Crisis resolution and home treatment teams and admissions

Jethwa et al (Psychiatric Bulletin, May 2007, 31, 170–172) discussed several reasons for the 37.5% reduction in monthly admission following the formation of the crisis resolution and home treatment service in Leeds. The question remains: which one of these factors has the greatest influence? There is little doubt that screening the patient first by competent crisis resolution staff and the availability of home treatment helps to avoid inappropriate admissions. However, the formation of the service was at the same time as the 35% reduction of 54 general adult beds from 155 to 101. It is well known that if there are fewer beds the threshold for admission goes up and only the more severely ill and those on sections are admitted.

Unfortunately Jethwa et al did not provide other data which might help to explain the lower admission rates. These include occupancy rates before and after formation of the service, if rates of patients admitted under the Mental Health Act 1983 had increased, if consultants had difficulty in finding a bed or had to put patients on a waiting list for admission, and if alternative in-patient facilities were used (e.g. other respite beds, hostels, private hospitals, etc.). Perhaps the more likely explanation for the 37.5% reduction in admission rates is that there were 35% fewer beds for admission and only the most severely ill were admitted.