Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-19T07:35:15.518Z Has data issue: false hasContentIssue false
  • English
  • Français

Home treatment services for acute mental disorders: an all-Ireland survey

Published online by Cambridge University Press:  23 January 2018

B. O’Keeffe  and
V. Russell
B. O’Keeffe*
Affiliation:
Finglas Community Mental Health Services,Dublin, Ireland
V. Russell
Affiliation:
Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont, Dublin, Ireland
*
*Address for correspondence: B. O’Keeffe, Finglas Community Mental Health Services, Century Business Park, St Margaret’s Road, Finglas, Dublin, Ireland. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To determine the distribution, functioning and perceived impact of home-based treatment (HBT) teams for acute mental disorders on the island of Ireland.

Methods

A 28-item questionnaire exploring the structure, staffing and operation of HBT teams was emailed to all clinical directors of mental health services in Ireland (n=26) and Northern Ireland (NI) (n=5). Quantitative data was analysed using the Survey Monkey package, while free-text responses to open questions were analysed for thematic content.

Results

In total, 11 of 16 (68%) mental health services in Ireland and four of five (80%) in NI confirmed the presence of HBT teams. For 80% of respondents the primary function of HBT was as an alternative to inpatient admission. All NI respondents reported provision of a 24/7 HBT service. A 7 day a week service was reported by 82% of Republic of Ireland respondents. In total, 70% of respondents reported a gate-keeping role for their teams. Staffing levels and multidisciplinary representation varied widely. Most respondents perceived HBT as improving patient/carer experience and cost-effectiveness.

Conclusions

Our findings suggest that the implementation of the HBT model in Ireland has not fulfilled the aspirations set out in mental health policy in both Irish jurisdictions. Many areas have no HBT services while wide variations in staffing levels and functioning persist. However, mental health services with established HBT teams appear convinced of their positive impact. An All-Ireland forum on HBT may help to define the model in an Irish context and standardise its future resourcing, operation and evaluation.

