Mental health crisis care systems: emerging models and critical components

Background: Mental health inpatient admissions are costly and often experienced negatively by service users. Community crisis service models have proliferated in recent years but for many models, evidence of effectiveness has yet to be established. Best configurations and critical ingredients of community crisis care systems are unclear.



Methods: We conducted an online survey of managers of community Crisis Resolution Teams to map mental health crisis care systems in England. We then used our survey data and publicly available NHS data about local area psychiatric hospital admission rates to explore associations between local system characteristics and service models, and hospital admission and detention rates.



Results: We received survey responses from 184/200 (92%) of managers. The composition of local mental health crisis systems varied greatly across England and the prevalence of service models seemed unrelated to the strength of evidence regarding their effectiveness. No clear typology of catchment area crisis care systems emerged. Provision of a crisis telephone service and provision of a crisis café within the local crisis system were associated with lower admissions rates. Provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with higher admission rates.



Discussion: Implications of the heterogeneity of community crisis care systems in England will be discussed. Our findings generate hypotheses about potential critical components of crisis systems, and suggest priorities for research and policy.