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The increase in compulsory treatment following introduction of a crisis resolution service as observed by Forbes et al ¹ was to be entirely expected as other studies have mentioned this association before. ^2,3 However, I am a bit puzzled about the explanation the authors provided regarding this finding - the team probably having a low threshold for accepting risk and being more likely to consider the use of the Mental Health Act. I certainly do not believe this to be an explanation that would ring true with other crisis teams, for I am under the impression that the staff in most crisis teams have a very high threshold for admitting someone; this is, I think, to do with their role of gatekeeping admissions (and controlling the beds).

The other important aspect that needs to be considered here relates to the fact that the team in the study do not have control over admissions under the Mental Health Act outside working hours, which are between 8 am and 12 pm. It would be useful to see the numbers of people admitted under the Act out of hours, who were being assessed by other professionals undertaking their own risk assessments. It should also be remembered that many patients assessed and admitted under the Mental Health Act during working hours are not always assessed by the crisis team; community mental health teams undertake their own Mental Health Act assessments.

Finally, let us consider the staffing levels within the crisis team: one part-time staff grade psychiatrist but no dedicated consultant. This in itself may explain the fact that the team has to rely heavily upon others to undertake assessments. Once professionals outside the crisis team make a decision to detain someone there is nothing that the crisis team can do about it; they simply have to find a bed for the detained person.