18. Crisis Resolution and Home Treatment policy in UK per se has made no difference to rate of in-patient admissions

Such was the conclusion of a paper published in the British Journal of Psychiatry  by two health economists :   Jacobs R & Barrenho E. Impact of crisis resolution and home treatment teams on psychiatric admissions in England. British Journal of Psychiatry 2011; 199 : 71-76

This is not new research; it is a reworking of data from the 2006 research paper by Glover G, Arts B, Babu KS ( post # 4 in news category on this website ), which had concluded that there was an association between CRHT availability and declining trends in psychiatric hospital admissions in England . The authors state that there are two main flaws in the Glover et al paper : 1. The differences in the admission rates of primary care trusts ( PCT) with and without CRHT services may be long standing-and precede CRHT development, and 2. Some unobservable characteristics might encourage more ” enthusiastic” or entrepreneurial ” PCT’s  to take up CRHT .Thus a control group is needed to evaluate the introduction of this policy  and the method needs to be able to remove any bias arising from  the possibility that PCT’s that take  up CRHT have characteristics that make them  more effective and enthusiastic about reducing admissions . The statistical analysis used was  the difference in difference technique. This method assumes that any pre existing  differences between the PCT’s who did not introduce CRHT’s  (  here, serving as the control group )and those that did, ( serving as the experimental group) would be the same over time and thus the influence of these differences on the admission rates can be removed.

They compared PCT’s with CRHT’s to PCT’s without CRHT’ using the difference in difference technique and their analysis ” suggests that the CRHT policy per se has not made a significant difference in admissions”

I do not have sufficient knowledge of statistical analysis to comment on these results. However, I will note comments made by the authors about  previous studies of CRHT that give off a slight whiff of bias.  Referring to the two studies  ( posts # 1, 3 in research section of this website )by Johnson et al of CRHT’s in London UK  that demonstrated a significant reduction in admissions attributable to CRHT  and one of which is the highest quality RCT of all the CRHT studies, they make the statement : ” …. these studies may suffer from a lack of generalisability to the rest of the country”, but provide no reason for this opinion. On the other hand, they make the statement that the results of their study concur with those of the  study by Tyrer et al ( post # 16 on this website) – a flawed study that showed no overall difference in admissions following the introduction of CRHT -presumably not lacking in generalisabilty in their opinion.

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