HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS British Journal of Psychiatry Advances in Psychiatric Treatment All RCPsych Journals		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Sandor, A. Articles by Sashidharan, S. P. Search for Related Content PubMed Articles by Sandor, A. Articles by Sashidharan, S. P.

Home treatment teams

Royal Free and University College Medical School, Department of Psychiatry and Behavioural Sciences, Holborn Union Building, Archway Campus, Whittington Hospital, Highgate Hill, London N19 5NF

Sarah Orme, Research Fellow

Psychology Division, University of Wolverhampton

Sir: The survey by Owen et al (2000) exemplifies the difficulties involved in researching home treatment teams, because of the multiplicity of definitions and wide nomenclature for services serving similar functions. Such diversity cannot be assessed adequately using a short survey and broad definition of the subject matter.

The definition of home treatment in the paper is much briefer than the broad definition in the questionnaire and the questionnaire refers to "access to community staff on a 24 hour basis", whereas the paper reports on "availability on a 24-hour basis". Such inconsistencies may give rise to inaccurate representations of what was surveyed. Furthermore, the questionnaire is internally inconsistent in referring to home treatment services both as an alternative to hospital admission and as a supplement to hospital-based services, which does not help identify the kinds of service being examined.

A similar but much more extensive recent (1998) survey (Orme, 2000) of nationwide crisis services found a wider penetration of services. Of 152 selfdefined crisis services, 22 were identified as home treatment services offering an alternative to admission. Of these, eight offered a 24-hour service (seven of which were available only on an on-call basis out of office hours) and eight were staffed by nurses only.

Owen et al report high expectations for new developments in home treatment. However, during the period of data collection regarding crisis services, 10% ceased operating or were being considered for closure. Will home treatment services go the same way?

References

ORME, S. (2000) Intensive home treatment services. In Acute Care in the Community (ed. N. Brimblecombe). London: Whurr Publishers.

OWEN, A. J., SASHIDHARAN, S. P. & EDWARDS, L. J. (2000) Availability and acceptability of home treatment for acute psychiatric disorders. A national survey of mental health trusts and health authority purchasers. Psychiatric Bulletin, 24, 169-171.[Abstract/Free Full Text]

Authors' reply

Northern Birmingham Mental Health NHS Trust, Medical Directorate, 71 Fentham Road, Erdington, Birmingham B23 6AL

We welcome the letter from Sandor and Orme (2000, this issue) and await with interest the results of the study to which they refer. Without access to further information concerning this work it is difficult to comment upon their finding that some crisis services have ceased operating. Our study revealed an enthusiastic support for crisis services (Owen et al, 2000), and our own experience working in inner-city Birmingham has demonstrated that home treatment is an effective intervention, which is more acceptable to clients than hospital admission and is sustainable over many years.

The suggestion that it is inconsistent to refer to home treatment as both an alternative and an adjunct to hospital admission betrays a common misconception about crisis services. Many people who would otherwise have been admitted to hospital are able to be successfully supported during crisis by home treatment, yet hospital admission remains an essential part of acute psychiatric services. Clients of home treatment services not infrequently require admission to hospital, although the length of stay is often short, with early discharge and community support. It is also important to point out that home treatment makes use of other crisis residential alternatives to hospital, such as crisis houses or family sponsorship schemes, with good effect.

There remains a wider issue concerning the reluctance of psychiatrists to embrace developments in community mental health services despite the evidence of its efficacy and general acceptability (Smyth & Hoult, 2000). We strongly recommend that the debate in this area should focus on the opportunities that are becoming available in developing innovative crisis services in the context of the National Service Framework. Our failure to do so would once again result in psychiatry being left behind in the development and implementation of modern systems of psychiatric care.

References

OWEN, A. L., SASHIDHARAN, S. P. & EDWARDS, L. I. (2000) Availability and acceptability of home treatment for acute psychiatric disorders. A national survey of mental health trusts and health authority purchasers. Psychiatric Bulletin, 24, 169-171.

SANDOR, A. & ORME, S. (2000) Home treatment teams (letter). Psychiatric Bulletin, 24, 394.[Free Full Text]

SMYTH, M. G. & HOULT, J. (2000) The home treatment enigma. British Medical Journal, 320, 305-309.[Free Full Text]

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Sandor, A. Articles by Sashidharan, S. P. Search for Related Content PubMed Articles by Sandor, A. Articles by Sashidharan, S. P.