Skip to main content
Download PDF

Similarities and differences between service users’ and carers’ experiences of crisis resolution teams in Norway: a survey

BMC Psychiatry volume 22, Article number: 266 (2022) Cite this article

Abstract

Background

Crisis resolution team (CRT) care in adult mental health services is intended to provide accessible and flexible short-term, intensive crisis intervention to service users experiencing a mental health crisis and involve their carers (next of kin). Research on users’ and especially carers’ experiences with CRT care is scarce and is mostly qualitative in nature.

Methods

Altogether, 111 service users and 86 carers from 28 Norwegian CRTs were interviewed with The Service User and Carer Structured Interviews of the CORE Crisis Resolution Team Fidelity Scale Version 2. Their experiences with different aspects of CRT care were reported with descriptive statistics, and differences between service users’ and carers’ experiences were analyzed with the Mann-Whitney U Test.

Results

The service users and carers reported that the CRT care mostly reflected their needs and what they wanted. The experiences of service users and carers were mostly similar, except for significant differences in received information and how the termination of CRT care appeared. Both groups experienced the organization of the CRT care as accessible, with continuity, reliability, and flexibility, but without a high intensity of care. Both groups found the content of the CRT care supportive, sensitive, with a choice of treatment type and a range of interventions beyond medication, but a lack of written treatment plans and discharge plans. Carers were rarely involved in discharge meetings. Regarding the role of CRTs within the care system, both groups agreed upon the lack of facilitation of early discharge from inpatient wards and lack of home treatment, but both groups confirmed some collaboration with other mental health services.

Conclusion

Service users and carers found that the CRTs were accessible, reliable, flexible, supportive, sensitive, and provided a range of interventions beyond medication. Limitations were lack of a high intensity of care, limited written treatment and discharge plans, limited provision of home treatment, and lack of gatekeeping of acute beds. Both groups experienced the CRT care as mostly similar, but with significant differences regarding involvement in care planning and discharge preparation.

Peer Review reports

Introduction

During the past two decades, several Western countries have established crisis resolution teams (CRTs). They intend to offer accessible, short-term, intensive, 24/7 home treatment; provide a range of interventions; involve other mental health services and carers; and serve as an alternative to acute hospital admissions for service users experiencing an acute and severe mental health crisis [1, 2]. CRTs are multidisciplinary mental health teams, and team members with different specialist competences collaborate giving a complex intervention to multifaceted mental health crises [3, 4]. A full-scale CRT model has not been implemented in Norway, and Norwegian CRTs have shown diversity in organization, treatment philosophy, and practices  compared to UK [5,6,7,8].

With the development of crisis resolution teams to provide more community-based care for service users experiencing an acute mental health crisis, a crucial issue is how service users and carers experience CRT care. In a Cochrane review, evidence from one randomized control trial and other uncontrolled trials suggests that the introduction of CRT care is associated with increased satisfaction among both service users and carers compared to standard care [9,10,11,12,13,14]. However, in a cluster-randomized controlled trial with special training in the model for the intervention CRTs, service users’ satisfaction was not significantly higher compared to control CRTs without such training, even if the intervention CRTs achieved higher model fidelity and effects on services [15].

Despite inconclusiveness regarding critical aspects of the CRT model [13], service users have experienced several elements as important and helpful. Of particular importance were accessibility, safety, a holistic approach, relational aspects, the inclusion of carers, and collaboration with other mental health services; as service users valued help from CRTs for these reasons [14, 16, 17]. Although the need for practical support has also been documented [18, 19], such support has rarely occurred in a CRT context [3, 19].

With the explicit intention of providing contextual and multifaceted crisis intervention, CRTs aim to involve and collaborate with carers and other parts of informal and professional networks [1, 20,21,22]. However, according to Morant et al. [16], the original family and social systems approach to home-based crisis intervention appears to have been diluted in CRT practice. Several studies have found that many carers report a positive attitude toward community-based care, and this may be related to the accessibility of services and the opportunity for carers to be included during the provision of health services [23, 24]. Nonetheless, despite its arguably positive contributions, community-based care may increase the burden of caregiving if the received support and follow-up of carers are inadequate [25, 26]. This also appears to be the case in CRT care [16, 20]. Carers may express a lower level of satisfaction with crisis care than service users and wish for more intensive treatment of the service user and the possibility of being included by health personnel [24, 27, 28].

