Quality Measures Database

Primary health care service provided in non-clinical settings, usually to vulnerable populations (e.g., homebased care, shelter-based care, Assertive Community Treatment teams, street nurses).
Additional Domain(s) : Patients with Acute Conditions, Continuity

Traditionally, a first episode or acute exacerbation of schizophrenia has led to
admission to an acute in patient unit. However, in recent years there has growing
interest in attempting to manage such episodes in the community. If this could be
done safely, it might avoid the stigma and costs associated with hospital
admission, thus providing benefits to service users and service providers. Crisis
resolution and home treatment teams (CRHTTs) are methods of organising
services that aim to avoid admitting acutely ill people to hospital by providing
intensive home-based support. A recent Cochrane review of crisis intervention
for people with serious mental health problems (Joy et al., 2002) was selected by
the GDG for review and further analysis.
The services most likely to help people who are acutely ill include crisis resolution and home treatment teams, early intervention teams, community mental health teams (CMHTs) and acute day hospitals. If these services are unable to meet the needs of a service user, or the Mental Health Act is used, inpatient treatment may prove necessary for a period of time. Whatever services are available, a broad range of social, group and physical activities are essential elements of the services provided.
For people with schizophrenia and other serious mental health problems in an
acute crisis, CRHTTs are superior to standard hospital based care in reducing
admissions and shortening stay in hospital, and appear to be more acceptable
than hospital based care for acute crises, and are less likely to lose contact with service users. Crisis resolution and home treatment teams may also have a marginally better effect on some clinical outcomes.

NICE. Schizophrenia. Core intervention in the treatment and management of schizophrenia in primary and secondary care. Clinical Guideline 1.December 2002. Section 1.3.1.2 P: 9. Retrieved on July 31, 2006 from: http://www.nice.org.uk/page.aspx?o=CG001NICEguideline

II: Less rigorous studies specifically focused on primary mental health care or extrapolated from higher quality studies from secondary mental health care.

• * When clients are too out of control crisis services are not adequate.
• If support is offered proactively, perhaps clients would not get "out of control"
• Those in severe crisis, suicidal, etc do not belong at home, they need to be stabilized. There has been and are people wandering the roads and streets helplessly not knowing what to do.

Ratings-based Rank Relevance 61 Actionability 111 Overall Importance 67		Stakeholder Rank Academics 89 Clinicians 69 Consumers 69 Decision Makers 79 �		Special Group Rank First Nations 96 Rural Areas 49 Federal Stakeholders 105
Regional Rank BC AB SK MB ON QC NB NS PE NL YT NT NU 119 77 86 50 84 35 32 128 102 83 120 37 105				Overall Rank        83