SCOTTISH CRISIS RESOLUTION/HOME TREATMENT NETWORK
SERVICE MAPPING REPORT
NOVEMBER 2010
Contents
1. Background
2. Resources
3. Working hours
4. Acute mental health assessment
5. Gate keeping
6. Crisis Resolution
7. Alternatives to Admission
8. Early discharge
9. Age range of patients
10. Multidisciplinary Assessment
11. Referral to CRHTT
12. Data of success
13. Future Plans
Common Abbreviations Used In Report
CMHT: Community Mental Health Team
CRHTT: Crisis Resolution Home Treatment Team (used synonymously with Intensive Home Treatment Team)
IPCU: Intensive Psychiatric Care Unit
OOH: Out of Hours
MHAS: Mental Health Assessment Service
URT: Urgent Referral Team
1. Background
Aim of Service Mapping
A questionnaire was sent out on behalf of the Scottish Crisis/Home Treatment Network, which is supported by the Mental Health Collaborative. The main purpose of this questionnaire was:
· to map the current configuration of Crisis Resolution/Home Treatment (CRHT) services/functions across Scotland;
· identify any plans to develop these services/functions;
· identify any current evaluations of impact of services/functions;
· and provide some baseline data to aid future analysis of the impact of CRHT services/functions on inpatient bed usage.
Structure of Questionnaire
One of the challenges faced in designing the questionnaire was to structure it in a way that recognised that the functions of a Crisis Resolution/Home Treatment service can be delivered by dedicated teams and/or within generic community mental health services. This is a particularly relevant issue for Scotland, as the service delivery structures for highly dispersed populations living in remote and rural areas are likely to be different from those for highly concentrated populations living within urban areas. Therefore, the questionnaire separated out the main functions of a Crisis Resolution/Home Treatment service and asked whether these were provided and if so, whether they were delivered by a dedicated CRHT Team and/or by CMHTs and/or through another arrangement.
Using the Mental Health Benchmarking Guidance: Appendix A, Service Definitions December 2008 for reference, the main functions were identified as:
· home based face to face acute mental health assessment within four hours of referral;
· gate-keeping to acute mental health admissions wards;
· brief crisis resolution interventions;
· intensive home based support as an alternative to a psychiatric inpatient admission;
· intensive home based support to facilitate early discharge from mental health inpatient wards.
For those areas that use a dedicated Crisis Resolution or Home Treatment Team to deliver some or all of the above functions, the survey then asked questions about which age ranges it serves, which professionals work in it and who can refer to it.
Finally, the questionnaire went on to look at whether NHS Boards have undertaken any evaluation of the effectiveness of their CRHT functions and to identify any plans for further development of these services.
A copy of the original survey document can be obtained from .
Analysis of Responses
The original aim was to combine the response to the survey with data from ISD about acute bed usage across Scotland. This initial report focuses on the returns from the NHS Boards and does not include any data on actual activity. Further work is needed to include activity data in this analysis.
Returns were received from every NHS Board with the exception of Orkney. This report summarises those returns. Due to the challenges in amalgamating and accurately summarising the returned data, a draft version went to contributing NHS Boards for verification of accuracy prior to producing this final document.
It was agreed that the survey results would be fed back to NHS Boards and it is expected that the analysis will:
· help NHS Boards to understand how their local approach compares with other Boards across Scotland;
· keep abreast of plans to develop CRHT across Scotland and;
· help NHS Boards to understand the impact that developments are already having.
2. Resources
The following table shows the Adult Acute and IPCU beds in each NHS Board. Please note that differences in local configurations of beds means that this data is not fully comparable.
NHS Boards / Adultacute beds[1] / IPCU Beds / 2008/9 adjusted NRAC Population[2] / Adult acute beds per adjusted 100,000 population[3] / IPCU beds per adjusted 100,000 population / Notes /
Ayrshire & Arran / 94 / 7 / 323,409 / 29 / 2.2 / Acute beds - all wards cover specific CMHT/GP catchment areas. IPCU provides area wide cover. Figure includes 4 beds for detox in Crosshouse Hospital.
Borders / 20 / 0[4] / 94,441 / 21 / 0 / 30 bedded unit. 18 beds for Adult 16-70. 10 beds for Older Adults 70 and over. 2 beds for Alcohol Detox.
Dumfries & Galloway / 44 / 0[5] / 135,208 / 33 / 0 / One of the wards also has 4 beds identified as “detox” beds. These are included in the total 44 beds. There is a separate ward for people over 65.
Fife / 89 / 10 / 282,216 / 32 / 3.5 / Fife provides these beds on 3 separate geographic sites Acute beds are for under 65s.
