Mental health services II

In recent years the way mental health services are organised has changed dramatically, with the emergence of new teams, with a focus on caring for people in their own homes as far as possible. These teams specialise in a particular area of health care, and patients will often move between teams as their illness or circumstances change. They may also have input from several teams at the same time. In these circumstances the care co-ordinator plays a key role in providing a consistent point of contact for the patient, and all teams have to work hard on their communication with other teams. This section describes three specialist teams – Crisis Resolution and Home Treatment teams (CRHT), Early Intervention in Psychosis teams (EIP) and Assertive Outreach teams (AOT). There are many other types of specialist teams such as perinatal services, liaison services, memory clinics, drug and alcohol services, which will be described in the appropriate chapters later in the book.

Figure 1 illustrates the pathway through four different mental health teams taken by Sam, a 19-year-old man. Sam presents to his GP for the first time, at the insistence of his mother who is concerned that he is spending all of his time in his bedroom, not seeing his friends, and tending to sleep all day, and stay awake all night. The GP is concerned that he may be depressed and refers him to the Community Mental Health Team (CMHT). He is seen initially by a social worker from the team, who visits him at home. He tells the social worker that he is spending most of his time on his computer because he has discovered a conspiracy that involves police forces in several countries working together to support terrorist activity. He is concerned that as he knows about it he will himself become a terrorist target, and feels he needs to lie low. He is very frightened and distressed by these beliefs, but has not discussed them with anyone else. The social worker is concerned that he is psychotic, and takes him in to the CMHT team base to see the psychiatrist in clinic for an urgent assessment.

Fig. 1 Sam’s pathway through mental health services.

The psychiatrist agrees that Sam has a psychotic illness, and prescribes antipsychotic medication. As he is young, and presenting with psychotic symptoms for the first time they agree to refer him to the Early Intervention in Psychosis service (EIP). A nurse from this team meets with Sam and his mother at home the next day, and agrees to become his care co-ordinator, and to visit him daily initially, to complete an assessment, monitor his progress, and offer support to his mother. However, Sam’s mental state deteriorates. He is very suspicious of the medication, fearing that it may poison him, and becomes increasingly suspicious of staff, and regretful that he has talked about his fears, as he thinks this will put him in danger. The EIP team decides that as things are deteriorating he may need admission to hospital. They therefore refer him to the Crisis Resolution and Home Treatment Team (CRHT). Their role is to assess whether it is possible to safely treat him at home with more intensive support from their team.

The CRHT consultant and nurse see Sam at home, and decide that it is not going to be possible to treat him at home because of the level of distress he is experiencing and his adamant refusal to take any medication. He is therefore admitted to the local inpatient unit under a section of the Mental Health Act. He is assessed and treated by the inpatient medical and nursing staff, and responds well to antipsychotic medication, which he agrees to take in hospital, and following his discharge. During his stay his care co-ordinator from EIP visits him regularly, and as his mental state improves takes him out for visits home. Prior to his discharge a CPA meeting is held, involving the inpatient team, EIP and CRHT, and they agree that as he now has a good relationship with his care co-ordinator he can be discharged without CRHT support.

Crisis Resolution and Home Treatment teams (CRHT)

These teams are sometimes known as Crisis Intervention, Crisis Response, or Rapid Response Teams. They are community teams, but their role is closely allied to that of the inpatient unit. They treat patients who would, in the past, have been treated in hospital. They are often based in inpatient units, and function 24 hours a day, 7 days a week. Their role includes:

Gatekeeping inpatient beds – this means that they are the final arbiters of whether a patient can be admitted to an acute inpatient bed. They will consider whether the treatment required can be delivered at home instead of in hospital, and if so will provide the necessary care.

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