All Wales Crisis Resolution Team Network Meeting

All Wales Crisis Resolution Team Network Meeting

All Wales Crisis Resolution Team Network Meeting

28th March 2007


Brahms Robinson, Newport HTT;
Liz Houghton, Newport HTT;
Andrew Moody, North Cardiff CRHTT;
Chris Storer, Powys CRHT Implementation Group;
Jan Preen, Blaenau Gwent CRHTT; / Caroline Shoebridge, East Caerphilly;
Julie O’Brien, Caerphilly Borough Council;
William Reimnitz,, Llanelli CRHT;
Richard Jones, Carmarthen CRHT;
Jayne Tottle, South Cardiff CRHTT.
Julie Denley, North Glamorgan Sen Nurse;


Mike Thomas, Powys
Chris Johnson, Pembs & Derwen / Karen McCormack, N E Wales
Jane Boland, N E Wales.

Action Points from Last Meeting

Service profile

Richard has not had an opportunity to liaise with Steve Onyett. Will feedback next time.


Brahms is meeting with Les Rudd to discuss CMHSD involvement which should be active from next meeting in May.

CSIP Guidance Statement on Fidelity and Best Practice

Was circulated as agreed. There had been no further discussion about the document external to the Network, but it was suggested that perhaps the Welsh CRHT services were not yet established enough to make a formal response, nor was the CRHT Network

Future funding of Network Meetings.

Lee-Ann to take issue to Pharmaceutical companies development group . Janssen funding up to July meeting, post July, is yet to be agreed although Lee-Ann is optimistic that the mixed group will agree some form of shared funding.

Mental Health Act

Information was shared as agreed

Service Profile

The group spent the morning workshop agreeing a draft framework for a CRHT service profile that would provide a framework for comparative analysis of services in conjunction with the Minimum Data set

This will be circulated to the Network core group for consultation and a working document circulated prior to the May meeting for discussion

Agenda Items

Minimum Data Set

Richard has devised an Excel tool to manage data on a day to day basis. It was originally built on new version Excel but due to difficulties on older machines he suggests that he will “rebuild it” on older version prior to full circulation. It was felt that it could be useful for services that don’t presently has a systematic process for data collection.

The tool could also be used by those that already have existing processes, to record and communicate monthly figures for electronic analysis. Richards suggests group collection of data to match demographic information detailed in service profiles and to produce report for whole of Wales in say 12 months time. This could inform Phill Chicks ‘National Stock-take’ of CRHT services. It was felt that there would be no data protection issues, as no identifiable patient information would be reported.

The question remains as to who would collate and analyse thus data nationally? Richard feels there may be room for this within his role in Swansea University. As we are still at exploratory stage at the moment it was agreed that collecting demographics for service profile should be our first priority. The issue could be approached after service profiles completed.

It was suggested that this topic be returned to at the next meeting.

Mapping Welsh CRHT Services

Brahms raised the issue of identifying potential CRHT leads within those areas where there was no CRHT Service presently. The Network has compiled circulation lists, but he feels that there needs to be a more systematic approach to communicating to all areas. This becomes more important as the Network completes it’s agreed aims re Service Profile, Data Set, Core Group, and the need to share information increases.

Jayne Tottle agreed to discuss with Cardiff link to All Wales Nursing Advisory Group who could direct the Network to local contacts

North Glamorgan Team Presentation – Julie Denley

Team was result of lengthy period of consultation. Trust felt that CRHT service would need to be funded, and felt that working with existing resources was untenable. After two years and negotiation with LHB funding provided for new service. Trust is not rushing implementation, waiting until staff are in post and ready.

Inpatient beds reduction programme

  • 39 beds initially, now reduced to 35.
  • 30 beds after 6 months post CRHT
  • 25 beds by September 2008.

(For population of 150,000)

Team will consist of 22 people when fully recruited –

Team Leader, Consultant, SHO, Staff Grade, 10 practitioners at Band 6, 6 support workers, 3 therapy staff (including OT, Psychologist and one post vacant for when future need defined), Admin.

Two functions are separated within the team – Crisis Assessment and Home Treatment

Crisis Assessment

24/7 as Crisis Assessment Service

  • Team has broad remit as well as assessment; gate keeping admission, bed management, contact for HTT Service users, post S136 and MHA assessments, Mental Health queries out of CMHT hours, Telephone triage for self referrals, advice and referral to other services including Home Treatment.
  • Team can provide time limited intervention usually one follow up appointment at unit.
  • 4 hour response time

Accessed by all agencies except secondary services e.g. police, non stat, self, primary care, A&E. DGH has a Psych Liaison service available 9-5, M-F in A&E of DGH. Out of hours referrals come to CRHT.

Self referral receive a 10 minute triage assessment and signposted on if necessary. Not a Unified Assessment as not practical. Team uses crisis specific assessment, not full CPA assessment.

All assessments take place in Assessment Unit; anyone who can’t attend is discussed with Consultant on call/EDT. If necessary options are CMHT domiciliary visit, MHA assessment at home (EDT)

Out of hours; Joint Assessment with Doctor. CRHT will defer decision if SU current to CMHT where possible e.g. Sunday nights. GP requests are screened and discussed with consultant on call if necessary.

Home Treatment

  • 8am – 9pm, 7 days a week
  • Caseload is approx 20 – 25 depending on level of intervention.
  • Team works closely with inpatient service – co-located and have shared management structure, hence shared goals/objectives.
  • “fluidity” with inpatient staff if inpatient unit quiet

Accessed by secondary services only – CMHT, Day Services, Inpatient, Assertive Outreach, CMHT Dom Visits, MHA assessment, Psych Liaison (DGH).

Initial contact is assessment in service user’s home and is considered for appropriateness for service, e.g. risk, intensity of symptoms and likelihood of engagement. If appropriate, agree care plan for intervention and review date, agree communication plan, update risk assessment.

Discharge planning starts early, input from other services is continued/restarted/put in place, assessment and planning completed, coping strategies identified. Discharge when CPA review meeting has taken place.

Gate keeping ensures purpose of admission is clear

Potential challenges

  • Maintain a balance between HT and Crisis Assessment..
  • AOT service is being developed and CMHT is changing at same time
  • CMHT staff are anxious “who are we left with if HT/AOT service taking all the clients”.

Any Other Business

It was confirmed the next meeting was on Tuesday 22 May 2007 at Llangoed Hall