Research has shown that there are often contradictions between service users and carers regarding the service user’s mental health problems and what should be considered necessary treatment and follow-up. Confidentiality and lack of consent may contribute to a lack of communication and mutual understanding [29, 30]. A Norwegian evaluation of Assertive Community Treatment team leaders’ experiences with collaboration with relatives showed that the possibility of meeting the service users together with family members helped develop a mutual understanding for all parties [31]. Understanding home-based crisis treatment as a collaborative project involving professionals, service users, and carers, the similarities and differences of service user and carer experiences need to inform the further development of CRT practice. However, studies that include both service users’ and carers’ experiences perspectives are scarce.

Three domains salient for optimal care were identified in the large qualitative study of several stakeholders’ (service users, carers, practitioners, managers, and referrers) views about critical ingredients in CRT care [16]. First, the organization of CRT care should provide a rapid initial response, frequent home visits, be accessible, reliable, and flexible, and have continuity of staff. Second, the content of CRT care should include emotional support, involve the whole family, and offer a range of interventions. Third, the role of CRTs within the care system included being a gatekeeper for acute admissions.

Aims

The aim of this study was to explore similarities and differences in how service users and carers experienced the care provided by Norwegian CRTs. The experiences have been explored related to three main areas of CRT care identified in the large qualitative study mentioned above [16]: the organization of the CRT, the content of the CRT care, and the role of the CRT within the system.

Methods

Study design

This quantitative explorative cross-sectional study was a part of the data collection for fidelity assessments of Norwegian CRTs in a multicenter study conducted in 2016 [6]. The study was done in collaboration with the Network of Acute Mental Health Services in Norway (akuttnettverket.no).

Setting

The CRTs in Norway are a part of community mental health centers (CMHCs) with outpatient clinics, mobile teams, and local inpatient wards. Each of 19 health trusts includes mental health services with hospital departments and two to four CMHCs [31, 32]. The CRTs and other CMHC units also collaborate with general practitioners and primary health and social services run by the municipalities.

Sample and recruitment

The sample of 111 service users and 86 carers (family members of service users) was recruited by the 28 CRTs participating in the multicenter study. These were half of the Norwegian CRTs identified in a previous survey [33]. The service users and carers were recruited independently, and it is unknown whether some of them were in the same family. The 28 CRTs from 15 health trusts responded to an invitation sent to all 19 health trusts in the country inviting their CRTs to participate in the study. The CRTs represented urban and rural areas in all four health regions.

Measures

The service users were interviewed using Norwegian translations of The Service User Structured Interview, and the carers were interviewed using The Carer Structured Interview. These interviews were a part of the procedures to collect data on service users’ and carer’ experiences for the CORE Crisis Resolution Team Fidelity Scale Version 2 [2]. The two structured interviews in English are with approval from the developers of the fidelity scale included as supplementary files 1 and 2 to make the complete questions available for the readers. Both interviews had the same 69 questions, except four, but the wording was adapted for each informant group. They covered experiences of referrals, waiting time, accessibility, frequency and duration of meetings, information, treatment plans, reliability, inclusion of families and friends, medication, practical help, flexibility, respect, discharge, continuity, collaboration with other health services, and home visits. The structured interviews did not contain any questions on socio-demographics or other personal issues. Because the CRTs met the service users both in their homes and in the CRT location, we have used the term meeting in this study, and not consultation or visit. Most questions had a dichotomous response scale (yes/no), and some had three or more alternative responses. No data was recorded on the service users or carers participating in the interviews.

Data collection and procedures

An evaluation team visited each CRT for 1 day to evaluate the team’s fidelity to the CRT model. The evaluation team consisted of three members: two clinicians and one service user researcher. The evaluators interviewed the team managers, team members, services users, carers, and managers from collaborating health services. Those data were only used in rating fidelity. The service user researcher conducted the interviews with service users and carers. These data were first included in rating fidelity, and then further analyzed in more detail in this study. Approximately half preferred to be interviewed by phone and half face to face during the evaluation team visit.

A month before the visit, the CRT staff was asked to recruit for interviews six service users and six carers seen by the CRT within the last 3 months. When approached by the staff, the service users and carers were informed about the purpose of the study and received written information about the study. The CRTs recruited, on average, four service users (range one to six) and four carers (range two to six). The staff found it somewhat harder to recruit carers than service users.

