Why mental health trusts should be wary of disbanding specialist crisis resolution teams

Study identifies crisis and home treatment teams as ‘key measure’ to improve patient safety

Financial pressures mean many mental health trusts are restructuring community services, or at least considering it. Around one in four services had merged their specialist crisis resolution and assertive outreach teams with generic community mental health teams by 2011, according to research out today.

Yet the study, by the national confidential inquiry into suicide and homicide based at the University of Manchester, also gives a few reasons why the disbanding of these specialist teams in favour of beefed up generic community support might be a bad idea.

The research mapped suicide rates over a 14-year period against 17 different changes that services said they had, or hadn’t, made during that time. Of the 17 changes tested, the one that was associated with the biggest gap between suicide rates at implementing and non-implementing trusts was whether the services had specialist 24-hour crisis resolution teams or not.

The study also found that trusts that had merged their specialist crisis, assertive outreach and dual diagnosis services into generic teams had suicide rates 13% higher than services that had maintained these teams.

While this finding was statistically not significant, merging specialist services was the only change of the 16 that, when implemented by trusts, led to higher suicide rates compared to non-implementers. All other changes led to reduced suicide rates.

Nav Kapur, professor of psychiatry at the University of Manchester and one of the study authors, told me that the findings built on a Lancet study by the same research team last year. The Lancet paper found that suicide rates dropped 18% after trusts had introduced 24-hour crisis teams (although I should point out that this finding also attracted some questions).

Professor Kapur told me:

“The finding on merging services in today’s report wasn’t statistically significant so we need to be cautious with that. But in the wider context of the other evidence we’ve seen on crisis resolution teams it’s something we feel needs looking at as a lot of clinical services tell us specialist functions are being depleted.

“The crisis services referred to in our paper are 24-hour fully functioning teams. We’re well aware that some others will offer partial provision but we weren’t able to explore the difference between fully functioning and partial crisis teams.”

The full report is well worth a read. It has plenty of other examples of how trusts have made changes to ward environments and policies that have led to falling suicide rates.

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