Forth Valley / 42 / 12 / 237,839 / 18 / 5 / Two acute beds are kept for planned alcohol detoxification and are used pretty well continuously. One bed is reserved for eating disorder patients.
Grampian[6] / 127 / 11 / 555,819 / 22 / 1.9 / Royal Cornhill 4 x 28 = 112 + Moray 15 = 127. Acute beds per 100,000 includes eating disorder and drug & alcohol detoxification. The Moray bed compliment to serve the Adult Mental Health population is 15 and the remaining 5 beds are used for Older Adult, Specialist and Learning Disabilities service user provision.
Greater Glasgow & Clyde / 295 / 44 / 1,349,983 / 22 / 3.3
Greater Glasgow / 250 / 36 / Greater Glasgow beds cover 18 - 65years over 5 main Hospital sites
Clyde / 45 / 8 / There are additional dedicated acute inpatient services and OACMHT for people over age of 65.
Highland / 98 / 21 / 247,920 / 40 / 8.5 / 26 acute and 9 IPCU in Argyll & Bute. 72 and 12 at New Craigs hospital. In Argyll & Bute admission and IPCU beds are for all of the adult population served i.e. includes 65 years+.
Lanarkshire / 144 / 0[7] / 471,386 / 31 / 0
Lothian / 124 / 24 / 940,386 / 13 / 2.3[8] / See below for breakdown
East Lothian / 12 / In Royal Edinburgh Hospital and also access the IPCU at Royal Edinburgh
Edinburgh / 80 / 12 / Acute beds for 18 – 65. East and Mid Lothian access IPCU beds as well.
Midlothian / 8 / In Royal Edinburgh Hospital and also access the IPCU at Royal Edinburgh
West Lothian / 24 / 12
Orkney / 0 / 0 / 14,719 / 0 / 0
Shetland / 0 / 0 / 15,826 / 0 / 0 / NHS Shetland utilises NHS Grampian facilities when accessing all forms of in patient psychiatric care. NHS Shetland uses its General Hospital as a place of safety in an emergency.
Tayside / 99 / 12 / 432,667 / 23 / 2.8 / Split 30/44/25. Murray Royal beds reduced from 44 to 30 on 1st May 2010. 44 beds in Dundee may be reduced to 40, but is on hold until decision re Test of Change around crisis teams is made as part of Steps to better Healthcare.
Western Isles / 4 / 0[9] / 19,650 / 20 / 0 / Psychiatric Intensive care beds accessed from Highland
SCOTLAND / 1191 / 141 / 5,121,467 / 23 / 2.8
3. What constitutes standard working hours and out of hours in each Board?
Ayrshire & Arran / Crisis Resolution team operates 24 hrs a day, 7 days a week
Borders / Standard working hours are 9am to 9.15pm, Monday to Sunday
Dumfries & Galloway / Dumfries Town and Nithsdale: 9am to 9pm Monday to Friday; 11am to 6pm Saturday and Sunday; other times classed as out of hours
Other Areas: 8.30am to 5pm Monday to Friday (except Wigtownshire where work until 6.30pm). Other times classified as out of hours.
Fife / 9am to 5pm Monday to Friday, other times classed as out of hours. West Fife outreach team (for known patients with severe and enduring mental illness) works extended hours, 9am to 9pm Monday to Friday and 9am to 5pm at weekends.
Forth Valley / Blank Return
Grampian / 9am to 5pm Monday to Friday, other times classed as out of hours
Greater Glasgow & Clyde
Greater Glasgow / CMHT: 9am to 6pm Monday to Friday, other times classed as out of hours.
Day Crisis: 9am to 8pm Monday to Friday. 9am to 5pm Saturday to Sunday, other times classed as out of hours.
Night Crisis: 7.30pm to 9.30am Monday to Friday. 4.30pm to 9.30am Saturday and Sunday.
Clyde / 9am to 10pm Monday to Friday. 10am to 6pm Saturday to Sunday. Other times classed as out of hours
Highland / 9am to 5pm
Lanarkshire / CMHT: 8.30am to 6.30pm Monday to Friday. Saturday, Sunday and Public Holidays 8.30am to 4.30pm Crisis Assessment Service 24/7 supporting A&E Departments and GP Out of Hours service.
Lothian
East Lothian / 8am to 12 midnight, 7 days per week, 365 days per year. (12 midnight to 8am is covered by MHAS/IHTT in Edinburgh)
Edinburgh / Monday to Friday, 9am to 5pm, other times classed as out of hours, inc. public holidays. Edinburgh’s IHTT/MHAS service provides cover from midnight until 8am for both East and Midlothian IHTTs
Midlothian / In Hours: 9am to 5pm Monday to Friday
Out of Hours: 8am to 12 midnight 365 days year
Out of hours: 12 midnight to 8am provided by Edinburgh IHTT’s
West Lothian / 7.30am to 8.30pm working hours, other times classed as out of hours.
