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Outcomes of crises before and after introduction of a crisis resolution team

Department of Mental Health Sciences, Royal Free and University College London Medical Schools, University College London, and Camden and Islington Mental Health and Social Care Trust

FIONA NOLAN, BA, RMN, CORE (British Psychological Society)

Sub-Department of Clinical Health Psychology, University College London, and Camden and Islington Mental Health and Social Care Trust

JOHN HOULT, MD, FRANZCP

Camden and Islington Mental Health and Social Care Trust

IAN R. WHITE, MSc, MRC

Biostatistics Unit, Cambridge

PAUL BEBBINGTON, PhD, FRCPsych and ANDREW SANDOR, MRCPsych

Department of Mental Health Sciences, Royal Free and University College Medical Schools, University College London, and Camden and Islington Mental Health and Social Care Trust

NIGEL McKENZIE, PhD, MRCPsych

Camden and Islington Mental Health and Social Care Trust

SEJAL N. PATEL

Sub-Department of Clinical Health Psychology, University College London

STEPHEN PILLING, MSc, CORE (British Psychological Society)

Sub-Department Sub-Department of Clinical Health Psychology, University College London, and Camden and Islington Mental Health and Social Care Trust, London, UK

Correspondence: Dr Sonia Johnson, Department of Mental Health Sciences, Royal Free and University College London Medical Schools, Wolfson Building, 48 Riding House Street, London W1W 7EY, UK. E-mail: s.johnson{at}ucl.ac.uk

Declaration of interest None.

Background Crisis resolution teams (CRTs) are being introduced throughout England, but their evidence base is limited.

Aims To compare outcomes of crises before and after introduction of a CRT.

Method A new methodology was developed for identification and operational definition of crises. A quasi-experimental design was used to compare cohorts presenting just before and just after a CRT was established.

Results Following introduction of the CRT, the admission rate in the 6 weeks after a crisis fell from 71% to 49% (OR 0.38, 95% CI 0.21-0.70). A difference of 5.6 points (95% CI 2.0-8.3) on mean Client Satisfaction Questionnaire (CSQ-8) score favoured the CRT. These findings remained significant after adjustment for baseline differences. No clear difference emerged in involuntary hospitalisations, symptoms, social functioning or quality of life.

Conclusions CRTs may prevent some admissions and patients prefer them, although other outcomes appear unchanged in the short term.

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