Southwark CResT Teams

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Southwark CResT Teams

• Presentation by
• Simon Rayner

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• Southwark has two Crisis Resolution Home
  Treatment Teams (CRT/HTT)
• North CResT covering Borough Bankside,
  Walworth, Bermondsey Rotherhithe.
• South CResT covering Camberwell, Peckham,
  Nunhead Peckham Rye, Dulwich

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• CResT teams are Multi-Disciplinary
• (Doctors, Nurses, Social Workers, Support Time
  Recovery Workers, Bed Managers and
  Administrators).
• We are open from 8am until 12 midnight
• 7 days a week 365 days a year.
• Psychiatric Liaison Services at AE is a
• 24 hour service.

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• We work with any person who lives in Southwark
  and has a psychiatric crisis.
• The teams are an alternative to a hospital
  admission.
• We gate-keep all possible admissions, to ensure
  all alternatives to admission have been explored.
• We provide intensive support in the clients home,
  rather than them being admitted into hospital.

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• We have an ethos of positive risk taking.
• We apply social systems interventions to the
  patients psychiatric crisis.
• Not afraid of getting our hands dirty (practical
  interventions)
• We prioritise those in high need.
• Service users and carers prefer to be treated at
  home rather than admission (more humane, and
  improved services of people who experience mental
  health services)

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Vignette 1

• A 24 year old female presents at surgery, there
  is no previous history of contact with mental
  health services.
• She reports feeling increasingly anxious over the
  past month and has been experiencing panic
  attacks during this time. Sleep and appetite are
  reported to be poor and she also states that her
  motivation is low. She has, on occasion
  experienced fleeting suicidal thoughts but denies
  any plans or intent to act on these now or in the
  future.
• She lives alone since her relationship of 3 years
  ended recently. Her social circle outside of the
  relationship had been limited and she describes
  herself as having always been a shy, timid type
  of person. She has never worked and is in
  receipt of benefits.
• Refer to ABT for Assessment
• Anxiety management
• Treatment of underlying depressive episode
• Not suitable for CResT
• as intensive input not indicated risk to self
  and others low.

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Vignette 2

• Family member is expressing concern that X has
  recently began to behave in a bizarre manner,
  withdrawing from family contact, stating that
  they are impostors that have replaced his real
  family. X has also started to neglect his
  personal hygiene and to dress in several layers
  of outlandish clothes. When the family member
  gained access to Xs flat it was in a chaotic
  state with several pieces of paper pinned to the
  wall containing unintelligible symbols and words.
• The family member reports that when X was at
  university he experienced a break down where he
  was withdrawn and believed that people were after
  him, which appeared to resolve.
• X presented with pressured speech and was at
  times distracted and appeared to be responding to
  internal stimuli. He reports that he hears a
  male voice externally telling him that he has
  been chosen for a special mission. He is unclear
  what this mission will be but receives commands
  from the voice that will lead to enlightenment.

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Cont

• X was agitated and at times guarded. He does not
  feel that anything is wrong with him. He
  expressed concern that his real family have
  disappeared and believes that his successful
  completion of his mission may lead to their
  return.
• He denies any ideas of harm to others, but has
  thought that his life will not be worth living if
  he is unable to complete his mission.
• X is male, single and unemployed.
• CResT referral and assessment is appropriate.
• Risk to others - low.
• Risk to self - moderate.
• Withdrawn from usual social systems/network.
• Could be assessed and treated at home with
  intensive input.

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The department of Health states that a crisis
service is not usually appropriate for
individuals with

• Mild anxiety disorders
• Primary diagnosis of alcohol or other substance
  misuse
• Brain damage or other organic disorders including
  dementia
• Learning disabilities
• Exclusive diagnosis of personality disorder
• Recent history of self harm but not suffering
  from a psychotic illness or severe depressive
  illness
• Crisis related solely to relationship issues.
• However, this has been superseded by new thinking
  on personality disorder not being a diagnosis of
  exclusion

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Referring for a Crisis Assessment

• Monday to Friday 9am until 5pm
• Refer all patients to appropriate ABT (CMHT).
• They will triage all service users and refer to
  CResT if appropriate.
• CResT will contact you directly to arrange an
  assessment.
• CResT should be able to get to your surgery
  within the hour.
• Weekdays after 5pm and Weekends
• For a Crisis Assessment you can refer directly to
  CResT.
• North CResT 020 7188 6991
• South CResT 020 7919 3500
• Pager (for both) 07659 158 085

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After the Assessment

• CResT take on patient.
• CResT refer patient to CMHT.
• CResT have patient admitted into hospital.
• Patient may not need psychiatric services.
• CResT may advise to refer patient to another
  service.