Data analysis

Altogether, 46 of the 69 questions had a dichotomous response scale (yes/no). To obtain a unified structure for analyses, the rest of the questions and response scales were adjusted to dichotomous questions in this way: For 12 yes/no questions with “not relevant” as a third possible response, “not relevant” was recoded as missing. For nine non-dichotomous questions with three alternative responses, the two most similar responses were merged, and the question was rephrased to fit the dichotomous responses of yes/no. For two questions with more than three responses, the responses were merged into two groups, and the question was rephrased to fit the response of yes/no. Finally, each question was abbreviated and rephrased to fit both informant groups.

Differences between service users and carers in the percentage of “yes” responses were tested using the non-parametric Mann-Whitney U Test. To avoid type I errors due to the high number of questions to be tested, we set the significance level to p < .01. As the questions had dichotomous response scales, and with a varying number of missing values, it was not possible to do factor analyses to identify common dimensions for groups of questions and define possible subscales. However, we grouped the questions thematically based on their content. All analyses were done using SPSS for Windows version 27.

We organized and presented the results as one figure for each of the three main themes identified in the large qualitative study, which contributed to the content of the fidelity scale [16]. Each figure included diagrams showing a pair of bars for each question within the respective theme and organized in groups for subthemes. We also commented on and interpreted the results and organized the discussions around the same themes and subthemes. We chose to structure our study on the results with these three themes from the large qualitative study during development of the fidelity scale, rather than on the four fidelity subscales which in the development of the fidelity scale were identified based on concept mapping involving items and participants also from several other sources and stakeholder groups [2, 16].

Results

General satisfaction with the CRT care

Altogether, 93% of the service users and 89% of the carers responded yes to a question about their overall satisfaction with the CRT care (‘Did you or the one you care for find that the treatment and support reflected your needs and what you wanted?’).

Experiences of organization of CRT care

Figure 1 shows how the service users and carers experienced the organization of the CRT care. The CRTs were accessible during the operating hours and by phone, but not during the night, even if some service users and carers reported they had needed that. The CRT had been able to come back for a second time the same day for the few who had asked for this. The CRTs were predictable regarding time for meetings and flexible regarding where and when to meet.

Fig. 1
figure 1

Service users’ (N = 111) and carers’ (N = 86) experiences of organization of crisis resolution teams’ care. Percentage of yes for each item. *) Items with significant differences (p < .01) between service users and carers

Full size image

The continuity of care was good, both regarding having a specific team member as a primary contact and in that the members in the team were updated on the service user’s situation and needs. For most service users, written information on the team and the treatment plan was not provided, and for more than half, the discharge preparation was limited.

Experiences of content of CRTs care

Figure 2 shows how the service users and carers experienced the content of the CRT care. The CRTs had asked for information about family and friends, including children of the service user. Most service users were willing to have carers involved in the CRT care. Half or more of the carers were involved in care planning or review and giving the service user support. A few carers were offered the opportunity to meet the team separately or provided with information on local resources for carers, and one carer had been provided his/her own support plan.

Fig. 2
figure 2

Service users’ (N = 111) and carers’ (N = 86) experiences of content of crisis resolution teams’ care. Percentage of yes for each item. *) Items with significant differences (p < .01) between service users and carers

Full size image

The treatment and support mostly reflected needs and wishes, and the CRT staff was experienced as nice, respectful, and understanding. All service users and carers felt listened to, and the length of the meetings was experienced as long enough to discuss their concerns.

A minority of the services users were provided follow-up on medication or side effects of medication. More than half reported that the CRT asked about any physical health problems, and a few were helped or tested for physical health problems. Very few were provided help with basic needs, economic benefits or needs, or legal or social problems. Some were provided help regarding structured self-management or personal plans on what to do in case of future crisis or relapse.

Experiences of the role of CRTs within the care system

Figure 3 shows how the service users and carers experienced home-based treatment and CRTs’ collaboration with other services. Less than half of the services users were provided with home-based treatment, and if not, this was often their own choice. Half were informed about other local services. One-third reported that other health services were involved, but only a few experienced that other health services providers attended a meeting. The CRTs had little collaboration with inpatient units in the mental health services, such as facilitating early discharge for service users from inpatient wards.

Fig. 3
figure 3

Service users’ (N = 111) and carers’ (N = 86) experiences of the role of crisis resolution team within the care system. Percentage of yes for each item. *) Items with significant differences (p < .01) between service users and carers

Full size image

Similarities and differences in service users’ and carers’ experiences

As shown in the three figures, the service users’ and carers’ experiences of Norwegian CRT care were mostly similar. Significantly fewer carers than service users reported having received written information about the CRT on the first day, had been asked about children in the family and their needs, had received a list of prescribed medication, had attended a discharge meeting, or had been informed on access to crisis help in the future and other available local services or resources. However, significantly more carers than service users reported that they had used the CRT’s direct phone number and had been involved in care planning or reviews.

