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Ending CRT care
Target
a) Service users and involved family are given at least 48 hours' notice before discharge from the CRT (excluding hospital admission).
b) The CRT discusses with service users and involved family regarding how and when CRT care should end.
c) The CRT will "taper" care i.e. planned decrease in frequency of care before discharge to meet service users' needs and preferences.
d) Service users or families may contact the CRT directly for support or advice for at least 2 weeks following discharge (regardless of general referrals policy).
e) There is all source agreement that the CRT provides service users and families with information about other services they could access following CRT discharge.
Why this is important
When interviewed, service users often comment that CRT care can seem to end abruptly, and that the transition from intensive support to the withdrawal of the CRT can be difficult. Mechanisms to plan the ending of care and contingencies if things do not go smoothly can help with this process.
Ways of doing this well
Re-referral after the end of care
Allowing service users to re-refer themselves during the couple of weeks following discharge from the CRHT has worked well for the South Staffordshire and Shropshire crisis teams, as can be seen from the case study below.
Re-referral after the end of CRHT care
Paul Bowers
Crisis Resolution/Home Treatment and Liaison Psychiatry Manager
South Staffordshire and Shropshire NHS FT
The idea of self-referral (or perhaps more accurately self re-referral in this case) can be a challenging one for many CRHT teams, throwing up a plethora of 'what if's' and generating a real sense of anxiety about the effect of a perceived open door policy on 'core' business. As a way to test out in a graded way what might happen if we set off on this journey and supported by the recommendation of a serious untoward incident investigation following a death shortly after CRHT intervention ended, a decision was taken that where a service user was discharged from the CRHT service (with an onward referral to secondary mental health services) and that person unexpectedly relapsed into crisis before the first face to face contact with the identified care co-ordinator took place, the CRHT service would take that person back onto its caseload without the need for further assessment in primary care. This approach was felt to be beneficial not only to service users and their carers and families but also to GP colleagues in primary care who we would historically have been asked to assess the person first, before the CRHT service was despatched. This invariably lead to understandable arguments between professionals, especially out of hours, so we had to ask ourselves what was to be gained by insisting GP's reviewed the person's mental health in the first instance, when we had already decided as a team that their needs were best met in secondary mental health services.
It's not the biggest service development or the most awe-inspiring but to us it has improved the service we offer to people and it has improved partnership working with both GP and community mental health team colleagues too.
Information sharing
Providing a summary of information for service users and GPS can be helpful in making sure everyone is clear about what has happened during CRT care (e.g. with medication) and what will happen next:
The Bristol team have also produced a helpful summary about re-access plans, in order to make it easier for service users to access services when they need them:
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:
- Bristol Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
- Witshire North Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
- South Gloucester CRT, Avon & Wiltshire Mental Health Partnership NHS Trust
- South Wiltshire Intensive Service, Avon & Wiltshire Mental Health Partnership NHS Trust
- East South Staffordshire (Tamworth) CRT, South Staffordshire & Shropshire Healthcare NHS Foundation Trust
- Greenwich CRT, Oxleas NHS Foundation Trust
- West South Staffordshire (Stafford) CRT, South Staffordshire & Shropshire Healthcare NHS Foundation Trust
- Sunderland, Northumberland, Tyne and Wear NHS Foundation Trust
- Wyre Forest, Bromsgrove and Redditch HTT, Worcestershire Health and Care NHS Trust
- Northamptonshire South CRHTT, Northamptonshire Healthcare NHS Foundation Trust
- Northamptonshire North (Kettering) CRHTT, Northamptonshire Healthcare NHS Foundation Trust
- South Powys HTT, NHS Wales
- Shropshire CRT, South Staffordshire & Shropshire Healthcare NHS Foundation Trust
- Newham Psychiatric Acute Community Team, East London NHS Foundation Trust
- South Tyneside Initial Response Team, Northumberland, Tyne and Wear NHS Foundation Trust
- Waltham Forest HTT, North East London NHS Foundation Trust
- Barking, Dagenham, Havering HTT, North East London NHS Foundation Trust
- Redbridge HTT, North East London NHS Foundation Trust
- Hastings CRT, Sussex Partnership NHS Foundation Trust
- Adur, Arundle & Worthing CRHTT, Sussex Partnership NHS Foundation Trust
- Eastbourne CRT, Sussex Partnership NHS Foundation Trust
- North West Sussex (Crawley) CRT, Sussex Partnership NHS Foundation Trust
- Surrey East (Redhill) HTT, Surrey and Borders Partnership NHS Foundation Trust
- South Essex West (Basildon) CRHTT, South Essex Partnership University NHS Foundation Trust
- South East Essex (Rochford) CRHTT, South Essex Partnership University NHS Foundation Trust
- Yeovil CRT, Somerset Partnership NHS Foundation Trust
- Bath Intensive Team, Avon & Wiltshire Mental Health Partnership NHS 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
- Taunton and Bridgewater CRHTT, Somerset Partnership NHS Foundation Trust
- Chichester CRHTT, Sussex Partnership NHS Foundation Trust
- Edinburgh IHTT, NHS Lothian
- Gloucester CRT, 2gether NHS Foundation Trust
- Hammersmith CRHTT, West London Mental Health NHS Trust
- Torbay CRT, Torbay and Southern Devon Health and Care NHS Trust
- South East Hertfordshire (Ware) CATT, Hertfordshire Partnership University NHS Foundation Trust
- Norwich HTT, Norfolk & Suffolk NHS Foundation Trust