An investigation of factors associated with psychiatric hospital admission despite the presence of crisis resolution teams.
BACKGROUND
Crisis resolution teams (CRTs) provide a community alternative to psychiatric hospital admission for patients presenting in crisis. Little is known about the characteristics of patients admitted despite the availability of such teams.


METHODS
Data were drawn from three investigations of the outcomes of CRTs in inner London. A literature review was used to identify candidate explanatory variables that may be associated with admission despite the availability of intensive home treatment. The main outcome variable was admission to hospital within 8 weeks of the initial crisis. Associations between this outcome and the candidate explanatory variables were tested using first univariate and then multivariate analysis.


RESULTS
Patients who were uncooperative with initial assessment (OR 10.25 95% CI-4.20-24.97), at risk of self-neglect (OR 2.93 1.42-6.05), had a history of compulsory admission (OR 2.64 1.07-6.55), assessed outside usual office hours (OR 2.34 1.11-4.94) and/or were assessed in hospital casualty departments (OR 3.12 1.55-6.26), were more likely to be admitted. Other than age, no socio-demographic features or diagnostic variables were significantly associated with risk of admission.


CONCLUSIONS
With the introduction of CRTs, inpatient wards face a significant challenge, as patients who cooperate little with treatment, neglect themselves, or have previously been compulsorily detained are especially likely to be admitted. The increased risk of admission associated with casualty department assessment may be remediable.
Cotton
Mary-Anne
MA
Department of Mental Health Sciences, Royal Free and University College Medical Schools, UCL, London, UK. m.a.cotton@doctors.net.uk
Johnson
Sonia
S
Bindman
Jonathan
J
Sandor
Andrew
A
White
Ian R
IR
Thornicroft
Graham
G
Nolan
Fiona
F
Pilling
Stephen
S
Hoult
John
J
McKenzie
Nigel
N
Bebbington
Paul
P
D000328:Adult; D002391:Catchment Area, Health; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003419:Crisis Intervention; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010348:Patient Care Team; D012307:Risk Factors