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We thank Dr Pelosi for his interest in our study on the impact of a CRHTT for older people (Psychiatric Bulletin, November 2008, 32, 268–270). However, there is no misinterpretation of data, as suggested by Dr Pelosi. We tested chi-squared differences in the proportion of total number of admissions over number of crisis events and not total number of admissions per se.

We agree that it is possible, but far from definite, that some of the patients seen by the crisis team may have been sub-threshold for admission and we clearly stated this in our discussion: ‘It may be argued that individuals who received home treatment only were below the “admission threshold” and the referrals to the CRHTT had been generated by the availability of this new service.’ However, by treating people early, one could argue that the CRHTT play an important role in preventing possible future admissions. As Dr Pelosi mentioned in his letter, crisis team support might ‘come in handy’ at the time of deterioration of illness, social or psychological crisis.

The views of patients and carers are also important when developing new services. Our study showed that carers showed a trend towards greater satisfaction with the CRHTT compared with hospital admission. This is in keeping with a Cochrane review (Joy et al, 2006) which has shown that home treatment is a more satisfactory form of care for adults of working age with severe mental illness and their families. Cooper et al (2007) also make the point that home treatment may be important in maintaining the independence of the older person.

As responsible clinicians who take pride in our work we should always strive to offer the best evidence-based care and review our practice accordingly. We have suggested that a gold standard double-blind randomised control trial needs to be done in older patients, including an economic evaluation. Nevertheless, our pragmatic study design shows that such a service may be helpful.