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Mental health crisis teams becoming 'default' for treating suicidal patients

There is an over-reliance on crisis teams to prevent suicide, which is increasing the risk to patients, a new study has found.

The report from the University of Manchester’s National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH) found that over 200 patients looked after by these teams a year die by suicide - three times as many as those in in-patient facilities.

It also found that 43%of patients under crisis resolution/home treatment (CRHT) who died by suicide lived alone, while a third had been discharged from hospital in the two weeks previously.

The report suggests that CRHT ‘may not have been a suitable setting for their care and raise concerns that CRHT has become the default option for acute mental health care because of pressure on other services, particularly beds’.

The report recommends that ‘Crisis teams are unlikely to be a safe setting for patients at high risk or who live alone. The use of crisis teams or CRHT should be kept under regular review.’

Professor Louis Appleby, Director of NCISH, said: ‘This year’s report reflects the increasing reliance on crisis teams in response to the strains felt by acute mental health services. Our findings suggest that we are accepting too much risk in the home treatment these teams offer, and that the crisis team is now the priority for suicide prevention in mental health.’

The researchers also found that risk of suicide is highest two weeks after discharge from hospital and recommends that ‘services should ensure that patients are followed up within 2-3 days of hospital discharge and that care plans are in place.’

The number of patients dying by suicide in in-patient facilities fell in England by 60% between 2004 and 2014, although there were 76 in 2014.

Readers' comments (6)

  • Answering a question we all knew the answer to, the solution is better funded services not the inadequate one we have now.Do the government care? I think not to them another suicide is another person off benefits.

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  • I spoke with a fellow Consultant Psychiatrist yesterday who told me that on Monday there were no psychiatric beds available in the WHOLE country.
    Why isn't this front page news???????
    If the same had happened for hospital beds it would have been.

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  • Trusts have implemented a 3 3 3 strategy some of course may offer more bed days .CPFT offers 3 days 3 weeks 3 months admissions.
    This is a tragic gamble on the lives of the vulnerable.Can we honstly believe a very depressed ,unwell patient can be cared for and treated safley within 3 days .Antidepressant therapy takes weeks to establish and as the patient becomes less retarded the risk of acting on suicidal ideas is higher.The assumption that a depressed retarded patient will engage in full disclosure of risk intent is sadly an assumption.Those of us who work in Mental Health Services are shocked appaled and afraid to speak out.People are visited once a day by Crisis Teams they do the best they can with poor resources.
    CBT is great ,psychological wellbeing services greatbut resources are targeted into Psychological Wellbeing as payemebts are by results.12 to 14 sessions offer throughout and easier to implement outcome measures .Forgotten are the acutely ,ill ,the people with chronic mental illness and generally a dissenting voice is sadly absent in these poorly served patient group.
    Tragedy and loss of life is sadly more evident.GP surgeries ,Casualty are blocked with frequent persistent attenders.Mental Health Services are meanwile reinventing Vanguard Teams ,Neighbourhood Teams ,On Call services ,Rapid Response Teams all to exclude bed days .Great concept fiscally but for many patients are left with clinically suboptimal services .Carers many of whom are young ,are working are elderly are left to shoulder an unacceptable burden.
    Mental Health Services continue to parade these innovations which may serve many but fail many too.In short butting the problem elsewhere is a tragic result with a domino.effect on other services which is wholly unacceptable .

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  • There are just too many changes going on in Trusts, moving around resources and spreading services too thin. New services set up and rolled out before they are full staffed, my concern is that there will be loss of life before too long. The staff in these teams, especially crisis teams are trying their hardest but I have always felt that home treatment, whilst can be a better environment for service users adds to the level of risk for many.
    There has always been a paucity of funding for mental health services and after a career of 34 years I have witnessed the dismantling of safe and effective services for some of the most vulnerable of people.

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  • As an out of hours GP I feel sorry for these crisis team guys at night. Thresholds are reduced so that most patients end up getting referred to them and I do not believe they are qualified to be rejecting most of the referrals.

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  • In my area, if a patient is in crisis they are told to go to A&E ... the last place they want to be and who in such a disturbed state wants to travel to a hospital some distance away when they cannot mange the situation they are in ... or know how to survive the next five minutes of their life!
    Very sad indeed, it is time mental health care was given a real boost in funds to ensure the care folk need is available at all times.
    In my area, there is one crisis team nurse on after 5 p.m. and at weekends .... disgusting!

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