Quality standard

Quality statement 7 (developmental): Home treatment in crisis

Quality statement 7 (developmental): Home treatment in crisis

Developmental quality statements set out an emergent area of cutting‑edge service delivery or technology currently found in a minority of providers and indicating outstanding performance. They will need specific, significant changes to be put in place, such as redesign of services or new equipment.

Quality statement

Children and young people with bipolar disorder, psychosis or schizophrenia who are in crisis are offered home treatment if it is suitable.

Rationale

Hospital admissions can be disruptive for a child or young person and their family or carers. It may be possible to avoid hospital admission if treatment and support can be provided at home. A crisis assessment will determine whether home treatment is a suitable option, based on the child or young person's needs, risks and circumstances.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that children and young people with bipolar disorder, psychosis or schizophrenia who are in crisis are offered home treatment if it is suitable.

Data source: Local data collection.

Process

a) Proportion of crisis episodes in children and young people with bipolar disorder, psychosis or schizophrenia that are assessed for the suitability of home treatment.

Numerator – the number in the denominator that are assessed for the suitability of home treatment.

Denominator – the number of crisis episodes in children and young people with bipolar disorder, psychosis or schizophrenia.

Data source: Local data collection.

b) Proportion of crisis episodes in children and young people with bipolar disorder, psychosis or schizophrenia that are assessed as suitable for home treatment and result in home treatment.

Numerator – the number in the denominator that result in home treatment.

Denominator – the number of crisis episodes in children and young people with bipolar disorder, psychosis or schizophrenia that are assessed as suitable for home treatment.

Data source: Local data collection.

Outcome

Mental health admission rates for children and young people.

Data source: Local data collection. National data are collected in the NHS Digital Child and Adolescent Mental Health Services secondary uses data set with Mental Health Services Data Set (MHSDS).

What the quality statement means for different audiences

Service providers (such as child and adolescent mental health services and early intervention in psychosis services) ensure that home treatment is available for children and young people with bipolar disorder, psychosis or schizophrenia who are in crisis.

Health and social care practitioners (such as psychologists and social workers) assess the suitability of home treatment for children and young people with bipolar disorder, psychosis or schizophrenia who are in crisis.

Commissioners (clinical commissioning groups and NHS England) commission home treatment services for children and young people with bipolar disorder, psychosis or schizophrenia who are in crisis.

Children and young people with bipolar disorder, psychosis or schizophrenia who have a crisis should have a discussion with their mental health professional to agree if treatment at home would be better for them than treatment in hospital. Treatment in hospital can be very disruptive (for example, they may miss time in school).

Source guidance

Psychosis and schizophrenia in children and young people: recognition and management. NICE guideline CG155 (2013, updated 2016), recommendations 1.5.7 (key priority for implementation), 1.5.2 and 1.5.3

Definitions of terms used in this quality statement

Crisis

A crisis may be suicidal behaviour or intention, panic attacks or extreme anxiety, psychotic episodes, or behaviour that seems out of control or irrational and likely to endanger the person or others. [Department of Health and Social Care's Mental health crisis care concordat (2014) and expert opinion]

Assessment for suitability for home treatment

A crisis assessment should be carried out by health and social care professionals who are experienced and competent in crisis working. The decision to start home treatment should depend not on the diagnosis, but on:

  • the level of distress

  • the severity of the problems

  • the vulnerability of the child or young person and issues of safety and support at home

  • the child or young person's ability to adhere to treatment.

[NICE's guideline on service user experience in adult mental health, recommendation 1.5.3, and NICE's guideline on psychosis and schizophrenia in children and young people, recommendation 1.5.3]

Home treatment

A service that assesses, supports and provides treatment at home to promote engagement and avoid admission to hospital. The service should be available 24 hours a day, 7 days a week. [NICE's guideline on service user experience in adult mental health, recommendation 1.5.7 and full guideline]

Equality and diversity considerations

Home treatment should be available to all children and young people with bipolar disorder, psychosis or schizophrenia in crisis, regardless of their age, if it is assessed as suitable.

Children and young people with psychosis from black and minority ethnic backgrounds are more frequently subject to compulsory admissions. It is therefore important that health and social care practitioners take into consideration ethnic and cultural backgrounds when making assessments for suitability for home treatment, so that compulsory admission is avoided whenever possible.