Home Based Crisis Team:
initial steps towards recovery
in the community
Dr. Sinead O’Brien.
Consultant Psychiatrist,
Home Based Crisis Team.
North Lee Mental Health Services.
Today.....
 Vision for Change
 City North Sector
 Development of HBCT-City North.
 Audit of case-load
 Future Directions
A Vision for Change
 Person centred
 Recovery orientated
 Holistic – all aspects of mental health:
biological (e.g. medication),
psychological (e.g. “talking therapies”)
and social (e.g. housing, employment,
education/training).
A Vision for Change
 Community-based – provide services in
communities where people live, reduce
hospital admissions, more home-based
treatments and outreach services.
 Multi-disciplinary
 Population Based
Mission Statement
 To provide a home-based crisis
assessment and multi-disciplinary
treatment and intervention service for
individuals presenting with acute
psychiatric illness in City North
sector. We endeavour to respect each
individual’s rights and values.
Cork City North Sector
 Population: 53,000
 2 Sector Multidisciplinary Teams.
 CNW: Dr Ruth Collins
 CNE: Dr Nataraj Gojanur
Cork City North Sector.
 Sector includes:
Knocknaheeny
Gurranabraher
Fairhill
Blackpool
Mayfield
The Glen.
RAPID
 “Revitalising Areas through Planning,
Investment and Development”.
RAPID aims to......
 Increase the investment made by Government
departments and state agencies in the 46
communities;
 Improve the delivery of public services through
integration and coordination
 Enhance the opportunities for communities to
participate in the strategic improvement of
their areas.
Rapid Areas in Cork
 Knocknaheeny/Hollyhill/Churchfield
 Blackpool /The Glen/Mayfield
 Fairhill/Gurranabraher/Farranree
 Togher/Mahon
Priorities of RAPID....
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family support,
physical environment,
health,
community safety,
education,
employment
training and youth support.
The Haase and Pratschke Index
 uses 3 dimensions of
affluence/disadvantage to comprise
their index.
 ‘Demographic Profile’,
 ‘Social Class Composition’
 ‘Labour Market Situation’
“Extremely disadvantaged”
 Farranferris,
 Knocknaheeny,
 Fair Hill B
 9% of National ED rating
HBCT
 Set up in 2007
 Funding for 1 additional Consultant
 CD and Heads of Discipline examined
need within North Lee MHS
North Lee MHS
 Majority (>50%) of ALL admissions
to Acute Unit were from City North
Sectors
HBCT
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1 Consultant Psychiatrist
1 Registrar
2 CMHN
1 social worker
0.6 Occupational Therapist
1 Psychologist
Clerical Support
Evolution of HBCT...April 2009
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1 Consultant Psychiatrist
1 Registrar
2 CMHN
0.6 social worker
0.6 Occupational Therapist
Clerical Support
My Vision...
Optimising
Physical
&Psychological
Health
Evidence
Based
Practice
SB
Intensive Case
Management
Health
Economics
Audit
Research
Ethics
Autonomy
Beneficence
Non-Maleficence
Justice
Inclusion Criteria
 The crisis team (HBCT) aim to treat individuals in the
community, where appropriate, for approximately 4
weeks. We are targeting adults with severe mental
illness, who require urgent assessment.
This includes:
 Those in acute psychosocial crisis
 Those with acute psychiatric conditions in need of
urgent psychiatric attention
 And those with long term, severe psychiatric problems
who experience either of the first two problems.
Exclusion Criteria
 risk of violence in home &/ or to staff
 primary diagnosis of organic brain damage
and dementia
 medical illness which may require medical
assessment
 primary diagnosis of active substance
misuse.
 severe personality disorder
HBCT Working Hours
 Mon-Fri.
 Mon-Thurs 9am-5pm.
 Fri 9am-4pm.
Referrals
 Referrals must be made by healthcare
professionals using the referral form.
 An urgent referral must be followed
up by a phone call to the team in
order to discuss the case.
 The client must be aware of the
referral and agreeable to assessment
in their home.
Assessments
 Initial assessment by 2 team
members.
 HBCT Proforma
 HONOS
 MADRAS
 Risk Assessement.
Acceptance/Non Acceptance
Procedure
 Referrer notified immediately via fax.
 Full detailed assessment to referrer
within 2 working days.
Clients working with HBCT
 Keyworker
 Initial daily reviews
 Weekly review of Collaborative Care
Plan.
Audit of Home Based Crisis Team
(HBCT)-Cork City North,
Activity over a 6 month period
Aims of Audit...
 To review Practices within HBCT
 Accountibility
 Service Development
Methods
 conducted over a six month period
 from 1/10/2009 to 31/03/2010.
 Data was analyse using SPSS version 14
and graphs compiled using Minitab
Graphics.
Results.......
Referrals
 158 referrals.
GP Perspectives on the Home
Based Crisis Team.
City North Sectors, Cork.
GP Satisfaction with HBCT
 92% of GPs were satisfied with the
team re
 management of patients
 as suitable alternative to
admission,
 time from referral to assessment,
 satisfaction with feedback and
correspondence from the team
GP’s.....
 100% of GPs identified they would
refer again
Future Plans
Future Plans
 Further strategy Meeting with CNE
 Further Meeting Primary Care Teams
 Meeting with Liaison Psychiatry
Future Plans
 Study ongoing re MDT input to HBCT
case-load.
 Continued CSQ-8 Collection
 Assessment of family/carer views
 Collection of emergency
presentations/admissions to acute unit.
 “Successful implementation of the
CRHT teams as alternatives to hospital
admission requires resources for home
treatment out of hours, effective systems
working among local services, stronger
local understanding and advocacy of the
teams’ role”
Onyett 2008
The Team!
Mairead Murphy (CMHN)
Martina Cullinane (CMHN)
Aisling Hassett (CMHN)
Damien Fleming (SW)
Valerie Morrison (OT)
Freda Wynne (Psychologist in Clinical Training)
Geraldine Kenny, Martina Carroll (Clerical
support)
 Dr. Deirdre Muller-Neff (Registrar)
 Dr. Sinead O’Brien
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