Discussion

In summary, most of the service users and carers reported that the CRT care reflected their needs and what they wanted. They found the care to be accessible, reliable, flexible, supportive, sensitive to choices about treatment types not limited to medication, psychological interventions, and involvement of other mental health services to a certain extent. However, most service users and carers did not experience other core CRT elements, such as 24/7 availability, high emphasis of home treatment, high intensity of care, practical and social help, gatekeeping of acute inpatient beds, and facilitation of early discharge from inpatient wards. The service users’ and carers’ experiences of the CRT care were mostly similar, but with some significant differences, mainly regarding involvement in care planning, provision of information on the CRT and other services, and involvement in the discharge process.

Experiences with organization of CRT care

High accessibility is a key element of CRT care. As reported in an earlier paper, we know that none of the CRTs in the study were operating 24 h, 7 days a week [6]. While 16 teams operated during extended hours on weekdays, and six of these also for some hours during weekends, the remaining 12 teams operated only during office hours on weekdays. Most needs during nights were expected to be met by GPs on call and other primary health services available 24/7. Still, an earlier study in Norway has shown that the likelihood of being admitted to an inpatient ward was significantly lower for patients treated by CRTs operating with extended hours than CRTs operating during office hours only [34].

High flexibility and reliability of CRTs regarding adjustment and keeping time for meetings were reported by most service users and carers. The same was reported for staff continuity, having a specific team member as a primary contact, and for team members being updated on the service user’s situation and needs.

Providing intensive care is also a key element of the CRT approach [1]. Our study confirmed previous findings of a lack of intensive care in Norwegian CRTs [6, 33]. We do not know if less intensive care was due to scarce resources or the treatment culture of the Norwegian CRTs, such as giving priority to longer meetings with the service users. Limited operating hours may also limit the provision of intensive care and CRT care for service users needing intensive care [6]. Service users and carers experienced the meetings as long enough to discuss their concerns, while sufficient time to talk was less provided in the UK [2]. Finding the balance between intensity of care and length of consultations might thus be important to optimize CRT care.

The lack of written treatment and discharge plans might reflect that CRT care is a short-term intervention and often a brief part of a longer care pathway involving other mental health services. However, the lack of written treatment and discharge plans in CRT care reflects a problem recognized in Norwegian mental health care, even though written treatment plans are statutory. CRTs may also find less need to write a treatment plan for service users who do not have a psychiatric disorder that needs further treatment after the CRT crisis intervention. Interviews with the Norwegian CRTs for the fidelity assessment showed that the teams did not use advance directives, which are not an established practice in Norway, but may collaborate with service users and carers forming written plans for actions in any future crises [6].

Experiences with the content of CRT care

The fact that Norwegian CRTs are reported to provide long meetings with emotional support and not only a medication focus may be a result of the Norwegian CRTs being multidisciplinary, including psychiatrists, psychologists, nurses, and social workers [31]. Morant et al. highlighted the importance of keeping “the broad biopsychosocial focus of the original CRT model and not operate using a more biomedical approach, enacted in brief home visits focused on medication and risk management with less psychosocial input” [16].

However, psychological support to many and medication and practical help to few may also reflect the needs of the service users. Compared to the UK, the Norwegian CRTs have a smaller proportion of patients with severe mental illnesses [5]. This may lead to less need for practical support and medication management in Norwegian CRTs and give more time for talking, which also may be important to facilitate a therapeutic alliance. The types of practical support mentioned as examples in the structured interviews were basic living needs (getting food, heating, cleaning, repairs), help to achieve benefits or handle debts, and help with urgent legal or social problems (including employment, housing, etc.).

The low number of service users being offered help or tests for physical health problems may also reflect a lower proportion of service users with severe illnesses, but also that the service users continue to use their general practitioners for help with physical health care during the weeks they get help for a mental crisis from the CRT. On the other hand, it may also reflect a limited focus from the CRTs on the service users’ physical health [16].

Experiences with the role of CRTs within the care system

Less than half of the service users reported being provided home-based CRT care, reflecting partly a substantial variation among Norwegian CRTs regarding providing home-based treatment [5, 6]. Contributing reasons for this may be level of resources (including limited operating hours), differences in treatment culture, differences in population density, and geographical distances between CRT location and service users’ homes [6]. However, service users with less severe mental problems may also have preferred meetings in the CRT location [6]. Some of the service users’ needs may also have been covered by other collaborating mental health services (like primary mental health care or other units at the community mental health center).

