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Dibben et al (2008) have carried out a useful evaluation of a newly established crisis resolution and home treatment service for older people. However, they have made a serious error in the interpretation of their results.

They have compared the 6-month periods before and after the local CRHTT extended its remit to include patients aged over 65 years. A crisis was defined as ‘an event where admission was being considered’. The main findings are as follows: ‘In the pre-CRHTT period there were 65 crisis events which resulted in 65 admissions. After the introduction of the CRHTT there were 102 crisis events of which only 70 required admissions. Of these, 66 crisis events led to direct hospital admission and 4 required admission after a brief period of home treatment.’ It is impossible to agree with the conclusion that ‘overall, the CRHTT reduced admissions by 31%’. There was, in fact, a slight increase in admissions and a substantial increase in proposed admissions after this service was made available.

Dibben et al briefly allude to the likely cause for this. Crisis resolution and home treatment teams act as extra gatekeepers to in-patient care after other mental health clinicians have made the decision that admission is required. I cannot imagine how any experienced clinician who knows their patients and the local service and who takes pride in their work could find such input from a separate team useful. However, there are times when it could be handy to arrange a bit of extra support for patients whose illness has deteriorated, and for distressed people who are experiencing a psychological or social crisis. In those circumstances, busy clinicians will simply lower their threshold for the stated intention to admit to hospital and pull in nurses from the crisis team knowing that they will assist the patient in the community for a couple of weeks. Of course, this is not a rational way to use health service resources but it is an inevitable result of the diversion of staff to sub-specialist teams with such narrow and largely pointless clinical duties.

The actual data obtained by Dibben et al will be useful in countering recent suggestions from crisis specialists that their services should be expanded to include older adults (Cooper et al, 2007).

Another letter commenting on this paper (Jha & Boskovic, 2008, this issue) demonstrates that there are psychiatrists who are thinking very clearly about how best to provide effective, efficient and comprehensive mental healthcare to older people. I urge policy makers to seek advice on service models from the authors, Drs Jha and Boskovic, and other experienced old age psychiatry clinicians. They must not repeat the mistakes that have been made with services for working-age adults and foist unnecessary crisis resolution teams on older people with mental disorders.