The National Service Framework for Mental Health (NSF) (DoH, 1999), standards 3, 4 and 5 in particular, and the subsequent NHS plan (DoH, 2000) instigated the creation of CRHTTs, with the Mental Health Policy Implementation Guide (MHPIG) (DoH, 2001) setting out the underpinning operational guidelines for their implementation. The National Suicide Prevention Strategy (DOH, 2006a) supported the development of CRHTTs and recognised the importance of close working between them and acute inpatient units, particularly concerning early discharge planning and its impact on of suicide reduction (Smyth, 2003). With the achievement of NSF targets (DoH, 2004; The Sainsbury Centre for Mental Health, 2006), the concept and delivery of home-based crisis care has become the norm for mental health services (DOH, 2006b).
There have been various attempts to define what is meant by a ‘crisis’ within a psychiatric context (James and Gilliland, 2005; Lillibridge and Klukken,1978; Roberts, 2000) although Caplans Crisis Theory (1964) is best known. This conceptual framework defines crisis as a time limited response to a life event which is not solvable by the individuals’ usual coping mechanisms. The symptoms of mental illness of those in crisis are regarded as signs that these coping mechanisms are failing. Caplan emphasised a community-wide approach to interventions with diagnosis being less important and treatment focused on problem-solving techniques and the person’s social network (Hubbeling and Bertram, 2012). The word Crisis in the Chinese language is translated to mean danger and opportunity (Greene et al, 2000) and, according to the theory, going through a crisis provides an ideal opportunity to learn new coping skills, whilst identifying, activating and improving those already possessed (AUTHOR, ????).
Despite the seminal importance of Caplan's work it has been considered dated because of its influence by Freudian thought (SCMH, 2001, pg2) and a reliance on disease concepts rather than health (Hunte and Morgan, 2008). Crisis theory is not cited in contemporary service literature (Anderson, 2006) and CRTT provision is not based upon it. However, although considered an atheoretical way of arranging services (Johnson & Needle, 2008), the MHPIG (DoH, ???) deals with the concept of crisis in practical terms rather than rejecting Caplans work (Anderson, 2006). But there is confusion over the real, or perceived, lack of clarity in the definition and understanding of what constitutes a crisis, with frequent tensions and conflicts within and between clinical teams as a result (Friedman, 2008; Hunte and Morgan, 2008). These maybe caused by different thresholds of tolerance or interpretations of crisis situations guided by personal motivations and/or agendas (Allen, 2010). Through implication of their name, there is a diverse expectation of functions that a CRHTT can or should provide which are not helpful for the team when focusing its limited resources (Onyett et al, 200?).
Ervin Goffmans (1961) study of asylums was one of the first sociological examinations of the social situation of the mentally-ill patient. He introduced the...