What about the Crisis Centre's contribution?

Barker et al ¹ argue that the introduction of a ‘high fidelity’ model of a crisis resolution and home treatment team (CRHTT) in Edinburgh is responsible for a marked reduction in acute psychiatric admissions. The authors found a decrease of 24% in acute psychiatric admissions in the year after the introduction of two intensive home treatment teams in November 2008. They claim, ‘there were no changes to mental health services’ in Edinburgh at that time other than the introduction of the CRHTT and a coinciding reduction in acute general adult in-patient beds.

However, Barker et al omitted to include other changes that may have influenced acute psychiatric admissions. The Edinburgh Crisis Centre operated as an interim service between 2006 and 2009. ² In March 2009 the service became fully operational, with overnight facilities and four beds. The Crisis Centre is a unique user-led service in Scotland jointly funded by NHS Lothian and City of Edinburgh Council. The Centre is based on a crisis house model with a voluntary sector provider and provides a round-the-clock, non-medical crisis service to residents of the City of Edinburgh. The staff team has a manager, assistant manager and 5.5 full-time equivalent project workers, some with social worker and nursing qualifications. The team also has 5.5 full-time equivalent crisis workers. The service only accepts self-referrals via its free-phone number.

Since opening in 2006, the Crisis service has systematically collected service usage data; between November 2008 and November 2009, 1241 service users self-referred. The introduction of four beds to the Crisis Centre in March 2009 gave users a further community-based option to hospital admission; 6% of those who self-referred used the beds for periods varying from one night up to seven nights. Some of these individuals also received treatment from the intensive home treatment teams in Edinburgh while using the Crisis Centre overnight. I suggest that this unique model of mental health service provision in Edinburgh of a Crisis Centrewith a small number of beds as well as the introduction of CRHTT has supported the decrease in admissions to hospital.