Keywords

Crisis resolutionhome treatmentsurveyIreland
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 36 , Issue 1 , March 2019 , pp. 7 - 17
Copyright
© College of Psychiatrists of Ireland 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bamford Review of Mental Health and Learning Disability (2005). A Strategic Framework for Adult Mental Health Services. Department of Health, Social Services, and Public Safety: Belfast (https://www.health-ni.gov.uk/publications/bamford-published-reports). Accessed 8 August 2017.Google Scholar
Bamford Review of Mental Health and Learning Disability (2007). A Comprehensive Legislative Framework. Department of Health, Social Services, and Public Safety: Belfast (https://www.health-ni.gov.uk/publications/bamford-published-reports). Accessed 8 August 2017.Google Scholar
Bannon, H, McDonald, B (2003). Satisfaction with home-based treatment in Mental Health. Irish Nurse 5, 24–25.Google Scholar
Barker, V, Taylor, M, Kader, I, Stewart, K, Le Fevre, P (2011). Impact of crisis resolution and home treatment services on user experience and admission to psychiatric hospital. The Psychiatrist 35, 106–110.Google Scholar
Bowe, M, Devitt, P, Kelly, F (2011). Changing Minds. Home Not Hospital. TAF Publishing: Dublin.Google Scholar
Carpenter, RA, Falkenburg, J, White, TP, Tracy, DK (2013). Crisis teams: systematic review of their effectiveness in practice. The Psychiatrist 37, 232–237.Google Scholar
Conboy-Browne, M, McCann, E, Steemers, F (2010). Evaluation of a home care service for patients with acute mental Illness in Dublin South East mental health services. HSE. (https://www.researchgate.net/publication/280837101_EVALUATION_OF_A_HOME_CARE_SERVICE_FOR_PATIENTS_WITH_ACUTE_MENTAL_ILLNESS). Accessed 4 January 2018.Google Scholar
Connolly, H (2012). Home treatment: changes to mental healthcare in Northern Ireland. Ulster Medical Journal 81, 49–50.Google Scholar
Crisp, N, Nicholson, K, Smith, G (editors) (2016). Building on progress: Achieving parity for mental health in Northern Ireland (The Commission on Acute Adult Psychiatric Care). (https://www.rcpsych.ac.uk/pdf/NI%20caapc_report_web.pdf). Accessed 4 January 2018.Google Scholar
Daly, A, Craig, S (2015). Activities of Irish Psychiatric Units and Hospitals 2015 Main Findings. HRB Statistics Series 29. (http://www.hrb.ie/uploads/tx_hrbpublications/Activities_in_Irish_Psychiatric_Units_and_Hospitals_2015.pdf). Accessed 1 June 2017.Google Scholar
Davies, P, Taylor, J (2010). Getting the Medicines Right 2: Medicines Management in Mental Health Crisis Resolution and Home Treatment Teams. National Mental Health Development Unit (https://www.rcpsych.ac.uk/pdf/Getting%20the%20Medicines%20Right.pdf). Accessed 20 July 2017.Google Scholar
Dean, C, Gadd, E (1990). Home treatment for acute psychiatric illness. British Journal of Psychiatry 301, 1021–1023.Google Scholar
Department of Health (2000). The NHS Plan: A Plan for Investment, A Plan for Reform. London.Google Scholar
Department of Health (2001). Crisis Resolution/Home Treatment Teams: The Mental Health Policy Implementation Guide. Department of Health: London.Google Scholar
Department of Health and Children (2006). A Vision for Change. Report of the Expert Group on Mental Health Policy. Stationery Office: Dublin.Google Scholar
Department of Health, Social Services, and Public Safety (2014). Bamford Action Plan 2012–15: Monitoring Report. Department of Health, Social Services, and Public Safety: Belfast (https://www.health-ni.gov.uk/publications/delivering-bamford-vision-action-plan-2012-15). Accessed 6 April 2017.Google Scholar
Dixit, A, Ruddle, M, Payne, A (2010). Setting up of home based crisis team service (Cork City North-East & North-West sectors) and service use in first two years (2007-2009). North Lee Mental Health Service, Cork, Ireland (http://slideplayer.com/slide/6848730/). Accessed 8 August 2017.Google Scholar
Gibbons, P, Cocoman, A (2006). Building Blocks: Evaluation of a Home Based Service for Patients with Acute mental Illness in North Kildare. Health Services Executive: Dublin.Google Scholar
Gibbons, P, Lee, A, Parkes, J, Meaney, E (2012). Value for Money: A Comparison of Cost and Quality in Two Models of Adult Mental Health Service Provision. HSE: Kildare.Google Scholar
Glover, G, Arts, G, Babu, KS (2006). Crisis resolution/home treatment teams and psychiatric admission rates in England. British Journal of Psychiatry 189, 441–445.Google Scholar
Hasselberg, N, Grawe, RW, Johnson, S, Ruud, T (2011). An implementation study of the crisis resolution team model in Norway: are the crisis resolution teams fulfilling their role? BMC Health Services Research 11, 96.Google Scholar
Healthcare Commission (2008). The pathway to recovery: a review of NHS acute inpatient mental health services. Commission for Healthcare Audit and Inspection. (http://www.ucl.ac.uk/core-resource pack/resources/papers/healthcare_commission_2008_The_pathway_to_recovery.pdf). Accessed 13 July 2017.Google Scholar
