16. Are intensive home treatment services associated with an increase in involuntary admissions and an increased suicide rate?

A controlled comparison of two crisis resolution and home treatment teams  The lead author of this article is an important figure in British psychiatry: editor of the British Journal of Psychiatry and Professor of Community Psychiatry at Imperial College London. However, there appear to be a number of problems with this paper. On line letters to The Psychiatrist from consultant psychiatrists in response to this article make the following points. The article is in fact, not a comparison of two crisis resolution and home treatment teams (CRHT’s); the second CRHT was  not in existence in the two time periods when the data was collected. None of the suicides in the catchment area where there is a CRHT happened when clients were under the care of the CRHT; it is therefore difficult to link the increase in suicide to the introduction of the CRHT. The significance of the increase in compulsory admissions under ” section 2 or 3″, is not clear to me. There is said to be a similar finding in the Keown paper ( post  # 6 in the research section of this website); however, these patients -before CRHT -would have ” been in hospital and detained under section 5(2) or 5(4)” which I presume is also a form of compulsory detention. It is now well known that intensive home treatment works in about 40% of cases–and these would be at the lowest end of the acuity scale; ie patients who would have sufficient insight and a cooperative attitude -and therefore not in need of compulsory admission or detention. The paper does raise important points and results from further research on these matters will be added to the website.

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