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Introduction of the Home Treatment Accreditation Scheme: a welcome development: policy context and Crisis Resolution and Home Treatment Service history in England.

The introduction of Crisis Resolution and Home Treatment (CRHT) services was a major element in the National Service Framework for mental health (Department of Health 1999), and has grown ever since. The following year, the NHS Plan (Department of Health 2000) made the establishment of CRHT services a national priority. The DoH described the specification that CRHT teams in England should meet in its Mental Health Policy Implementation Guide (Department of Health 2001) and made a Public Service Agreement in 2002 that included targets for both the number of CRHT teams and the number of people to be treated by them (cited in National Audit Office 2007). In 2006, the DoH published its Guidance Statement on Fidelity and Best Practice for Crisis Services (Department of Health 2006) to help ensure that CRHT teams remained focused on their core business. The National Institute for Mental Health in England/Care Services Improvement Partnership, superseded by the National Mental Health Development Unit (actively supported development of CRHT services nationally using its regional teams. With such clear guidance from the DoH in terms of elements such as team composition and population size to be covered, CRHT services were prioritized and successfully set up, by mental health trusts in their service developments. For the period 1 April 2006 to 31 March 2007, the DoH reported that 343 CRHT teams were in place and providing 95 397 episodes of care to 75 868 individuals (National Audit Office 2007). By 2007, the National Audit Office reported that ‘CRHT brings clinical benefits and increased patient satisfaction. It can also reduce the stigma and social exclusion frequently faced by people suffering from acute mental illness’ (2007, p. 7). The report also stated that in terms of financial cost, ‘an acute mental health service making full use of CRHT services in appropriate cases costs approximately £600 less per crisis episode than one in which CRHT is not available’ (2007, p. 7). Other papers describe similar findings for CRHT outcomes such as those reviewed by Sjolie et al. (2010). Since 2007, there have been many changes in mental health care generally and in acute home treatment specifically. Some CRHT teams have amalgamated into large teams covering larger populations and some have amalgamated with general mental health liaison services in acute (general health) hospitals. This has led to a dilution of function in some areas, yet has had no negative impact when done well in others. There have been problems with some CRHT teams losing their acuity and acting more like extended hour General Community Mental Health Teams. A further factor has been a separation of urgent assessment function, from intensive home treatment delivery, between two or more different teams, where the same team provided these previously. Finally, some teams now operate by providing a local home treatment service and then join up with one or more other teams to cover their out-of-hours service, over a larger geographical area, especially where the team sizes are relatively small. With so much variation in how CRHT is now delivered in the UK, combined with the fact that at the time of writing, localized Clinical Commissioning Groups (CCGs) are about to take over from Primary Care Trusts, it is more important than ever that the CRHT function is strengthened and remains a viable alternative to acute in-patient admission rather than diluted through a loss of focus on mental health acuity or a reduction of resources. CCGs have far more autonomy from central DoH guidance now compared with the past, a distinct CRHT function will no longer be Journal of Psychiatric and Mental Health Nursing, 2014, 21, 180–183