Home Treatment Accreditation Scheme (HTAS) (2015). Standards for Home Treatment Teams, 2nd edn. Royal College of Psychiatrists: (https://www.rcpsych.ac.uk/pdf/HTAS%20Standards%20SecondEdition%202015.pdf). Accessed 4 January 2018.Google Scholar
Hoult, J (1999). Developing the South Islington crisis resolution team. Mental Health Review Journal 4, 14–16.Google Scholar
Hoult, J, Reynolds, I (1984). Community orientated treatment compared to psychiatric hospital orientated treatment. Social Science & Medicine 18, 1005–1010.Google Scholar
Hubbeling, D, Bertram, R (2012). Crisis resolution teams in the UK and elsewhere. Journal of Mental Health 21, 285–295.Google Scholar
Hubbeling, D, Bertram, R (2014). Hope, happiness and home treatment: a study into patient satisfaction with being treated at home. Psychiatric Bulletin 38, 265–269.Google Scholar
Hunt, IM, Rahman, MS, While, D, Windfuhr, K, Shaw, J, Appleby, L, Kapur, N (2014). Safety of patients under the care of crisis resolution home treatment services in England: a retrospective analysis of suicide trends from 2003 to 2011. Lancet Psychiatry 1, 135–141.Google Scholar
Iqbal, N, Nkire, N, Nwachukwu, I, Young, C, Russell, V (2012). Home-based treatment and psychiatric admission rates: experience of an adult community mental health service in Ireland. International Journal of Psychiatry in Clinical Practice 16, 300–306.Google Scholar
Jacobs, R, Barrenho, E (2011). Impact of crisis resolution and home treatment teams on psychiatric admissions in England. British Journal of Psychiatry 199, 71–76.Google Scholar
Jethwa, K, Galappathie, N, Hewson, P (2007). Effects of a crisis resolution and home treatment team on inpatient admissions. Psychiatric Bulletin 31, 170–172.Google Scholar
Johnson, S (2013). Crisis resolution and home treatment teams: an evolving model. Advances in Psychiatric Treatment 19, 115–123.Google Scholar
Johnson, S, Nolan, F, Hoult, J, White, IR, Bebbington, P, Sandor, A, McKenzie, N, Patel, SN, Pilling, S (2005). Outcomes of crisis before and after introduction of a crisis resolution team. British Journal of Psychiatry 187, 68–75.Google Scholar
Johnson, S, Nolan, F, Pilling, S, Sandor, A, Hoult, J, McKenzie, N, White, IR, Thompson, M, Bebbington, P (2005). Randomised controlled trial of acute mental health care by a crisis resolution team: the North Islington crisis study. British Medical Journal 331, 599–602.Google Scholar
Joint Commissioning Panel for Mental Health (JCPMH) (2013). Guidance for commissioners of acute care – inpatient and crisis home treatment (http://www.jcpmh.info/good-services/acute-care-services/). Accessed 8 August 2017.Google Scholar
Karlsson, B, Borg, M, Eklund, M, Kim, HS (2011). Profiles of and practices in crisis resolution and home treatment teams in Norway: a longitudinal survey study. International Journal of Mental Health Systems 5, 19.Google Scholar
Kennedy, P (2003). CRHT for rural areas: the Monaghan story in: More than the sum of all the parts. Improving the whole system with Crisis Resolution and Home Treatment. Northern Centre for Mental Health (http://intensivehometreatment.com/wp-content/uploads/2010/08/More-than-the-sum-of-all-the-parts.pdf). Accessed 14 November 2017.Google Scholar
Lloyd-Evans, B, Bond, GR, Ruud, T, Ivaneka, A, Gray, R, Osborn, D, Nolan, F, Henderson, C, Mason, O, Goater, N, Kelly, K, Ambler, G, Morant, N, Onyett, S, Lamb, D, Fahmy, S, Brown, E, Paterson, B, Sweeney, A, Hindle, D, Fullarton, K, Frerichs, J, Johnson, S (2016). Development of a measure of model fidelity for mental health Crisis Resolution Teams. BMC Psychiatry 16, 427.Google Scholar
Lloyd-Evans, B, Paterson, B, Onyett, S, Brown, E, Istead, H, Gray, R, Henderson, C, Johnson, S (2017). National implementation of a mental health service model: A survey of Crisis Resolution Teams in England. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.12311.Google Scholar
Lunawat, VK, Karale, M (2014). Repeat users of crisis resolution and home treatment team. Psychiatria Danubina 26 (Suppl. 1): 10–14.Google Scholar
McCauley, M, Bergin, A, Bannon, H, Russell, V (2005). How do GPs experience home-based treatment for acute psychiatric disorders? Primary Care and Community Psychiatry 10, 159–163.Google Scholar
McCauley, M, Rooney, S, Clarke, C, Carey, T (2003). Home based treatment in Monaghan: the first 2 years. Irish Psychiatrist 20, 11–14.Google Scholar
McCrone, P, Johnson, S, Nolan, F, Pilling, S, Sandor, A, Hoult, J, McKenzie, N, Thompson, M, Bebbington, P (2009). Economic evaluation of a crisis resolution service: a randomised controlled trial. Epidemiologia E Psichiatria Sociale 18, 54–58.Google Scholar