Some of the same factors, as well as not operating 24/7, may have contributed to the lack of gatekeeping of acute psychiatric beds and lack of facilitation of early discharge from inpatient wards [6]. However, the most important reason for this was probably that the national health authorities and the health trusts had not given the role of gate keeping acute beds to the crisis resolution teams [35].

Comparison of service users’ and carers’ experiences

For most questions in our study, service users and carers reported similar experiences, and there were significant differences for only a few questions. Some of the ingredients agreed upon by both groups have been deemed important in CRT care, like a holistic approach, relational aspects, inclusion of other mental health services, and accessibility [14, 16, 17]. Most of the questions in the Service User and Carer Structured Interviews were about concrete aspects of CRT care, and the response options were mostly dichotomous, which may partly explain the high agreement between service users and carers as this gave less room for partial disagreements.

The current study showed differences in how service users and carers experienced the exchange of information and discharge from CRTs. While the service users more often took part in a discharge meeting and received information, the carers reported that they were seldom included in discharge meetings and received less information about local services and how to access crisis help in the future. This is in line with other studies exploring the role and experiences of carers [20, 28].

According to Lamb et al. [36], critical ingredients in CRT care, like crisis planning and support for carers, are rarely provided at optimal levels and are likely to lead to the CRT model not functioning as intended. Brennan et al. described that carers often experience being burdened with responsibility [28], while simultaneously, they are left out when important decisions are made that influence their lives and the person they care for [37]. Our finding that carers were rarely included in this part of the CRT care confirmed these earlier studies. This seems contradictory to findings that collaborative crisis services are important to improve outcomes for both carers and service users [28]. Furthermore, carers are considered an important part of home-based treatment. They often provide significant daily life support to persons experiencing mental distress and being at risk of a relapse of a mental health crisis [38, 39]. They may also evaluate the situation regarding whether assistance is required differently than do the service users [40]. Home-based services like CRT have carer involvement and contribution as a prerequisite, and it is surprising when carers are not included in the planning and preparation for discharge [28].

Our study showed that most of the service users and carers were given a direct phone number to the CRT and that more carers than service users had used this number. A direct phone number to reach the CRT is a key element of the CRTs’ accessibility when service users and carers need to speak to a mental health professional for support or advice. Our finding indicates that this key element is of particular importance to carers.

Service users received a list of medication significantly more often than did the carers. This may seem like a plausible finding, given the fact that medication is considered confidential. However, carers are sometimes involved in the follow-up of the service user’s daily medication, indicating that in some cases, the CRT staff may involve service users and carers in joint meetings on medication and side effects.

More carers reported that they were involved in care planning and support than service users reported that carers were. This may have been due to carers being recruited from a recent sample of CRT care episodes where carers were involved, while service users may have been recruited from the total sample of recent CRT episodes. On the other hand, the involvement reported by carers is compatible with the enthusiasm many Norwegian CRTs have shown for an open dialogue approach involving family and network [41].

Morant found that carers in the UK stood out in reporting that they felt excluded from care processes and that their views were often not considered [16]. It has proven to be important in a recovery process that service users and carers are actively involved in choice regarding types of treatment. Involvement and collaboration can also contribute to the transfer of experience-based knowledge from service users and carers to service providers.

Strengths and limitations

One strength of the study was the larger number of service users and carers than in previous qualitative studies on service users’ and carers’ experiences with CRT care. Furthermore, the informants represented half of the Norwegian CRTs in most health trusts in both rural and urban areas in all health regions. This suggests that the data may be representative of service users and carers of such teams in Norway. However, the sample may have been biased toward positive experiences, as the service users and carers recruited by the CRT for interviews may have been among those with a predominantly good relationship to the CRT. Also, several raters participating in the evaluation team may have introduced some unknown variances in conducting the structured interviews, despite joint training and close collaboration between raters.

One strength is that two experts by experience were co-researchers and members of the research group. Being interviewed by an expert by experience may have made service users and carers feel safe and understood and made it easier for them to share their experiences. It may also have improved recruitment to interviews if the CRT told potential informants that experienced service users were among the researchers. The co-researchers also contributed to the interpretation and discussion of the results.

