7. Are crisis resolution and home treatment services seeing the patients they are supposed to see?

This is the third in the series of reports from England’s National Audit Office, and it tackles an issue that is of vital importance to the functioning of intensive home treatment teams. For these teams to reduce admissions and to be cost effective they need to target the ” sweet spot” or the ” Goldilocks” range of acuity. If one takes the range of acuity of patients  in a mental health crisis who are destined for hospitalization, intensive home treatment can handle the bottom 40-45% of that range. Acuity, in this sense is a combination of risk, symptom severity, functional impairment, degree of cooperation and social support. Accepting patients below this is a waste of resources;  dealing with  patients beyond this range means that home treatment is less likely to be successful . The most successful teams net as many of  the patients in this range of acuity as they can , hence the importance given to gatekeeping beds in England. This project examines the gatekeeping role and other related issues, by identifying 25 sites across England that represent a cross section of location, structure and current practice. They audited the 20 most recent hospital admissions at each site , interviewing the CRHT manager and Ward manager separately about each admission. They also audited the 20 most recent referrals to the CRHT team, interviewing the manager about the source, appropriateness and outcomes of each referral.

NAO are CRHT seeing patients they are supposed to be seeing