McLoughlin, M, Abba-Aji, A, Omoseni, O (2005). Home-based treatment – the West Clare experience: hurdles to cross? Irish Psychiatrist 6, 150–155.Google Scholar
Menon, A, Flannigan, C, Tacchi, MJ, Johnston, J (2015). Burnout-or heartburn? A psychoanalytic view on staff burnout in the context of service transformation in a crisis service in Leeds. Journal of Psychoanalytic Psychotherapy 29, 4,330–342.Google Scholar
Moore, GF, Audrey, S, Barker, M, Bond, L, Bonell, C, Hardeman, W, Moore, L, O’Cathain, A, Tinati, T, Wight, D, Baird, J (2015). Process evaluation of complex interventions: Medical Research Council guidance. British Medical Journal 350, 1–7.Google Scholar
Morrow, R, McGlennon, D, McDonnell, C (2016). A novel mental health crisis service – outcomes of inpatient data. Ulster Medical Journal 85, 13–17.Google Scholar
Murphy, SM, Irving, CB, Adams, CE, Waqar, M (2015). Crisis intervention for people with severe mental illnesses. Cochrane Database Systematic Reviews CD001087.Google Scholar
The National Audit Office (2007). Helping people through mental health crisis: the role of crisis resolution and home treatment services (Report by the controller and auditor general. HC 5 session 2007-2008 The Stationary Office: London.Google Scholar
National Clinical Programme for Mental Health (2014). National clinical programme for the assessment and management of patients presenting to emergency departments following self-harm (http://www.hse.ie/eng/about/Who/clinical/natclinprog/mentalhealthprogramme/selfharm/selfharm.html). Accessed 13 July 2017.Google Scholar
Nelson, T, Johnson, S, Bebbington, P (2009). Satisfaction and burnout among staff of crisis resolution, assertive outreach and community mental health teams. A multicentre cross-sectional survey. Social Psychiatry and Psychiatric Epidemiology 44, 541–549.Google Scholar
Nkire, N, Sardinha, S, Nwosu, B, McDonough, CM, De Coteau, PA, Duffy, I, John, L, Waddington, JL, Russell, V (2015). Evaluation of knowledge and attitudes among primary care physicians in Cavan–Monaghan as ‘gatekeepers-in-waiting’ for the introduction of Carepath for Overcoming Psychosis Early (COPE). Early Intervention in Psychiatry 9, 141–150.Google Scholar
North Eastern Health Board (NEHB) (2001). The Cavan/Monaghan Project. A model for a New Community Health Service. North Eastern Health Board Monograph presented at the conference ‘Planning for a New Community Mental Health Services in Ireland’, Cavan (http://www.lenus.ie/hse/bitstream/10147/250031/1/AModelforCommunityMentalHS.pdf). Accessed 6 July 2017.Google Scholar
Nwachukwu, I, Nkire, N, Russell, V (2014). Profile and activities of a rural home-based psychiatric treatment service in Ireland. International Journal of Psychiatry in Clinical Practice 18, 125–130.Google Scholar
Paton, F, Wright, K, Ayre, N, Dare, C, Johnson, S, Lloyd-Evans, B, Simpson, A, Webber, M, Meader, N (2016). Improving outcomes for people in mental health crisis: a rapid synthesis of the evidence for available models of care. Health Technology Assessment 20, 1–162.Google Scholar
Rhodes, P, Giles, SJ (2014). “Risky Business”: a critical analysis of the role of crisis resolution and home treatment teams. Journal of Mental Health 23, 130–134.Google Scholar
Semrau, M, Barley, EA, Law, A, Thornicroft, G (2011). Lessons learned in developing community mental health care in Europe. World Psychiatry 10, 217–225.Google Scholar
Sjolie, H, Karlsson, B, Kim, HS (2010). Crisis resolution and home treatment: structure, process and outcome – a literature review. Journal of Psychiatric Mental Health Nursing 17, 881–892.Google Scholar
Smyth, M, Hoult, J (2000). The home treatment enigma. British Medical Journal 320, 305–308.Google Scholar
Stein, L, Test, M (1980). Alternative to mental health treatment I: conceptual model, treatment program and clinical evaluation. Archives of General Psychiatry 37, 392–397.Google Scholar
Thornicroft, G, Alem, A, Antunes Dos Santos, R, Barley, E, Drake, RE, Gregorio, G, Hanlon, C, Ito, H, Latimer, E, Law, A, Mari, J, McGeorge, P, Padmavati, R, Razzouk, D, Semrau, M, Setoya, Y, Thara, R, Wondimagegn, D (2010). WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care. World Psychiatry 9, 67–77.Google Scholar
Tyrer, P, Gordon, F, Nourmand, S, Lawrence, M, Curran, C, Southgate, D, Oruganti, B, Tyler, M, Tottle, S, North, B, Kulinskaya, E, Kaleekal, JT, Morgan, J (2010). Controlled comparison of two crisis resolution and home treatment teams. The Psychiatrist 34, 50–54.Google Scholar
Wheeler, C, Lloyd-Evans, B, Churchard, A, Fitzgerald, C, Fullarton, K, Mosse, L, Paterson, B, Galli Zugaro, C, Johnson, S (2015). Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review. BMC Psychiatry 15, 74.Google Scholar
Wright, B, Russell, V (2007). Integrating mental health and primary care services: a challenge for psychiatric training in Ireland. Irish Journal of Psychological Medicine 24, 71–74.Google Scholar