Crisis houses

1. Introduction

Version followed: the UK residential crisis house model as described by the NIHR/SDO "Alternatives Study" group (Johnson, Gilburt, Lloyd-Evans, Slade, Morant, Osborn and colleagues, 2007–2010). Its working detail comes from four published exemplars: Drayton Park Women's Crisis House (NHS, Camden & Islington), Maytree (charity, non-medical suicide respite, London), Sheffield Crisis House (run by Rethink for the NHS) and the Rotherham Crisis Alternative service specification (v1.1, 2024). Where these differ, each is named.

A crisis house is a service model, not a therapy. It is a small residential unit, usually in an ordinary converted house, that offers a short stay with 24-hour support to adults in acute mental health crisis. It is meant for people who cannot be supported at home but do not need, or do not want, an acute ward [source: Johnson et al. 2007; Sheffield Crisis House page]. The Alternatives Study describes three main types [source: Johnson et al. 2007; Johnson, Morant et al., Implementing alternatives]:

• Clinical crisis houses: NHS-run, staffing closer to a ward's, may accept detained patients.
• Non-clinical crisis houses: voluntary-sector, few mental-health-qualified staff, often accept self-referral. Some serve specific groups, such as Black communities or women.
• Crisis team beds: beds in a hostel or community unit, closely integrated with a crisis resolution and home treatment team (CRHT).

Related variants include family-sponsor or host-family placement (Denver and Madison historically; Powys, Hertfordshire and Lille more recently) and evening sanctuaries such as Dial House in Leeds, which is non-residential and open until 2am [source: Johnson et al. 2007; Mind 2011].

How change is meant to happen. The house removes the person briefly from the setting of the crisis into a calm, domestic, less coercive place. There, daily one-to-one talk, informal everyday care and practical help let the person rest. Staff help the person make sense of how the crisis developed, rebuild coping strategies and sort out pressing practical problems, while keeping links to work, friends and community. The person then returns home quickly with a plan and follow-up. Service users rate these houses as less coercive, more supportive and more autonomy-granting than wards [source: Johnson, Morant et al.; Osborn et al. 2010; Mind 2011]. Maytree frames its version as befriending: an equal, non-judgemental relationship in which suicidal thoughts can be spoken about openly, because isolation is seen as central to suicide [source: Centre for Public Impact, Maytree case study].

This guide is written for a clinician working in a crisis house or referring to one: a CRHT, CMHT or liaison clinician, a care coordinator, or a psychologist or therapist supporting a stay.

2. Framework

There are no therapy phases. The sequence below is the published care pathway, assembled from the exemplars. Steps marked [synthesis] are ordering choices made for this guide.

Length of stay varies by version:

• Maytree: one stay only, four nights / five days, with no repeat stays.
• Sheffield: at most 5 nights.
• Rotherham: at most 7 nights. Delayed-discharge stays are up to 3 nights, Friday to Monday. Extensions need joint agreement and only happen in exceptional circumstances.
• Drayton Park: one week at first, extendable to a maximum of four weeks.
• Host families (Hertfordshire): 3–12 weeks.

[source: Maytree case study; Sheffield page; Rotherham spec; Drayton Park page; Mind 2011]

Scale and staffing (examples):

• Sheffield: 6 bedrooms.
• Rotherham: 1–2 places, with one staff member sleeping in overnight (sleeping, not waking, nights).
• Gofal (Wales): 1:2 staff-to-resident ratio.
• Maytree: 4 beds; two staff and three volunteers by day, two volunteers sleeping in at night.
• Drayton Park: an all-women team on site 24 hours, plus two body therapists.

[source: as cited above; Mind 2011]

Medical cover. In non-clinical houses and crisis team beds, CMHTs usually provide medical cover. People stay under their CMHT or CRHT, which keeps clinical responsibility [source: Johnson, Morant et al.; Rotherham spec].

