Social systems intervention and crisis resolution. Part 1: Assessment

The National Health Service (NHS) Plan (Department of Health, 2000) set out an intention to establish 335 crisis resolution and home treatment teams in England by 2004, with the expectation that bed usage in acute adult general psychiatry could be further reduced (Joy et al, 2001). The initiative also aimed to make generally available a more acceptable and appropriate model of care, including ‘interventions aimed at maintaining and improving social networks’ (Department of Health, 2001b: p. 16). The work of these teams is usually characterised as diverting care away from admission beds (Brimblecombe, 2001). However, enabling early discharge, when admission has not been avoided, can also be part of their routine remit. This article emerged from the experience of one crisis resolution team receiving in-service training in social systems intervention and crisis resolution. The team asked for something to refer to, in the way of a practical ‘how to do it’ guide, supplementing theoretical instruction and complementing otherwise invaluable on-the-job training. As in-patient wards review their working practices and align themselves with crisis resolution teams (Department of Health, 2002a), this guide also serves as an introduction for ward staff to the relevance of social context when providing in-patient care. Furthermore, it is anticipated that this overview will be of interest to generic community mental health teams (Department of Health, 2002b), specialist assertive outreach teams (Department of Health, 2001a) and early-intervention teams (Department of Health, 2001c) and to approved social workers performing assessments under the Mental Health Act 1983 (Dunn, 2001). The theoretical background (Caplan, 1964, 1974; Polak, 1967, 1970) and practical procedures (Fish, 1971; Polak, 1971a, 1972) brought together here were first explored and established 30 and more years ago. One of the earliest mobile psychiatric emergency services was set up in Amsterdam 70 years ago, with the aim of preventing hospitalisation (Querido, 1968). As community psychiatry has developed, the relevance of social context in general (Cohen, 2000), and crisis intervention in particular (Hoult, 1986; Rosen, 1997; Minghella et al, 1998; Joy et al, 2001), in providing acute psychiatric care has remained crucial. Certainly, clinical experience in setting up and running current crisis resolution and home treatment teams endorses the continuing relevance of social systems intervention when resolving crises in acute mental health care.