Crisis houses and similar approaches to providing respite or sanctuary outside of hospital have been developing alongside CRHT and hospital approaches. They have strong support from service user groups.
These are community-based crisis services that offer residential support and include:
- Clinical crisis houses
These services are similar in many features to hospital based services although located within community settings69. They provide residential services with staff onsite through the night and have a high level of clinical staff involved in providing onsite care.
- Specialist crisis houses
These services share similar features to Clinical crisis houses but are aimed at specific groups such as women70 and people with early psychosis.
- Crisis team beds
These services provide a small number of beds aimed at short stays and are fully integrated with CRHT teams.
- Non-clinical alternatives71
Mainly managed by the voluntary sector with few clinical staff but many have also forged strong links with CRHT teams.
Crisis houses however will be relevant for a relatively restricted population and may have modest benefits if home treatment is properly equipped and fully functional. Where crisis houses have been unsuccessful, this is where staffing is low and remote from inpatient units. Inevitably difficulties have arisen in coping with disturbed behaviour or they have ended up providing residential care to a group of patients who would not usually have been admitted. Peer support crisis initiatives can be positive but will be constrained by what levels of crisis it is appropriate for peers to manage and the support peers need.
Nevertheless a recent service evaluation of a community-based mental health crisis house in inner city Liverpool showed significant improvements in symptoms, social functioning, mood and activities of daily living, and a reduction in risk issues72.