3. Guiding principles

• An alternative to admission and the least restrictive option. Ask "could this person avoid a ward here?" before sending them to one [source: Rotherham spec; Sheffield page].
• Homely, domestic setting. Keep it a house, not a ward: own bedroom, kitchen, shared meals, ordinary furniture [source: Johnson, Morant et al.; Drayton Park page].
• Voluntary stay and less coercion. Satisfaction depends largely on feeling less coerced and having a voice. Negotiate rather than impose [source: Osborn et al. 2010; Johnson, Morant et al.]. Most non-clinical houses see detained patients as incompatible with their ethos.
• Choice and the person's own definition of crisis. Take the person's account of what counts as a crisis seriously, and offer self-referral where the model allows it [source: Mind 2011; Drayton Park page].
• Guest, not patient; equality in the relationship. Maytree's befriending treats guests as equals. Mind urges staff to treat people "as guests" and to spend time with them. In practice: sit, eat and talk with people [source: Maytree case study; Mind 2011].
• Talk openly about suicide. Ask about suicidal thoughts directly every day. Do not avoid the subject [source: Maytree case study].
• Limits as part of the treatment. Fixed, short stays and clear boundaries prevent over-dependence and keep the crisis focus. State the end date at the start [source: Maytree case study; Johnson, Morant et al.].
• Holistic, recovery-oriented and less medicalised. Focus on the person's story, coping and practical life. Still check that medication and physical health are covered, since sources note these get less attention than on wards [source: Johnson, Morant et al.].
• Trauma-informed, with gender-safe options. Explore and validate disclosures of past or current abuse. A women-only setting helps some women feel safe [source: Drayton Park page; Johnson et al. 2007].
• Keep the person's life going. Support them to keep working, studying and seeing friends during the stay [source: Johnson, Morant et al.; Mind 2011].
• Peer support and lived experience. Encourage mutual support among residents. Use staff or volunteers with lived experience of crisis where the model includes them [source: Johnson, Morant et al.; Mind 2011; Maytree case study].
• Positive risk-taking, supported. Staff need backing to hold manageable risk outside hospital rather than escalating by reflex [source: Mind 2011].
• Clear remit, defended. Keep referral criteria clear and resist pressure from statutory services to take people beyond what the house is staffed for, or to waive time limits [source: Johnson, Morant et al.].
• Joint working with the crisis team. The house works alongside CRHT and CMHT, not in their place. Agree who reviews, who prescribes and who follows up [source: Johnson, Morant et al.; Rotherham spec].
• Small kindnesses matter. Ordinary warmth (a cup of tea, company at a meal) is part of the work, and staff can be professional while remaining themselves [source: Mind 2011].
• Personalised, not generic, advice. Generic suggestions like "have a bath" can feel like rejection. Tailor every coping suggestion to the person [source: Mind 2011].

4. Intervention inventory

These are the service components the sources describe. None of the sources publishes a session-by-session manual. The step-by-step detail below is put together from the exemplars, and any steps beyond what a source states are marked [synthesis]. All example language is illustrative.

4.1 Referral and gatekeeping

• Purpose / when: To route a person in crisis to the least restrictive setting that can safely hold them. Consider a crisis house when home treatment is not enough, for example when the home environment is harmful, carers cannot continue, the person lives alone and feels unsafe, or there is self-neglect. Consider it before a ward [source: Johnson et al. 2007; Rotherham spec].
• Steps:
  1. Assess face to face. Rotherham requires an up-to-date FACE risk assessment plus current assessment and review notes.
  2. Discuss the options with the person. Sheffield's teams explicitly offer the house as an alternative to admission.
  3. Phone the house, then send the agreed referral form.
  4. Disclose any reasonable adjustments needed.
  5. Agree the arrival time and give a verbal handover.
  6. Where the model allows self-referral (Drayton Park, Maytree, Crisis Point Manchester), tell the person they can phone directly.
  [source: Rotherham spec; Sheffield eligibility page; Drayton Park page; Mind 2011]
• Example language (illustrative): "There is a house nearby, not a hospital, where you'd have your own room and staff around day and night for a few days. Would you like to hear what it's like?"
• Watch for: Slow referral and admission, especially at night. Delays of one to three days sometimes ended in admission, so phone early [source: Johnson, Morant et al.]. Referrers may not know the house exists, which is a known under-use problem [source: Johnson, Morant et al.].

