6 General adult psychiatry6.4 Emergency psychiatry
6.4.2 Crisis intervention and home treatment
3 min read
Written by Resident Doctor Committee · Published
Crisis theory
Caplan described a crisis as a precipitating event that overwhelms a person's usual coping.
The instability that follows ends in new coping, a return to old patterns, or deterioration.
The classic four to six weeks is a theoretical description, not a deadline for recovery or care.
Brief, intensive help works best while the person is still actively seeking a way through.
What the event means to the person matters as much as the event: losing a job may also threaten housing or family.
Stages of crisis intervention
Revisit these steps at each contact.
Establish immediate safety and a working relationship.
Clarify what happened and why usual coping failed.
Identify strengths, past helpful strategies and current support.
Agree a few achievable goals, starting with immediate needs.
Act together and adjust as circumstances change.
Review what helped and arrange continuing care.
Crisis resolution and home treatment teams
Crisis resolution and home treatment (CRHT) teams give rapid, intensive, short-term care to people who would otherwise be admitted, and they support earlier discharge.
They treat in the least restrictive setting that is safe, often the person's own home.
Self-harm, substance use, dual diagnosis, learning disability or personality disorder do not on their own exclude anyone.
Access is all-age and round the clock, with referrals from patients, carers, primary care, emergency services, liaison teams or wards, often through a single point of access.
Role | Contribution |
|---|---|
Team lead | Staffing, operational decisions, escalation |
Mental health nurses | Frequent assessment, medication support, monitoring |
Social worker | Social needs, safeguarding, approved mental health professional assessment if qualified |
Support workers, occupational therapy | Practical help, daily functioning, structured activity |
Pharmacist, non-medical prescriber | Medication review, prescribing within competence |
Consultant psychiatrist | Diagnosis, treatment, complex risk and admission decisions |
Assessment and formulation
Assess mental and physical state, risk to self and others, vulnerability, capacity, substance use and safeguarding, including dependent children in the household.
Whether home care is feasible is separate from how ill the person is: a severely ill person may have enough support, while a milder one may live in an unsafe household.
Formulate with the patient, involve carers, and reassess as circumstances change.
The home treatment plan
Contact may be daily or more often at first, and teams should be able to visit twice a day; contact tapers as need falls, not to a fixed timetable.
The plan combines prescribing and physical monitoring with brief psychological work, problem solving and practical help with housing or benefits.
Teams support carers without assuming they can supervise continuously.
Every plan states an out-of-hours contact, actions on deterioration, what happens after a missed visit, and thresholds for reassessment or admission.
Benefits and limits
Home treatment gives intensive care between contacts but cannot reproduce continuous ward observation.
Trials suggest greater satisfaction and less family burden, but effects on readmission, symptoms and quality of life are uncertain.
Trials tended to exclude people unsafe at home or with substantial substance problems, so their results generalise with care.
Contraindication | Reason or response |
|---|---|
Immediate, serious danger to self or others | Continuous observation is impossible between visits |
Medical instability needing inpatient care | Monitoring and emergency treatment need hospital facilities |
Unsafe or no home, or isolation | Find practical solutions or another safe setting, not automatic refusal |
Cannot engage with the contact required | The plan cannot run safely |
Compulsory treatment that cannot lawfully happen at home | Assess for admission under the applicable law |
The acute care pathway
Gatekeeping means the CRHT team asks whether admission can safely be avoided; it should speed decisions, not delay emergency care.
Before early discharge, the team confirms that remaining needs can be met at home and that responsibility has transferred explicitly.
When CRHT care ends, the team hands over to the community team, informs the general practitioner and tells the patient who now provides care.
Escalation to admission responds to changing need and does not mean home treatment failed.
Reviewing crisis care
Judge crisis care by safety incidents, missed deterioration, readmission, patient and carer experience and continuity, since avoiding admission alone does not prove good care.
Check whether access or outcomes differ by housing, deprivation, ethnicity or age.