Mental health crisis teams ‘given too many high risk cases’

Too many mental health patients at ‘high risk’ of taking their own lives are being diverted to intensive community services that may not be suitable for them, experts have warned.

The report, by researchers at the National Confidential Inquiry on Suicide and Homicide, found crisis resolution home treatment teams have become the “default option” for acutely ill patients due to the pressures on other acute services, particularly inpatient beds.

More than 2,100 mental health beds were closed between April 2011 and November 2014.

The researchers found around 200 suicides a year involved patients under the care of crisis teams, three times as many in inpatient units.

Crisis teams are designed to offer intensive support to patients at home as an alternative to hospital admission. Teams that operate 24 hours appeared to add to the overall safety of a service, but the researchers warned that they were being “used for too many patients at high risk”.

More than four in 10 (44%) people who died by suicide while under the care of crisis teams lived alone, suggesting that home treatment “may not be suitable for people who lack other social supports”, the researchers found. A third died within a week of starting crisis team support, and 40% died within a fortnight of leaving hospital.

Professor Louis Appleby, director of the inquiry, said: “This year’s report reflects the increasing reliance on crisis teams in response to the strains felt by acute mental health services.

“Our findings suggest that we are accepting too much risk in the home treatment these teams offer, and that the crisis team is now the priority for suicide prevention in mental health.”

Findings from a government-funded study of crisis teams published last year revealed that most services fell short of recommended guidelines. When rated on a scale of one to five for performance against key standards, less than a quarter (24%) of teams scored 3 or more for their intensive support, a measure of how frequently they visited service users. Only 3% scored 3 or more on ‘preventing future crises’.

Research by Community Care into crisis team provision found that funding for the services dropped 8.3% between April 2010 and April 2015 when accounting for inflation. Referrals increased by an average of 18% over the same period.

Researchers at the national inquiry reviewed evidence on suicides covering the past 20 years, and found a changing pattern of risk factors for mental health patients, with higher rates of isolation, substance misuse and financial problems among those who died by suicide. They identified some improvements in suicide prevention, including ward safety measures.