Community mental health teams, crisis resolution teams and assertive outreach teams....what are the differences?

Professor Elizabeth Kuipers: Perhaps I’ll start with community mental health teams which are your secondary provision really. After you’ve been referred to your GP, he or she might then pass you on to the next layer of care, which is quite often an adult community mental health team, which – they vary across the country – but usually they have quite a broad remit. They will see people from the kind of medium, severe end of problems who need a range of help and services and support to the quite severe end of people who need really quite a lot of help and support, and their job is usually to organise some sort of care package, which includes treatment and support and help with benefits, and they’ve usually got quite big caseloads, perhaps 25, 30 plus caseloads, and so the intensity of the help they give tends to be... people either come into them or they are home visited once a week, once a fortnight – that kind of level.

Crisis resolution teams are sort of what they say they are, they’re much more concerned with people in emergency situations, people having a crisis. What do you need at that minute that will help to resolve the kind of upsurge in problems that has caused you to feel much, much worse, to become suicidal or to be more dangerous to other people?And so they are very focused on coming in perhaps 2 or 3 times a day. They can be called crisis resolution or home treatment teams. In some areas, a home treatment team is seen as an equivalent to a hospital admission, but you just stay at home, but are visited really quite a lot, and offered treatments in your home setting, and that will be to try and resolve that crisis without you moving out of the house.

It varies where you are. The thing about crisis resolution teams is that they are particularly effective, they actually can help keep people out of hospital, and a lot of people don’t particularly like to go to hospital, so they can actually help keep you at home even if you are having... if your symptoms... if you are feeling much worse and so people find that rather preferable. So quite a lot of areas will have those, they won’t always be called that  – they are called all sorts of things – they might be called a home treatment team, a crisis resolution team and have different acronym.

The assertive outreach team, however, that’s an idea that came much more from American research, perhaps nearly 20 years ago now, and in America they don’t do home visiting, they don’t have that tradition of home visiting in the way that we do here.

It’s aimed at people who really didn’t want any services sometimes and have proved themselves not only not particularly willing to come into a team base, or to a clinic, they perhaps really don’t want any mental health service. So you’re having to work much harder in an assertive outreach team to go and find the person and make contact with them and try and set up some sort of supportive service that they want at that stage to offer them any treatments at all. They’ll often deal with people who are perhaps homeless, or really rather hard to reach, sort of out of contact with other services. So they are really looking at a group of people who otherwise would almost get no services, and so they have often got much smaller caseloads and again will be trying to visit people much more assertively – going out, asking relatives where someone is and doing a rather different job, so not just looking at crises, trying to do a longer term job.