Crisis team fidelity in Wessex

We conducted a small-scale survey to investigate the management and operational procedures of local crisis teams within the Wessex Deanery in a similar vein to the 2006 national survey. ¹ These findings were compared with the Department of Health's Guidance Statement. ²

A senior practitioner or team manager from local crisis teams completed a form on their respective case-load, staffing, available resources and the service they provide. We were particularly interested to see whether the teams had day-hospital facilities and whether they provided services outside the 16–65 year age group as outlined by the Department of Health. ³ We compared the results with the national survey data.

Six out of the nine teams responded. All provided a 24-hour service and gate-keep in-patient beds, significantly more than what the national survey showed (72% of teams gate-keep in-patient beds and 53% provided a 24-hour service).

Only 33% (two teams) provided a service for 16- to 65-year-olds, with the rest covering 18- to 65-year-olds. Outside this scope, half (three teams) provide services for individuals with intellectual disability and only 17% (one team) for older persons. Only one team had a day hospital.

There was a wide range of team staffing levels, including part-time staff, from 11.7 to 37.5, with patient episodes varying from 284 to 900. Given the government guidelines on staffing (15 per 150 000 population with 300 patient episodes), only half of teams had sufficient staffing (88% in the national survey).

There was a similar input from nurses in Wessex and nationally (100% v. 98%), higher input from support workers (100% v. 70%), approved mental health professionals (83% v. 49%), occupational therapists (50% v. 30%) and psychologists (50% v. 8%).

All teams had medical staff input. The proportion composition found was 8.6%, higher than the 5.2% reported by Middleton et al. ⁴ All teams had consultants and 83% (five teams) had dedicated consultants with other medical staff and half (three teams) had dedicated non-consultant staff.

To ensure crisis resolution and home treatment teams are successful as alternatives to hospital admission, it is vital to have sufficient staff and resources. Teams in Wessex had higher multidisciplinary team staff diversity than the national average, ¹ but only half of them had adequate staffing according to the Department of Health guidance.