Abstract

Britain's National Health System plans to create 335 "crisis resolution and home treatment teams" (CRHT) by 2004 for mental health patients. This study sought to understand the reasons that participants in a CRHT program were hospitalized and to identify predictors of hospitalization. The most common reason for hospitalization was "risk to self"; ideas of suicide and previous hospitalization were significant predictors of hospitalization. Further research is needed to identify additional predictors and to determine if these results are applicable in other settings. [The Assertive Community Treatment (ACT) teams outlined for Ontario in the "Making it Happen: Implementation Plan for Reformed Mental Health System" are similar to the CRHT teams in this study.] Background: A substantial amount of evidence from controlled trials has demonstrated that the majority of individuals with severe, acute mental health problems can be cared for by communityfocused services. Research has shown that the clinical and social outcomes associated with community care are equal to or better than hospital care. This evidence supports Britain's National Health System plan to create 335 "crisis resolution and home treatment teams" (CRHT) by 2004. In previous studies, about 11% to 29% of individuals receiving treatment from CRHTs required hospitalization. The objectives of the current study were to: 1) examine reasons for admission to hospital and 2) identify variables that could predict the need for hospitalization after home treatment had commenced.

Method: Two community treatment teams in North-West Herfordshire, established in 1994, were involved in the study. These teams, which provide 12-hour care on a daily basis, consist of 8 nursing staff and a junior doctor. A consultant and a clinical manager also provide support for both teams. A nurse and a psychiatrist assess referred individuals over 16 years old for suitability for the program. Those found suitable for the program receive home visits (up to 3 times a day) and telephone calls as clinically required.

For this study, demographic and clinical data were collected from all program participants upon initiation and completion of the program. A total of 293 individuals participated in the program during the 12-month study period. The data were analyzed using statistical techniques to identify which factors were predictive of hospitalization.

Findings: During the study 62 (21.1%) of the CRHT program were admitted for care in the hospital. Reasons for hospitalization included: 1) risk to self (53.2%); 2) risk to others (11.3%); 3) carers unable to cope (8.1%); service user's preference (4.8%); 5) noncompliance with treatment (4.8%); and 6) other or not recorded (17.7%). The statistical analysis showed that ideas of suicide (measured by the Scale for Suicide Ideation) and previous hospitalization significantly increased the risk that individuals would be admitted to hospital. These factors, however, only predicted 12.3% of the hospitalizations.

Conclusions: As CRHT spread across Britain, it is important to inform clinicians as to who are most or least likely to benefit from such services. This study has identified two factors that increase risk of hospitalization but further research is required to identify additional factors and to determine if the results are valid in other settings. [The Assertive Community Treatment (ACT) teams outlined for Ontario in the "Making it Happen: Implementation Plan for Reformed Mental Health System" are similar to the CRHT teams in this study.]

Reference: Brimblecombe N, O'Sullivan G, Parkinson B. "Home Treatment as an alternative to inpatient admission: characteristics of those treated and factors predicting hospitalization". Journal of Psychiatric and Mental Health Nursing 2003; 10: 683-687.