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Risk to staff in a crisis resolution team

Published online by Cambridge University Press:  02 January 2018

Nicky Goater
Affiliation:
Hammersmith and Fulham Crisis Resolution Team, West London Mental Health Trust, London, email: nicky.goater@wlmht.nhs.uk
Eleanor Rowland
Affiliation:
Imperial College London
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Abstract

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Columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2011

Crisis resolution and home treatment (CRHT) teams are now well established. There is significant evidence that they reduce bed use, are cost-effective and patients prefer them to admission. Reference Joy, Adams and Rice1

A CRHT team is dependent on the expertise and imagination of its staff to help understand and resolve a crisis. However, the risk to staff of working intensively with people who would otherwise be in hospital is not well documented. The evaluations of CRHTs have not considered the staff or the impact of frequent visits from different staff on people at high risk of acting violently. Reference Joy, Adams and Rice1,2 Risk management is a continuous task in a CRHT team. There is some concern that risks to patients may increase with the introduction of a CRHT team, although this is far from established. Reference Tyrer, Gordon, Nourmand, Lawrence, Curran and Southgate3

We conducted an anonymous survey of the Hammersmith and Fulham Crisis Resolution Team in London. We asked whether they had felt physically vulnerable during community visits and encouraged them to describe any relevant incidents. Respondents included doctors, nurses, occupational therapists, support workers and bank staff. Duration of work with the team ranged from a few weeks to over 6 years. All had at least two jobs in psychiatric services before joining the crisis team and most had several years of previous mental health experience, in CRHT teams and on wards.

More than half of the respondents (13 of 20) had felt physically vulnerable while on a home visit. Their experiences ranged from feeling concerned about personal safety when with patients who were aroused or were experiencing psychosis, to being chased out of an abode when violence was threatened. No one had been physically harmed. The remaining seven people had all worked with the team for less than a year. Everyone working in the team for longer than a year reported feeling physically vulnerable during at least one visit.

We found that exposure to risk from patients was ubiquitous among all established CRHT staff in our study. It is particularly important to document risk to staff to avoid minimisation. As health services reduce costs, crisis teams will be asked to increase the threshold and reduce the duration of in-patient care further. Crisis resolution home treatment teams receive several hundred referrals a year. The short response times, high expectations and anxiety of referrers, as well as pressure to act and prevent admission all potentially reduce thinking about risk.

References

1 Joy, CB, Adams, CE, Rice, K. Crisis intervention for people with severe mental illnesses. Cochr Dat Syst Rev 2007; issue 4. CD001087.Google Scholar
2 National Audit Office. Helping People through Mental Health Crisis: The Role of Crisis Resolution and Home Treatment Services. TSO (The Stationery Office), 2007.Google Scholar
3 Tyrer, P, Gordon, F, Nourmand, S, Lawrence, M, Curran, C, Southgate, D, et al. Controlled comparison of two crisis resolution and home treatment teams. Psychiatrist 2010; 34: 50–4.Google Scholar
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