Effectiveness of a Crisis Resolution and Home Treatment Program for the Acute Treatment of Severe Mental Illness

The Catalan Government established in 2017 the creation of Crisis Resolution and Home Treatment teams (CRHT) as an alternative treatment for psychiatric crises in the community. Since then, different programs have been developed with great heterogeneity.

The following study evaluates a CRHT program in terms of Patient Reported Outcomes Measures and helps creating a homogeneous model.

We conducted a quasi-experimental study of the patients attending the CRHT during 2021. Patients were assessed on admission and at discharge. Demographic, clinical and functional variables were considered as well as satisfaction and family burden. Primary outcome variables were analyzed in 175 patients by intention-to-treat (ITT) as well as per protocol (PP) in 161 patients.

The Health of the Nation Outcome Scale (HoNOS) mean decreased 4.2 points whereas The Global Assessment of Functioning scale (GAF) improved 13 points. The mean difference in The EuroQoL-5D-3L Health Questionnaire (EQ-5D-3L) was 0,05. The Positive and Negative Syndrome scale (PANSS) mean was reduced by 16 points in the patients with psychosis. 137 patients reported depressive symptoms. The Zarit Burden Interview (ZBI) scale was assessed in 135 caregivers, of whom 60% had low or any burden. Satisfaction levels were considered in 92 patients and their caregivers, with a total mean of 28,7 in the Encuesta de satisfacción con los servicios de atención domiciliaria (SATISFAD) scale.

The program has proved its effectiveness in resolving crisis with an improvement in clinical, functional and social aspects. Changes in the HoNOS, the GAF and the PANSS scale were significant, whereas the increase in quality of life was less relevant. It resulted remarkable the high prevalence of depressive symptoms, even with no diagnostic for depression. The perceived satisfaction of patients and families was notorious, with low levels of burden.