of doing this well
Involving service users in 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 user's 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.
Relevant reading
The National Audit Office carried out a study looking at service user and carer experiences. They used data from satisfaction questionnaires, three service user focus groups, three carer focus groups, as well as performing a secondary analysis on data collected from some service user focus groups conducted by MIND. They found that service users and carers appreciate a holistic approach to CRHT, and often value personal engagement as highly as clinical expertise
Healthcare Commission: The Pathway to Recovery (2008)
Priority area 1: Putting a greater focus on the individual and care that is personalised. Staff should consider how practices can be adapted to involve and engage service users as much as possible, however unwell the person may be. Involvement should be based on a human rights approach, so that services are focused around the needs of service users rather than those of the services. (p.7)
Sainsbury Centre for Mental Health: Crisis Resolution and Home Treatment (2006)
CRT intervention includes some form of intervention in addition to medication review/delivery, risk assessment and referral on to other services.
A CRHT team should spend time talking to service users and their social networks; it is one of the most therapeutic things they can do. One of the most frequent complaints made about mental health services in general is how little time health professionals spend with service users and how little information they provide. The daily visits should not be just cursory affairs; staff should be making regular enquiries about the person's symptoms, functioning, social interactions, relationships and whatever is relevant. Carers should be asked for their comments on the above, and about how it is affecting them. Both service users and carers need information about the illness and its course, prognosis and treatment. (p.19)
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:
- South Wiltshire Intensive Service, Avon & Wiltshire Mental Health Partnership NHS Trust
- West South Staffordshire (Stafford) CRT, South Staffordshire & Shropshire Healthcare NHS Foundation Trust
- West Suffolk HTT, Norfolk & Suffolk NHS Foundation Trust
- South Gwent CRHTT, NHS Wales
- Gateshead CRT, Northumberland, Tyne and Wear NHS Foundation Trust
- Surrey Heath HTT (Frimley), Surrey and Borders Partnership NHS Foundation Trust
- Hastings CRT, Sussex Partnership NHS Foundation Trust
- Adur, Arundle & Worthing CRHTT, Sussex Partnership NHS Foundation Trust
- Hounslow HTT, West London Mental Health NHS 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
- Mendip CRHTT, Somerset Partnership NHS Foundation Trust
- Teignbridge CRHTT, Devon Partnership NHS Trust
- South Hams and West Devon CRHTT, Devon Partnership NHS Trust
- North Devon CRHTT, Devon Partnership NHS Trust
- East and Mid Devon CRHTT, Devon Partnership NHS Trust
- South East Hertfordshire (Ware) CATT, Hertfordshire Partnership University NHS Foundation Trust