Crisis resolution/home treatment team workers’ understandings of the concept of crisis



The crisis resolution/home treatment (CR/HT) model has brought significant reform of acute mental health care in the UK and beyond. The complex issue of conceptualising crisis is, however, overlooked in CR/HT literature. This study aimed to investigate how crisis is understood amongst those working in CR/HT teams.


Framework analysis was applied to semi-structured interviews with 39 CR/HT workers representative of multidisciplinary mix and drawn from four different teams.


Whilst there was an acknowledgment of the concept’s complex nature, there was consensus in: respondents’ characterising of crisis; about three different presenting clinical patterns (‘clusters’) encountered in CR/HT work; and, the pattern of the crisis phenomenon over time.


The findings suggest further development of the CR/HT model, including improving conceptual clarity (to benefit communication with referrers and judge clinical outcome), better timed intervention, and varying intervention for different clusters of crisis presentation.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Ball JS, Links PS, Strike C, Boydell KM (2005) “It’s overwhelming…everything seems to be too much”: a theory of crisis for individuals with severe persistent mental illness. Psychiatr Rehabil J 29:10–17

    PubMed  Article  Google Scholar 

  2. 2.

    Bonynge ER, Lee RG, Thurber S (2005) A profile of mental health crisis response in a rural setting. Community Ment Health J 41:675–685

    PubMed  Article  Google Scholar 

  3. 3.

    Botha UA, Koen L, Joska JA, Parker JS, Horn N, Hering LM, Oosthuizen PP (2009) The revolving door phenomenon in psychiatry: comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country. Soc Psychiatr Epidemiol. doi:10.1007/s00127-009-0085-6

  4. 4.

    Bridgett C, Polak P (2003) Social systems intervention and crisis resolution. Part 1: assessment. Adv Psychiatr Treat 9:424–431

    Article  Google Scholar 

  5. 5.

    Brimblecombe N (2001) Acute mental health care in the community: intensive home treatment. Whurr Publishers, London

    Google Scholar 

  6. 6.

    Burns T (2004) Community mental health teams: a guide to current practices. OUP, Oxford

    Google Scholar 

  7. 7.

    Burns T, Priebe S (2004) The survival of mental health services: a pressing research agenda? Br J Psychiatry 185:189–190

    PubMed  Article  Google Scholar 

  8. 8.

    Callahan J (1998) Crisis theory and crisis intervention in emergencies. In: Kleespies PM (ed) Emergencies in mental health practice: evaluation and management. The Guilford Press, New York, pp 22–40

    Google Scholar 

  9. 9.

    Caplan G (1964) Principles of preventive psychiatry. Tavistock Publications, London

    Google Scholar 

  10. 10.

    Department of Health (2001) The mental health policy implementation guide. The Department of Health, London

    Google Scholar 

  11. 11.

    Fakhoury W, Priebe S (2002) The process of deinstitutionalization: an international overview. Curr Opin Psychiatry 15:187–192

    Article  Google Scholar 

  12. 12.

    Glover G, Arts G, Babu KS (2006) Crisis resolution/home treatment teams and psychiatric admission rates in England. Br J Psychiatry 189:441–445

    PubMed  Article  Google Scholar 

  13. 13.

    Johnson S (2004) Crisis resolution and intensive home treatment teams. Psychiatry 3:22–25

    Article  Google Scholar 

  14. 14.

    Johnson S, Nolan F, Hoult J, White IR, Bebbington P, Sandor A, McKenzie N, Patel SN, Pilling S (2005) Outcomes of crises before and after introduction of a crisis resolution team. Br J Psychiatry 187:68–75

    PubMed  Article  Google Scholar 

  15. 15.

    Johnson S, Nolan F, Pilling S, Sandor A, Hoult J, McKenzie N, White IR, Thompson M, Bebbington P (2005) Randomised controlled trial of acute mental health care by a crisis resolution team: the North Islington crisis study. Br Med J 331:599–602

    Article  Google Scholar 

  16. 16.

    Mays N, Pope C (2000) Qualitative research in health care: assessing quality in qualitative research. Br Med J 320:50–52

    Article  CAS  Google Scholar 

  17. 17.

    National Audit Office (2007) Helping people through mental health crisis: the role of crisis resolution and home treatment services. Report by the Comptroller and Auditor General. HC 5 Session 2007–2008

  18. 18.

    Office of the Deputy Prime Minister (2004) The English indices of deprivation 2004: summary. ODPM, London

    Google Scholar 

  19. 19.

    Pope C, Ziebland S, Mays N (2000) Qualitative research in health care: analysing qualitative data. Br Med J 320:114–116

    Article  CAS  Google Scholar 

  20. 20.

    Ritchie J, Spencer L (1994) Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG (eds) Analyzing qualitative data. Routledge, London, pp 173–194

    Google Scholar 

  21. 21.

    Smyth MG (2003) Crisis resolution/home treatment and in-patient care. Psychiatr Bull 27:44–47

    Article  Google Scholar 

  22. 22.

    Zavradashvili N, Donisi V, Grigoletti L, Pertile R, Gelashvili K, Eliashvili M, Amaddeo F (2009) Is the implementation of assertive community treatment in a low-income country feasible? The experience of Tbilisi, Georgia. Soc Psychiat Epidemiol. doi:10.1007/s00127-009-0125-2

Download references


We are grateful to the CR/HT workers interviewed who gave their time and shared their ideas, and team managers who supported this study. We thank Dr Nancy Pistrang for her invaluable advice and support in conducting and writing-up this study. This project was funded by the UCL graduate school.

Author information



Corresponding author

Correspondence to Simon Tobitt.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tobitt, S., Kamboj, S. Crisis resolution/home treatment team workers’ understandings of the concept of crisis. Soc Psychiatry Psychiatr Epidemiol 46, 671–683 (2011).

Download citation


  • Crisis
  • Crisis resolution
  • Crisis theory
  • Home treatment
  • Acute psychiatric care