[No Title]

Dr Mahadun & Sadiq are right on both counts. The title ‘A controlled comparison of the introduction of a crisis resolution and home treatment team’ should be the proper title of the article. The top two lines of data in Table 2 are also incorrect, and should read as shown here.

These data illustrate an effect of the crisis resolution team (CRT) overall in reducing bed days. We agree that the interpretation of the data cannot provide a causal pathway between the experience of seeing a CRT and then having a higher risk of being admitted compulsorily, as we were not following the experience of individual patients through the care system. However, it is a reasonable hypothesis to posit that the increase in compulsory admissions following the introduction of the CRT was a direct consequence of the change in service provision across the trust. The same conclusion might be made about the change in suicide rates, but of course we stress that this was not a significant difference. The conclusion we are putting forward, and this was not one we were expecting when we started the study, is that the service configuration that follows the introduction of a CRT is one that tends to limit admissions and may possibly be directly associated with more compulsory admissions and more suicides. This is an important hypothesis to test, but we agree it cannot be confirmed from our data.

Table Number of bed days occupied in two 9-month study periods before and after the introduction of a crisis resolution (CRT) team

Patient status	Team	CRT service (number per 1000 population	Control service (number per 1000 population)
Total	Pre-CRT	6133 (74.2)	15 525 (72.4)
	Post-CRT	5542 (67.1)	15 352 (71.6)

Drs Ogunremi & Talat argue from the position of enthusiasts for the CRT policy and we do not disagree with their opinion that it is a ‘viable and acceptable approach to treating people with severe mental illness’. But all policies have to be tested and evaluated, and clearly all your correspondents would agree that if a CRT, for whatever reasons, makes decisions that lead to greater compulsion and more suicides in either the shorter or longer term, their implementation should be questioned. In this context it could also be argued that a reduction in bed usage is probably a poor outcome measure; quality of life, patient satisfaction and clinical improvement over a reasonable period (e.g. probably about a year to cover all aspects of an illness episode) are much preferred.