9. Social systems intervention and crisis resolution: a ” how to do it guide” based on work of Paul Polak

One of the key elements  of intensive home treatment is social systems intervention. This is necessary because many crises that lead to admission ( called the “referral crisis” in these papers) are triggered by life events and changes in the various social systems of which the patient is a part. One of the negative aspects of hospital admission is that these social system factors are not recognized and dealt with sufficiently; the ascendance of biological psychiatry has not helped. It was estimated that the average acute psychiatric admission addressed only one-third ( largely related to the individual) of the pertinent issues creating the need for hospitalization. Two-thirds ( largely related to social circumstances) remain to cause future difficulties on discharge. This can result in what John Hoult calls ” the perseveration” of mental health systems – in which patients are repeatedly admitted without the social factors behind these crises ever being dealt with adequately. Hoult–one of the world’s leading experts on intensive home treatment- and the person probably most responsibe for its wide spread adoption by the NHS in England was very much influenced by the work of Paul Polak on social systems ( done in the 1970’s) . These two excellent papers by a British CRHT psychiatrist and Paul Polak were specifically written as a practical guide for training staff on intensive home treatment teams. The cases are real patients. Note the high level of acuity of these patients that the teams are able to deal with; and note the absence of medication usage in some of the examples.  social systems intervention and crisis resolution pt 2 Bridgett and Polak    social systems intervention and crisis resolution part 1 Bridgett and Polak