4.2 Suitability and exclusion assessment

• Purpose / when: To decide whether the house can safely meet the person's need. Use this at every referral.
• Steps: Check against the published criteria for the house in question.
  • Sheffield: aged over 18; in crisis; able to engage with staff in a non-clinical setting; able to carry out daily living activities; registered with a local GP.
  • Rotherham exclusions: acutely unwell, or an immediate or significant risk to self or others that needs ward-level care; no suitable place to go on discharge; likely to need more than 7 nights; lacks capacity to understand why they are being admitted; cannot manage self-care or medication with no more than minimal prompting; cannot stay free of illicit drugs and alcohol; under 18.
  • Maytree exclusions: acute mental illness; no home to return to; active drug or alcohol problems.
  • Detained patients: only clinical houses, and some team-bed or non-clinical houses for people on leave, accept people under a section.
  [source: Sheffield eligibility page; Rotherham spec; Maytree case study; Johnson, Morant et al.]
• Example language (illustrative): "The house has staff overnight but they sleep rather than stay awake, so I need to check with you how safe you'd feel at night there."
• Watch for: Rotherham's "sleeping nights" staffing means night-time risk must be judged carefully. Refusing unwell people frustrates referrers, so give the reasons and an alternative [source: Rotherham spec; Johnson, Morant et al.].

4.3 Pre-stay telephone befriending (Maytree version)

• Purpose / when: To build a relationship and judge fit before the stay. Specific to Maytree-type suicide respite.
• Steps: Volunteers make 4–5 befriending phone calls and write reports. Staff review the reports, then assess the person by phone or in person [source: Maytree case study].
• Example language (illustrative): "I'm calling to see how today has been, and you can talk about the suicidal thoughts as much as you want to."
• Watch for: Whether the person can use a talking relationship. Volunteer reports flag risks and concerns.

4.4 Arrival, handover and agreeing the length of stay

• Purpose / when: To make the stay collaborative and time-limited from the first hour. Use on admission.
• Steps:
  1. Take the verbal handover and make a clinical entry in the provider's notes.
  2. Agree the length of stay with the person and the referring team.
  3. Show the person their room and the shared spaces.
  4. Agree when the first review will happen (Rotherham: within 72 hours).
  [source: Rotherham spec]. Showing the person round and explaining house expectations is [synthesis].
• Example language (illustrative): "We've agreed five nights, so you'd leave on Saturday. Let's use that time well and start planning for Saturday from today."
• Watch for: A clear end date from day one reduces later conflict over extensions.

4.5 Agreement Plan and daily meeting times (Drayton Park)

• Purpose / when: To give structure without ward routines. Set it up at admission.
• Steps: Agree a written plan with the person that sets regular times during the day for one-to-one meetings. Review it each day [source: Drayton Park page]. The daily review is [synthesis].
• Example language (illustrative): "When in the day would be best for us to sit down properly, morning or afternoon?"
• Watch for: Missed meeting times as an early sign of withdrawal or deterioration [synthesis].

4.6 Care/support plan and interagency agreement

• Purpose / when: To record what extra emotional and practical support will be given, and who does what. Use at admission and update at reviews.
• Steps:
  1. Write a care plan agreed with the person.
  2. Name the CMHT or CRHT clinician who keeps clinical responsibility.
  3. Record arrangements for emergency physical and mental health care.
  4. Arrange a follow-up assessment by the care coordinator during the stay.
  [source: Rotherham spec; Johnson, Morant et al.]
• Watch for: Unclear medical cover. Non-clinical houses depend on the CMHT for it [source: Johnson, Morant et al.].

