In crisis mode

Crisis Houses could offer an alternative, more holistic, way to support people recovering from a period of mental distress, easing pressure on over-subscribed NHS services


Image: Istock

Michael Broad

Researcher, Campbell Tickell

There is no doubt that the Covid-19 pandemic has left its scars. According to the Office for National Statistics, self-reported moderate to severe depression cases in Great Britain are up 10% compared to pre-pandemic levels.

Covid-19 has led to livelihoods being lost, lockdown-induced trauma, loneliness and grief, all of which has had an impact on people’s wellbeing. Throughout the pandemic:

  • In England, 4.8 million more people consumed alcohol at higher risk levels
  • Nationally the number of adults seeking treatment for opioid addiction increased by 20%
  • Refuge, a national domestic abuse helpline, reported a 60% increase in calls and online chat use
  • NHS anti-depressant prescriptions have also increased by 5% and talking therapy referrals have decreased by a third.

Common sense tells us that doctors cannot prescribe a pill to heal long-term traumas. However, one option that can contribute to recovery is that of Crisis Houses.

Recovery solution

Crisis houses can vary and offer slightly different services. However, they usually offer:

  • Overnight accommodation
  • A small number of beds
  • A home-like environment
  • 24/7 emotional support and a keyworker

Most services do not have medical staff on site, but community mental health teams visit service users during their stay. Depending on the service, stays vary between 2-4 weeks. Crisis Houses can act as an alternative to hospital. However, they are not suitable for patients detained under the Mental Health Act.

Need for research

As a service model, Crisis Houses are woefully under-researched. The little evidence available points to the model's potential – three interesting recent research studies indicate that there are a number of benefits:

In 2019, the BMJ found the service created statistically significant improvements in accidental self-injury, substance misuse, hallucinations and feelings of personal safety.

Another study found that an individual’s stay in a Crisis House is 19 days shorter than on an acute hospital ward. This translated to the service saving around £742,000 per year for the NHS.

In 2021 the Psychological, Social and Integrative Approaches Journal published the findings of semi-structured interviews of discharged hospital inpatients and of woman-only crisis house service users. Focusing on users with domestic violence traumas, hospital inpatients felt ‘coercive measures’ led to distrust in staff. While acknowledging hospitalisation kept them physically safe, many felt the experience replicated and worsened their traumas.

In contrast, Crisis House service users felt that the non-clinical, home-like environment led them to build collaborative, trusting relationships with support staff. It made them feel valued as an individual and able to open up.

In this woman-only Crisis House, service users could feel physically safe and recover by sharing experiences with their peers. The freedom to come and go from the house (i.e. they were not being locked in, as might be the case on psychiatric ward) enabled them to keep social ties and employment. This further supported their recovery when they left the Crisis House.

Users felt trusting relationships enabled them to inform staff when they were triggered to engage in dangerous behaviour (suicidal ideation and self-harm). Not only did talking prevent these behaviours, but it also enabled them to find effective coping strategies.

“Crisis House service users felt that the non-clinical, home-like environment led them to build collaborative, trusting relationships with support staff. It made them feel valued as an individual and able to open up.”

Cost-effective model

While the research is scant the studies cited above do point to a cost-effective model that is better for people and better for the NHS in terms of cost savings and reduced pressure on already over-subscribed services.

The NHS is currently grappling with a backlog of need. Latest estimates say there are six million people waiting for treatment and the Health Secretary has said that it could take two years or more to clear this.

Crisis Houses can relieve pressure on the NHS and provide more holistic and recovery-focused support. This enables people to pick up their life as soon as possible after a period of mental distress and should be part of the pathway of treatment options available in every community.


Why we must invest in mental health research


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