One limitation is the lack of information on sociodemographic or other characteristics of the service users and carers and the lack of information on who was related and had experienced the same CRT care episode. Differences in characteristics of CRT care episodes reported by service users and carers may also have influenced the comparison of their experiences in unknown ways. Lack of graded response scales may have limited the sensitivity to measure differences in experiences. The structured interviews with specific questions and closed response alternatives did not give the service users and carers any possibility to tell of other experiences or choose other alternative responses. The cross-sectional design of the study did not allow the research to draw any conclusion on causality. The study was conducted within a Norwegian context, which may limit generalizability to other contexts.

Conclusion

Most of the service users and carers reported that the CRT care reflected their needs and what they wanted. The CRTs were accessible, reliable, flexible, supportive, sensitive, and with a range of interventions beyond medication. Limitations were lack of high intensity of care, limited written treatment and discharge plans, limited provision of home treatment, and lack of gatekeeping of acute beds. The service users’ and carers’ experiences of the CRT care were mostly similar, but with significant differences regarding involvement in care planning and discharge preparation.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CRT:

Crisis Resolution Team

CMHC:

Community Mental Health Center

References

  1. Johnson S, Needle J, Bindman JP, Thornicroft G. Crisis resolution and home treatment in mental health. Cambridge: Cambridge University Press; 2008.

    Book  Google Scholar 

  2. Lloyd-Evans B, Bond GR, Ruud T, Ivanecka A, Gray R, Osborn D, et al. Development of a measure of model fidelity for mental health crisis resolution teams. BMC Psychiatry. 2016;16(1):427.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Klevan TG, Karlsson BE, Ruud T. “At the extremities of life” – service user experiences of helpful help in mental health crises. Am J Psychiatr Rehabil. 2017;20(2):87–105.

    Article  Google Scholar 

  4. Winters S, Magalhaes L, Kinsella EA. Interprofessional collaboration in mental health crisis response systems: a scoping review. Disabil Rehabil. 2015;37(23):2212–24.

    Article  PubMed  Google Scholar 

  5. Hasselberg N, Grawe RW, Johnson S, Ruud T. An implementation study of the crisis resolution team model in Norway: are the crisis resolution teams fulfilling their role? BMC Health Serv Res. 2011;11:96.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hasselberg N, Holgersen KH, Uverud GM, Siqveland J, Lloyd-Evans B, Johnson S, et al. Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway. BMC Psychiatry. 2021;21(1):231.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Karlsson B, Borg M, Eklund M, Kim HS. Profiles of and practices in crisis resolution and home treatment teams in Norway: a longitudinal survey study. Int J Ment Health Syst. 2011;5(1):19.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wheeler C, Lloyd-Evans B, Churchard A, Fitzgerald C, Fullarton K, Mosse L, et al. Implementation of the crisis resolution team model in adult mental health settings: a systematic review. BMC Psychiatry. 2015;15:74.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Carroll A, Pickworth J, Protheroe D. Service innovations: an Australian approach to community care – the northern crisis assessment and treatment team. Psychiatr Bull. 2001;25(11):439–41.

    Article  Google Scholar 

  10. Hopkins C, Niemiec S. Mental health crisis at home: service user perspectives on what helps and what hinders. J Psychiatr Ment Health Nurs. 2007;14:310–8.

    Article  CAS  PubMed  Google Scholar 

  11. Johnson S, Nolan F, Hoult J, White IR, Bebbington P, Sandor A, et al. Outcomes of crises before and after introduction of a crisis resolution team. Br J Psychiatry. 2005;187:68–75.

    Article  PubMed  Google Scholar 

  12. Johnson S, Nolan F, Pilling S, Sandor A, Hoult J, McKenzie N, et al. Randomised controlled trial of acute mental health care by a crisis resolution team: the North Islington crisis study. BMJ. 2005;331(7517):599.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Murphy SM, Irving CB, Adams CE, Waqar M. Crisis intervention for people with severe mental illnesses. Cochrane Database Syst Rev. 2015;2015(12):Cd001087.

  14. Winness MG, Borg M, Kim HS. Service users’ experiences with help and support from crisis resolution teams. A literature review. J Ment Health. 2010;19(1):75–87.

    Article  PubMed  Google Scholar 

  15. Lloyd-Evans B, Osborn D, Marston L, Lamb D, Ambler G, Hunter R, et al. The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial. Br J Psychiatry. 2019;216(66):314–22.

    Google Scholar 

  16. Morant N, Lloyd-Evans B, Lamb D, Fullarton K, Brown E, Paterson B, et al. Crisis resolution and home treatment: stakeholders’ views on critical ingredients and implementation in England. BMC Psychiatry. 2017;17(1):254.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Agar-Jacomb K, Read J. Mental health crisis services: what do service users need when in crisis? J Ment Health. 2009;18(2):99–110.

