Open Access Research article

An implementation study of the crisis resolution team model in Norway: Are the crisis resolution teams fulfilling their role?

Nina Hasselberg1*, Rolf W Gråwe2, Sonia Johnson3 and Torleif Ruud4

Author Affiliations

1 R&D Department, Mental Health Services, Akershus University Hospital and Institute of Clinical Medicine, University Oslo, Norway

2 Department of Research and Development, Alcohol and Drug Treatment Health Trust in Central Norway; Norwegian Centre for Addiction Research, University of Oslo, Norway

3 Department of Mental Health Sciences, University College London, London, UK

4 R&D Department, Mental Health Services, Akershus University Hospital and Professor, Institute of Clinical Medicine, University Oslo, Norway

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BMC Health Services Research 2011, 11:96  doi:10.1186/1472-6963-11-96

Published: 10 May 2011

Abstract

Background

The establishment of crisis resolution teams (CRTs) is part of the national mental health policy in several Western countries. The purpose of the present study is to describe characteristics of CRTs and their patients, explore the differences between CRTs, and examine whether the CRTs in Norway are organized according to the international CRT model.

Methods

The study was a naturalistic study of eight CRTs and 680 patients referred to these teams in Norway. Mental health problems were assessed using the Health of the Nation Outcome Scales (HoNOS), Global Assessment of Functioning Scales (GAF) and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).

Results

None of the CRTs operated 24 hours a day, seven days a week (24/7 availability) or had gate-keeping functions for acute wards. The CRTs also treated patients who were not considered for hospital admission. Forty per cent of patients waited more than 24 hours for treatment. Fourteen per cent had psychotic symptoms, and 69% had affective symptoms. There were significant variations between teams in patients' total severity of symptoms and social problems, but no variations between teams with respect to patients' aggressive behaviour, non-accidental self-injury, substance abuse or psychotic symptoms. There was a tendency for teams operating extended hours to treat patients with more severe mental illnesses.

Conclusions

The CRT model has been implemented in Norway without a rapid response, gate-keeping function and 24/7 availability. These findings indicate that the CRTs do not completely fulfil their intended role in the mental health system.

Keywords:
acute psychiatric services; crisis resolution teams; mental health services; implementation study; patient characteristics