4.7 Daily one-to-one sessions

• Purpose / when: This is the core therapeutic contact: a daily conversation about the crisis, feelings and plans. Use every day of the stay.
• Steps:
  • Drayton Park offers a daily one-to-one with a staff member.
  • At Maytree, each guest talks every day with one staff member (qualified in psychotherapy or counselling, or with lived experience) and one volunteer befriender.
  • Content [synthesis]: how the person is today; suicidal thoughts and risk; what led to the crisis; what helps; practical tasks; progress towards going home.
  [source: Drayton Park page; Maytree case study]
• Example language (illustrative): "What's been the hardest part of today? … And what happened in the days before you came here, as you see it now?"
• Watch for: Staff availability to talk was what users valued most at Drayton Park [source: Johnson et al. 2007]. Signs it is working: the person names triggers and options, and engages more each day [synthesis].

4.8 Open conversation about suicidal thoughts

• Purpose / when: To reduce isolation and make risk visible. Use daily with anyone in suicidal crisis.
• Steps:
  1. Ask directly about suicidal thoughts in the daily conversations.
  2. Listen without judgement.
  3. Volunteers and staff record and pass on risk concerns at handover.
  [source: Maytree case study]. Adding standard risk practice is [synthesis]: ask about intent and plans; agree a safety plan; arrange lethal-means counselling, meaning safe storage or removal of means, with the person's agreement; escalate to CRHT if risk rises.
• Example language (illustrative): "Are you having thoughts of ending your life today? Tell me about them; you won't shock me."
• Watch for: Relief at being able to say it is a good sign. Rising intent or any new plan needs immediate escalation (see 4.17).

4.9 Exploring the crisis and its pathway

• Purpose / when: To help the person understand how this crisis developed, so they can spot early signs next time. Use from about day 2 [synthesis on timing].
• Steps: Explore the build-up and triggers together and map the sequence. Sheffield describes supporting people to "explore the crisis". The Alternatives Study names understanding "crisis pathways" as a staff focus [source: Sheffield page; Johnson, Morant et al.]. Writing the sequence down as a timeline and feeding it into the safety plan is [synthesis].
• Example language (illustrative): "Let's go back to when things were last okay and walk forward. What was the first thing that shifted?"
• Watch for: Self-blame narratives. Gently reframe them as understandable responses to pressure [synthesis].

4.10 Coping and self-management skills

• Purpose / when: To equip the person with strategies they can use at home. Use throughout the stay.
• Steps: Teach and practise strategies that fit the person: distraction, anxiety management, grounding and self-help tools. Work on alternatives to harmful coping such as self-injury or substance use [source: Sheffield page; Drayton Park page]. Choosing two or three strategies, practising them in the house and writing them into the discharge plan is [synthesis].
• Example language (illustrative): "When the panic rose last night, what did you do? Let's try a grounding exercise now so you have it ready tonight."
• Watch for: Generic advice can feel dismissive [source: Mind 2011]. It is working when the person reports using a strategy on their own.

4.11 Informal everyday support and homely care

• Purpose / when: To provide care and containment through ordinary domestic life. Use continuously.
• Steps:
  • Keep company at mealtimes.
  • Help with washing and with making phone calls.
  • Cook healthy food at home and encourage eating well. At Maytree, volunteers cook and eat with guests.
  • Keep the house calm and restful.
  [source: Drayton Park page; Maytree case study; Johnson, Morant et al.]
• Example language (illustrative): "We're about to eat; come and join us, even if you don't feel like talking."
• Watch for: Rest, eating and sleeping improving. Withdrawal to the room for long periods [synthesis].