    Article  Google Scholar 

  18. Voronka J, Wise Harris D, Grant J, Komaroff J, Boyle D, Kennedy A. Un/helpful help and its discontents: peer researchers paying attention to street life narratives to inform social work policy and practice. Soc Work Ment Health. 2014;12(3):249–79.

    Article  Google Scholar 

  19. National Audit Office. Helping people through mental health crisis: the role of crisis resolution and home treatment services. London: The Stationary Office; 2007.

    Google Scholar 

  20. Klevan TG, Davidson L, Ruud T, Karlsson BE. “We are different people”: a narrative analysis of carers’ experiences with mental health crisis and support from crisis resolution teams. Soc Work Ment Health. 2016;14(6):658–75.

    Article  Google Scholar 

  21. Lloyd-Evans B, Johnson F. Crisis resolution teams: how are they performing? Ment Health Today. 2014:18–9.

  22. van Oenen FJ, Schipper S, Van R, Visch I, Peen J, Cornelis J, et al. Involving relatives in emergency psychiatry: an observational patient-control study in a crisis resolution and home treatment team. J Fam Ther. 2018;40(4):584–601.

    Article  Google Scholar 

  23. Brice GH Jr, Swarbrick MA, Gill KJ. Promoting wellness of peer providers through coaching. J Psychosoc Nurs Ment Health Serv. 2014;52(1):41–5.

    Article  PubMed  Google Scholar 

  24. Burns-Lynch B, Murphy AA, Gill KJ, Brice G. Persons in recovery, family members, and staff perspectives of psychiatric crisis needs. Am J Psychiatr Rehabil. 2014;17(2):114–27.

    Article  Google Scholar 

  25. Broady TR, Stone K. “How can I take a break?” coping strategies and support needs of mental health Carers. Soc Work Ment Health. 2014;13(4):318–35.

    Article  Google Scholar 

  26. Rowe J. A covenant between mental health services and family carers. Ment Health Pract. 2012;16(2):22–3.

    Article  Google Scholar 

  27. Borg M, Haugård E, Karlsson B. It does not work without us’ – Carers’ experiences with mental health crisis [‘Uten Oss går det ikke’ – pårørendes erfaringer med psykisk krise]. Nordic Journal for Health Research [Nordisk tidsskrift for helseforskning]. 2012;8(2):16–29.

    Article  Google Scholar 

  28. Brennan A, Warren N, Peterson V, Hollander Y, Boscarato K, Lee S. Collaboration in crisis: Carer perspectives on police and mental health professional's responses to mental health crises. Int J Ment Health Nurs. 2016;25(5):452–61.

    Article  PubMed  Google Scholar 

  29. Landeweer E, Molewijk B, Hem MH, Pedersen R. Worlds apart? A scoping review addressing different stakeholder perspectives on barriers to family involvement in the care for persons with severe mental illness. BMC Health Serv Res. 2017;17(1):349.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Weimand BM, Sällström C, Hall-Lord ML, Hedelin B. Nurses’ dilemmas concerning support of relatives in mental health care. Nurs Ethics. 2013;20(3):285–99.

    Article  PubMed  Google Scholar 

  31. Ruud T, Hasselberg N, Holgersen KH, Uverud GM, Foss T, Neuhaus S. 1000 patients and 25 crisis resolution teams. Who are they, what was done and what happened? Results from a multi-centre study on outcome of treatment by crisis resolution teams in mental health services. [1000 pasienter og 25 akutteam. Hvem er de, hva ble gjort og hvordan gitt det? Resultater fra en multisenterstudie om utfall av behandlingen ved ambulante akutteam i psykisk helsevern]. Lørenskog: Akershus University Hospital; 2016.

  32. Ruud T, Friis S. Community-based mental health Services in Norway. Consortium Psychiatricum. 2021;2(1):47–54.

    Article  Google Scholar 

  33. Ruud T, Karlsson B, Klevan T, Hasselberg N. Crisis resolution teams in mental health services. Practice and experiences [Ambulante akutteam i psykisk helsevern: Praksis og erfaringer]. Lørenskog: Akershus University Hospital; 2015.

