Crisis teams

Sir: In 1997 we worked in two crisis assessment and treatment teams (CATTs) in the western suburbs of Melbourne, Australia. We found the work stimulating and are grateful for the opportunity to have worked in a highly developed community psychiatry service. It is therefore easy for us to agree with many of the points made by Carroll et al in their description of the Northern Crisis Assessment and Treatment Team (Psychiatric Bulletin, November 2001, 25, 439-441). While the article stimulated a degree of nostalgia for our time in Australia it has also encouraged us to make a few comments based on our collective experience.

It is true that the most skilled clinicians staff CATTs. Undoubtedly, this is because the work is seen as more challenging, is more prestigious and provides better pay. However, not only can this denude the other teams within the area (case management team and in-patient team) of the most motivated clinicians, it also begets an elite team with a strong culture. The strong team culture does help ensure effective teamwork within the CATT, but we found that it can be exclusive and cause strained relations with members of other teams, damaging the effective working of the area mental health service as a whole (the wider team).

As gatekeepers the CATT clinicians see all patients prior to admission to assess suitability for home treatment. In practice this can be cumbersome. The situation can occur where an acutely unwell patient is assessed in turn by his/her case manager, a doctor in the case management team, a CATT clinician and possibly a CATT doctor. Then, if admission is required, he/she is assessed by the admitting doctor and nurse. Where the aim is to create a seamless service, we found that the inter team strife and procedural arrangements sometimes created seams.