4.12 Practical problem-solving and community access

• Purpose / when: To resolve the practical problems that drive or prolong the crisis. Use from admission.
• Steps: Identify urgent practical issues and work on them with the person, including housing, phones, benefits, GP access, food banks and local groups. Make referrals and phone calls together [source: Johnson, Morant et al.; Rotherham spec; Mind 2011 on Stockport Mind].
• Example language (illustrative): "Which of these worries would make the biggest difference if we sorted it this week, the rent letter or the GP appointment?"
• Watch for: Problems that cannot be solved within the stay. Hand them over explicitly at discharge [synthesis].

4.13 Keeping community roles going

• Purpose / when: To prevent the loss of role and routine that can come with admission. Use throughout the stay.
• Steps: Support the person to keep attending work or college and to see friends, and to keep their routines where they can [source: Johnson, Morant et al.; Mind 2011].
• Example language (illustrative): "Would it help to go to work tomorrow and come back here in the evening?"
• Watch for: Overload. Agree a gradual level of activity [synthesis].

4.14 Medication support and medical liaison

• Purpose / when: To keep medication and physical health safe in a non-ward setting. Use for anyone on medication.
• Steps: Store and give out medication safely, or support self-administration. Help arrange repeat prescriptions and medication reviews through the CMHT or CRHT doctor. Make sure emergency physical and mental health care arrangements are in place [source: Drayton Park page; Rotherham spec].
• Watch for: Physical health and medication review can get less attention than on wards, so check them deliberately [source: Johnson, Morant et al.].

4.15 Trauma-informed response to abuse disclosure

• Purpose / when: To respond safely when people disclose past or current abuse. Use whenever a disclosure is made. This is core to Drayton Park's model.
• Steps: Staff are trained to explore and validate disclosures of abuse [source: Drayton Park page]. The further steps are [synthesis]:
  1. Listen and believe.
  2. Do not press for detail.
  3. Ask about current safety.
  4. Follow safeguarding procedures for current abuse or risk to children.
  5. Offer onward referral, for example to domestic abuse services.
• Example language (illustrative): "Thank you for telling me. What happened to you matters, and it may help explain why things have felt so unbearable."
• Watch for: Distress spiking after a disclosure. Return to grounding (4.10).

4.16 Body therapy (Drayton Park)

• Purpose / when: To offer soothing and relaxation. Drayton Park offers massage sessions three times a week, given by two dedicated body therapists on the team [source: Drayton Park page].
• Steps: This is delivered only by the dedicated body therapists, never by the referring clinician. Making it optional and asking for explicit consent each time, taking particular care given the trauma-informed context, is [synthesis].
• Watch for: Distress linked to touch in people with a trauma history. Always offer the option to decline [synthesis].

4.17 Peer support and lived-experience roles

• Purpose / when: To reduce isolation and stigma. Use throughout the stay.
• Steps: Make room for mutual support among residents in shared spaces. Where the model includes staff or volunteers with lived experience, use them (Maytree, Dial House). National guidance cited in the Rotherham specification expects crisis alternatives to include peer support workers [source: Johnson, Morant et al.; Mind 2011; Maytree case study; Rotherham spec].
• Watch for: Distress spreading between residents, or one resident taking on a carer role. Staff should notice and gently redirect [synthesis].

4.18 Children staying with their mothers

• Purpose / when: To avoid separating mothers and children during a crisis. Drayton Park decides case by case at referral, and Gofal (Wales) allows children in some houses [source: Drayton Park page; Mind 2011].
• Steps: Assess at referral. Agree who cares for the child day to day [synthesis]. Keep usual safeguarding duties.

