title: National implementation of a mental health service model: A survey of Crisis Resolution Teams in England.
abstract: In response to pressures on mental health inpatient beds and a perceived 'crisis in acute care', Crisis Resolution Teams (CRTs), acute home treatment services, were implemented nationally in England following the NHS Plan in the year 2000: an unprecedentedly prescriptive policy mandate for three new types of functional community mental health team. We examined the effects of this mandate on implementation of the CRT service model. Two hundred and eighteen CRTs were mapped in England, including services in all 65 mental health administrative regions. Eighty-eight percent (n = 192) of CRT managers in England participated in an online survey. CRT service organization and delivery was highly variable. Nurses were the only professional group employed in all CRT staff teams. Almost no teams adhered fully to government implementation guidance. CRT managers identified several aspects of CRT service delivery as desirable but not routinely provided. A national policy mandate and government guidance and standards have proved insufficient to ensure CRT implementation as planned. Development and testing of resources to support implementation and monitoring of a complex mental health intervention is required.
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Brynmor
authors.identifier: http://orcid.org/0000-0001-9866-788X
authors.initials: B
authors.lastname: Lloyd-Evans
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Bethan
authors.initials: B
authors.lastname: Paterson
authors.affiliation: Onyett Entero Ltd/Department of Psychology, University of Exeter Washington Singer Building, Exeter, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Onyett
authors.affiliation: Glenside Campus, University of the West of England, Bristol, UK.
authors.forename: Ellie
authors.initials: E
authors.lastname: Brown
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Istead
authors.affiliation: Glenside Campus, University of the West of England, Bristol, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Gray
authors.affiliation: Institute of Psychiatry, Kings College London, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Henderson
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Sonia
authors.initials: S
authors.lastname: Johnson
mesh_terms: D003419:Crisis Intervention / Q000458:organization & administration*; D004739:England; D019983:Guideline Adherence; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D017146:Models, Organizational; D016730:Program Development; D011568:Psychiatric Nursing / Q000458:organization & administration; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: acute care; crisis resolution; home treatment; implementation; mental health services