ABSTRACT
Information was obtained from the case notes of 118 clients referred to the Tower Hamlets Crisis Intervention Service (CIS) for the first time during 1984–1985, from interviews with twenty-nine GPs, thirty SWs and twenty-three other professionals who had made referrals during this period and from interviews with 107 clients of the service.
The CIS is a part of the wider range of psychiatric and social services in Tower Hamlets. Run jointly by the District Health Authority and the Local Authority it offers the help of a multidisciplinary team (which may or may not include a psychiatrist) to assess and support families in crisis in the borough. Referrals are accepted from GPs, SWs and other professional caregivers and the presence of psychiatric illness in the family is not a condition of acceptance (although the presence of a family living in the borough is). The therapeutic approach is eclectic but with a special interest in the enhancement of family support. Clients of the service tend to be young and female.
Although few of the clients referred to the service were psychotic the serious nature of the crises referred to the service was evident from both the opinion of referrers and from the clients themselves. Seventy-nine percent of clients were thought to have a diagnosable psychiatric condition.
Both clients and referrers provided evidence to support the view that the service provided by the CIS is effective, efficient, appropriate, equitable, acceptable and, 131to most, accessible. It was thought less acceptable to the substantial Bangladeshi population in Tower Hamlets.
Contrary to expectation clients whose families did not attend meetings with the team benefited as much as those whose families did.
The service was also valued as providing training opportunities for members of the caring professions.
This paper reports an evaluation of an innovative Crisis Intervention Service (CIS) in an inner city borough (Tower Hamlets).
A companion paper (Parkes 1992) reported the views of Social Workers (SWs) and General Practitioners (GPs) regarding twelve services available to families in crisis in this borough. These SWs and GPs commonly see people in crisis although few of them think that the training that they received ‘usually’ prepares them to cope adequately with these crises. They had found the Tower Hamlets CIS the most helpful service for people in crisis; it was also the most accessible and the feedback received from the service most prompt and satisfactory. An emergency clinic at a psychiatric hospital provided a more rapid response than the CIS (which is only available during the working day) but was seen as less helpful and the feedback was poor.
There are many kinds of crisis service (Cooper 2008). Most are only open to people who have been diagnosed as mentally ill. They facilitate rapid admission to short-stay in-patient services with the backup of multidisciplinary teams working in the community. Others attempt to keep patients out of hospital by providing support to patients and their families in the community. Several of these have demonstrated striking reductions in the rate and duration of hospital admissions without detriment to the subsequent health or social adjustment of the patient (Langsley, Machotka and Cowenhalf 1971; Ratna 1978; Reynolds, Jones and Barry 1990).
The Tower Hamlets CIS was set up as a joint health and social services project in 1976. It provides a multidisciplinary team who visit families in crisis in order to provide assessment of their needs and, when appropriate, short-term support in the community. It differs from most other crisis services in attempting to prevent as well as treat mental ill health. Thus it accepts referrals from a range of professional caregivers and is not limited to people with overt mental illness, defining a crisis as any situation which creates distress in a family. The family is seen as the unit of care. Although the team is free to make use of the full range of psychiatric and social work services, the preferred method of treatment is short-term family therapy aimed at reinforcing or restoring the family as a support system to its members. Most assessment and treatment is carried out in the home. Case notes are ‘family’ and ‘problem’ oriented.
This paper reports the results of an evaluation of the service as seen through the eyes of referrers and clients of the service.