Shetland / 9am to 5pm Monday to Friday, other times classed as out of hours
Tayside / Blank Return
Western Isles / Blank Return
4. How do you provide home based face to face acute mental health assessment within four hours of referral? (Please see Section 3 for local definitions of in hours and out of hours)
NHS Board / In hours / Out of hoursAyrshire & Arran / CMHT, CRHTT / CRHTT
Borders / CRHTT / In-patient Charge Nurse
Dumfries & Galloway / CMHT (Wigtown & Stewartry), CRHT (Dumfries and Nithsdale) / Medic 9pm – 9am, CRHTT (Dumfries and Nithsdale until 9pm weekdays and 11am to 6pm weekends)
Fife / No service / No service
Forth Valley / CRHTT (only if referrer thinks admission may be required), junior doctor ‘on call’ back up / CRHTT (until 9 p.m. mon-fri
10-6 at weekends), Junior doctor ‘on call’
Grampian[10] / CMHT, medics, liaison, URT, enhanced access arrangements / medics, enhanced access arrangements, liaison
Greater Glasgow & Clyde
Greater Glasgow / CMHT, CRHTT, medics / CRHTT
Clyde / CMHT, CRHTT / CRHTT
Highland / CMHT, medics (Argyll & Bute only) / Medics - telephone advice (Argyll & Bute only)
Lanarkshire / CMHT / CMHT weekend & Public Holidays Crisis Assessment Service
Lothian
East Lothian / CRHTT / CRHTT
Edinburgh / CRHTT, medics / CRHTT, medics
Midlothian / CRHTT / CRHTT
West Lothian / CRHTT / Medics
Shetland / No service / No service
Tayside / CMHT / No service
Western Isles / CMHT, medics / CMHT, medics (5pm-9pm)
5. How is gate keeping to the acute mental health admission wards managed?
(Please see Section 3. for local definitions of in-hours and out of hours)
NHS Board / In hours / Out of hoursAyrshire & Arran / CMHT, CRHTT / CRHTT
Borders / CRHTT / In-patient Charge Nurse
Dumfries & Galloway / CMHT, medics / CRHTT
Fife / Medics, Nurse led assessment team see al new referrals in first instance / Medics, Nurse led assessment team see al new referrals in first instance
Forth Valley / CRHTT / CRHTT (until 9 p.m. mon-fri
10-6 at weekends)
Grampian / CMHT, medics, Nurse Practitioner Service (Moray), liaison, URT, enhanced access arrangements / Medics, Nurse Practitioner Service (Moray), Crisis CPN Service, enhanced access arrangements, liaison
Greater Glasgow & Clyde
Greater Glasgow / CMHT, CRHTT / CRHTT
Clyde / CRHTT, CMHT / No service
Highland / CMHT, medics (both Argyll & Bute), MHAT (excluding Argyll & Bute) / No service (Argyll & Bute), Nurse triage (excluding Argyll & Bute)
Lanarkshire / CMHT / Crisis Assessment Service
Lothian
East Lothian / CRHTT / CRHTT
Edinburgh / CRHTT / CRHTT
Midlothian / CRHTT, medics / CRHTT
West Lothian / CRHTT / CMHT
Shetland / CMHT, medics (in consultation with Aberdeen) / medics (in consultation with Aberdeen)
Tayside / CMHT (Angus only at present)
Western Isles / Medics / Medics (5pm-9pm)
Notes on Grampian
The urgent referral team (URT) operates 09:00 to 17:00 Mon to Fri and is designed to support immediate access to specialist assessment and intervention, until the service user can return to either CMHT or Primary Care responsibility. The URT will see people from Aberdeen and surrounding area only (not whole of Aberdeenshire). / Enhanced Access is an arrangement for CMHT members to offer known service users a fast track to assessment, which bypasses NHS24 and Primary Care OOH systems. The service user contacts their catchment ward and will be offered assessment by the on call doctor. / Liaison Service operates 9am to 5pm Mon to Sun and provides a service to all non psychiatric hospitals. The Nurse Practitioner Service (Moray) operates 24/7 on a 12 hr shift system and provides 80% of first line emergency care response supported by a junior doctor in training who covers the remaining 20%. All team members are non medical prescribers and have admitting rights to the acute inpatient facility6. How do you provide brief crisis resolution interventions?