    Google Scholar 

  34. Hasselberg N, Grawe RW, Johnson S, Saltyte-Benth J, Ruud T. Psychiatric admissions from crisis resolution teams in Norway: a prospective multicentre study. BMC Psychiatry. 2013;13:117.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Helsedirektoratet. Organisation and practice of crisis resolution teams at community mental health centres (DPS). Report IS-2156. [Organisering og praksis i ambulante akutteam ved distriktspsykiatriske sentre (DPS). Rapport IS-2156]. Oslo: Norwegian Directorate of Health [Helsedirektoratet]; 2014.

  36. Lamb D, Lloyd-Evans B, Fullarton K, Kelly K, Goater N, Mason O, et al. Crisis resolution and home treatment in the UK: a survey of model fidelity using a novel review methodology. Int J Ment Health Nurs. 2020;29(2):187–201.

    Article  PubMed  Google Scholar 

  37. Lavoie JAA. Relative invisibility: an integrative review of carers’ lived experiences of a family member’s emergency mental health crisis. Soc Work Ment Health. 2018;16(5):601–26.

    Article  Google Scholar 

  38. Albert R, Simpson A. Double deprivation: a phenomenological study into the experience of being a carer during a mental health crisis. J Adv Nurs. 2015;71(12):2753–62.

    Article  PubMed  Google Scholar 

  39. Griffiths M, Allen J, Patel K, Bell V. Promoting family inclusive practice in home treatment teams. J Ment Health Train Educ Pract. 2020;15(5):261–73.

    Article  Google Scholar 

  40. Lyons C, Hopley P, Burton CR, Horrocks J. Mental health crisis and respite services: service user and carer aspirations. J Psychiatr Ment Health Nurs. 2009;16(5):424–33.

    Article  CAS  PubMed  Google Scholar 

  41. Buus N, Bikic A, Jacobsen EK, Muller-Nielsen K, Aagaard J, Rossen CB. Adapting and implementing open dialogue in the Scandinavian countries: a scoping review. Issues Ment Health Nurs. 2017;38(5):391–401.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the service users and carers for participating in interviews and sharing their experiences with CRT care. We thank the team leaders, team members, and mercantile staff in the crisis resolution teams for collaboration and information during the data collection, the members of the fidelity evaluation team for the data collection, and the staff in the Department for Research and Development in Mental Health Services at Akershus University Hospital for administrative support and electronic recording of data.

Funding

The study was financed by the participating health trusts and the authors’ affiliations through the work of all contributors involved and by additional funding from the Norwegian Directorate of Health for the fidelity assessment of the crisis resolution teams.

Author information

Authors and Affiliations

  1. Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway

    Nina Hasselberg, Bente Weimand, Johan Siqveland & Torleif Ruud

  2. Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway

    Trude Gøril Klevan & Bente Weimand

  3. University of South-Eastern Norway, Notodden, Vestfold, Norway

    Gunn-Marit Uverud

  4. Nidelv Community Mental Health Center, Clinic of Mental Health, St Olavs hospital, Trondheim, Norway

    Katrine Høyer Holgersen

  5. Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway

    Katrine Høyer Holgersen

  6. National Center for Suicide Research and Prevention, University of Oslo, Oslo, Norway

    Johan Siqveland

  7. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Torleif Ruud

Authors
  1. Nina Hasselberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Trude Gøril Klevan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bente Weimand
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gunn-Marit Uverud
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katrine Høyer Holgersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Johan Siqveland
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Torleif Ruud
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

N.H. conducted the fidelity assessments as leader of the evaluation team and drafted the manuscript. G.M.U. took part in the fidelity assessment as a member of the evaluation team. N.H., G.M.U., T.G.K., B.W., and T.R. analyzed the data. T.R. conceived the study and was the principal investigator. All authors took part in writing the manuscript, and all read and approved the final manuscript for submission.

Corresponding author

Correspondence to Torleif Ruud.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Regional Committee for Medical Research Ethics South-East Norway (reg. no. 2012/1458a) and by the Data Protection Officers in each of the 15 health trusts with participating crisis resolution teams. All patients in the multi-center study signed an informed consent to participate in the study. However, no data was collected on the 111 service users and 86 carers interviewed on the CRT practice, and we subsequently did not ask them for a written consent. The study followed the principles in the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hasselberg, N., Klevan, T.G., Weimand, B. et al. Similarities and differences between service users’ and carers’ experiences of crisis resolution teams in Norway: a survey. BMC Psychiatry 22, 266 (2022). https://doi.org/10.1186/s12888-022-03928-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12888-022-03928-w

Keywords

BMC Psychiatry

ISSN: 1471-244X

Contact us