4.19 Escalation when risk exceeds the house's capacity

• Purpose / when: To move to a higher level of care when needed, for example when there is significant risk to self or others, acute disturbance, or the person can no longer care for themselves.
• Steps: Contact the responsible CRHT or CMHT for urgent reassessment. Dial House, for example, refers back to the crisis team on the rare occasions someone is not safe to go home [source: Mind 2011; Rotherham spec]. Further steps are [synthesis]: use emergency services if danger is immediate; stay with the person; record the decision; tell the person honestly what is happening and why.
• Example language (illustrative): "I'm worried that the house can't keep you safe tonight, so I'm calling the crisis team now, and I'll stay with you while we sort it."

4.20 Overnight cover and incident handling

• Purpose / when: To keep nights safe with low staffing.
• Steps: Rotherham has one staff member sleeping in. At Maytree, two volunteers sleep in, one on each floor, and handle incidents. The on-call route must be clear [source: Rotherham spec; Maytree case study]. A bedtime check-in with each resident is [synthesis].
• Watch for: Low staffing at night and weekends is a known weakness [source: Johnson, Morant et al.].

4.21 Safety planning for the return home

• Purpose / when: To prepare for going home. Use from mid-stay to discharge.
• Steps: Drayton Park does safety planning to support the return home [source: Drayton Park page]. The plan's content is [synthesis]: warning signs (from 4.9), coping strategies (4.10), people to contact, crisis numbers, lethal-means safety steps, and follow-up appointments.
• Example language (illustrative): "Let's write down what you'll notice first if things start slipping, and what you'll do then."

4.22 Pre-discharge meeting

• Purpose / when: To confirm destination and follow-up. Held the day before discharge.
• Steps: The admitting team meets the day before discharge to confirm follow-up and arrangements, and records the outcome in both organisations' notes. People not open to a community team are followed up by CRHT or liaison [source: Rotherham spec].

4.23 Ending and reflection letter (Maytree)

• Purpose / when: To mark the ending and leave the person with a record of their strengths.
• Steps: A staff member writes a reflection letter, with input from volunteers, that highlights the guest's strengths. It is sent with a follow-up call within two weeks of leaving. Mind's 2011 report describes this as a personal goodbye letter [source: Maytree case study; Mind 2011].
• Watch for: Write from specific observations made during the stay, not stock phrases [synthesis].

4.24 Follow-up and liaison after the stay

• Purpose / when: To bridge the gap after discharge, which users experience as a vulnerable point.
• Steps:
  • Maytree: a follow-up call within two weeks; with consent, contact with the GP, psychiatrist or mental health worker; an escort to psychiatric appointments where possible.
  • Sheffield: up to 6 weeks of Navigator support, face to face or by phone, on the causes of the crisis and preventing the next one.
  • Drayton Park: a weekly Wednesday support group and workshops through the year for former residents.
  [source: Maytree case study; Sheffield page; Drayton Park page]
• Watch for: People in Mind's inquiry wanted more emotional support after leaving [source: Mind 2011].

4.25 Outcome monitoring and staff reflection

• Purpose / when: To track benefit and keep staff practice reflective.
• Steps: Rotherham requires a patient-reported outcome measure at admission and discharge. Maytree's evaluations used CORE at arrival and departure. Maytree staff run monthly reflection groups for volunteers, with oversight from a consultant psychotherapist [source: Rotherham spec; Maytree case study]. The licensed measure's items are not reproduced here.

4.26 Referrer awareness and remit setting (service level)

• Purpose / when: To keep referrals appropriate and the house used. Ongoing.
• Steps: Raise awareness among local teams. Publish clear referral criteria and a robust referral form. Adapt pathways over time [source: Johnson, Morant et al.].

4.27 Host-family placement (variant)

• Purpose / when: To provide a family setting instead of a staffed house. Use where such a scheme exists.
• Steps:
  • Selected, paid hosts take one or two guests.
  • The guest joins household meals and chores.
  • The home treatment team visits, daily at first in Hertfordshire, and can be called at any time.
  • Stays run for weeks: 3–12 weeks in Hertfordshire, 17–21 days in Lille.
  [source: Johnson et al. 2007; Mind 2011]

5. Handling problems

Items marked [source] are named in the sources. Everything marked [synthesis] is this guide's own guidance.

