Intended for healthcare professionals

Rapid response to:

Paper

Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38519.678148.8F (Published 15 September 2005) Cite this as: BMJ 2005;331:599

Rapid Response:

Crisis Teams:Why are Patients and Trainee Psychiatrist not satisfied!

Sir,

In this section we would like to discuss not only about the Islington
study but also about the current practice of crisis teams generally.

A)About the North Islington Study:

It is reassuring from the study that patient's quality of life improves
and the admission rate decreases with the advent of crisis team. The
North Islington Study higlights that the Patient's satisfaction was
equivocal. We feel it could have been better if the authors identified the
reasons for the equivocal finding of patient's satisfaction.Some of
the reasons for patients not being satisfied could be

1.Percieved Refusal of Admission

2.Inability to see Doctor Always

3.Assessed by Different "faces" during their Presentation

With regards to the reduced admissions, the study could have done a cost
effective analysis as well.It is important to establish that the cost
benefit of reduced admission is more than the summation of the cost of
providing the crisis team service including crisis beds.

B)About the current practice:

We would also like to point out that there is a serious concern
amongst the trainee psychiatrists regarding the "deskilling" of their
assessment skills.It used to be a fantastic experience of assessing
patients on our own in the A&E at midnight.These assessments
provided us the platform to gain valuable experience under enormous
pressure. Most of the current crisis team`s initial assessment does not
comprise of a trainee psychiatrist.This "deskilling" of trainee
psychiatrists could be overcome by a 6 month mandatory posting with
crisis teams (or) joint assessments throughout their rotation.

Competing interests:
None declared

Competing interests: No competing interests

01 September 2005
Dr Arun Prasad Subramanian
SHO Rehabilitation Psychiatry
Dr Saravana T R Subbian MRCPsych
Beighton Hospital Sheffiled S20 1NZ