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Acute psychotic episode, schizophrenia, manic depression, moderate to severe depressive disorder

The Crisis Resolution and Home Treatment Team provides intensive support for individuals with an acute episode of functional mental illness (e.g. acute psychotic episode, schizophrenia, manic depression, moderate to severe depressive disorder) who would otherwise require admission.

Those who present with acute stress reactions with secondary suicidal ideation/ intent who would otherwise require admission but who often respond well to brief input from home treatment.

Previously unknown people who are acutely unwell who require assessment over a 1 – 2 week period to determine the diagnosis and who otherwise would require admission.

Those with severe functional mental illness who require in-patient care and will benefit from intensive home treatment in the period following discharge from hospital.

Specific short treatments, such as the introduction of Clozapine and other a-typical psychotropic medication, which may normally require admission to hospital.

Individuals with dual diagnosis (being a diagnosis of serious mental illness and substance misuse) who become acutely mentally unwell. 

People with a co-morbid personality disorder.

People with one of the above who also have a co-morbid alcohol related issues and /or who are homeless.

People who are clinically appropriate for early discharge from psychiatric in-patient care. This includes in-service users at home on Section 17 leave and service users on Community Treatment Orders.

Service users will normally, but not exclusively, be permanent residents of the catchment area. The team will be expected to assess those from outside the catchment who present in crisis to determine the most appropriate way of dealing with the crisis. Temporary residents (e.g. in bed and breakfast) will not be discriminated against: the prime consideration should be need. If people are temporary residents without a local GP, again need is the key. CRHTT’s will encourage local registration, even if for a temporary residence.
 

Adults with co-occurring mental illness and substance misuse are eligible for home treatment when clinically appropriate. If the referred person is intoxicated at the time of referral, and the referrer feels the person is at serious risk of harm, the referrer should lead on arrangements to ensure the safety of the person until they can be fully assessed.
 
CRHTT will contribute to the assessment of risk and support the referrer in developing an interim plan of care until the person is medically fit for mental health assessment. CRHTT does not provide home treatment for substance misuse detoxification.

CRHTT will accept referrals of adults who have taken an overdose. Advice will be given to the referrer to arrange treatment for the overdose as a priority, by transfer to A&E for physical health checks, before the CRHTT assessment proceeds.
 

Age range treated

CRHTTs primarily provide crisis assessment, followed by home treatment where appropriate, where the crisis episode is of such severity that admission to hospital is being considered, to the following:

• Those aged 18 years and over with mental health problems.
• Older persons under the care of adult mental health community teams.
• Adolescents under exceptional circumstances (please see CAMHS notes below).
• Older persons under the care of older persons mental health community teams presenting with functional mental problems.

CAMHS provide services for service users in crisis who are aged under 18. If a child/adolescent (under 18 years old) with mental health problems presents in crisis at A&E out of hours, CRHTT will support duty doctors in their assessment. If a 16 – 18 year old requires out of hours crisis support awaiting follow up from the Adolescent Outreach team during usual working hours, CRHTT will provide that support.