• Referral delays, especially at night. Delays of one to three days sometimes led to admission [source: Johnson, Morant et al.]. Response: phone in the morning; send the documents with the first call; agree an arrival time; if the house cannot take the person that day, arrange interim home treatment visits [synthesis].
• Pressure to accept people beyond the remit, or to waive time limits. This is a known problem; the sources' answer is to keep criteria clear and defend the house's boundaries [source: Johnson, Morant et al.]. Response: refer back to the written criteria; discuss with the gatekeeper; offer an alternative rather than a bare refusal [synthesis].
• Deterioration during the stay. Response: increase one-to-one contact; ask about risk directly; bring the CRHT or CMHT review forward; escalate as in 4.19 [source: Mind 2011; Rotherham spec; synthesis].
• Staff anxiety with high-risk residents. Sources suggest more exposure to high-risk cases, with training and support [source: Johnson, Morant et al.]. Add: talk risk decisions through at handover and record shared positive-risk decisions [synthesis].
• Withdrawal or non-engagement (stays in room, misses meetings). Response: offer low-demand contact such as tea or a meal (4.11); shorten sessions; revisit the Agreement Plan; ask what would make the house feel safer. If the person has no engagement at all, review with the referrer whether the house is meeting their need [synthesis].
• Feeling left alone or unsupported. Some people reported having no contact from the crisis team once referred [source: Mind 2011]. Response: make sure CRHT or the care coordinator actually reviews the person during the stay (Rotherham: within 72 hours) [source: Rotherham spec].
• Wanting to extend, or dependence. Fixed limits are deliberate [source: Maytree case study]. Rotherham extends only in exceptional cases, by joint agreement [source: Rotherham spec]. Response: name the end date daily; bring discharge planning forward; offer the follow-up and alumni routes (4.24) as the continuation [synthesis].
• Alcohol or illicit drug use in the house. Rotherham and Maytree make abstinence during the stay a condition [source: Rotherham spec; Maytree case study]. Response: check safety first (intoxication, overdose risk); then talk it through without shaming; agree whether the stay can continue; involve the CRHT or dual-diagnosis services [synthesis].
• Conflict or distress between residents. In small shared houses one resident's distress affects others [synthesis]. Response: separate the people involved; give each one-to-one time; reset house expectations in a short house meeting [synthesis]. The low disturbance of crisis houses compared with wards is valued, so act early to protect it [source: Osborn et al. 2010].
• Leaving the house unexpectedly or going missing. Response: follow the provider's missing-person and risk procedure; contact the person by phone; tell the CRHT. For people on Section 17 leave, follow the detaining team's conditions [synthesis] [uncertain: specific procedures].
• Abuse disclosure or a current safeguarding concern. Validate the disclosure and follow safeguarding procedures (4.15) [source: Drayton Park page; synthesis].
• Overwhelm during crisis exploration. Response: slow down; switch to grounding; postpone detailed exploration to the next session [synthesis].
• Generic coping advice that feels like rejection. Response: personalise suggestions; ask what has helped before [source: Mind 2011].
• Rupture with staff, for example after a refusal, a rule enforced or an escalation. Response: name what happened; acknowledge the person's view; explain the reason; ask what would help to restore trust; record the repair [synthesis]. Lower perceived coercion drives satisfaction, so negotiate wherever possible [source: Osborn et al. 2010].
• No suitable place to go home to. This is an exclusion at Rotherham and Maytree [source: Rotherham spec; Maytree case study]. If it emerges during the stay, start housing work at once (4.12) and tell the responsible team [synthesis].
• Medication and physical health missed. Schedule a CMHT or CRHT medical review early [source: Johnson, Morant et al.; Rotherham spec].
• Rural catchments and limited places. These are known limits [source: Johnson, Morant et al.]. Response: plan in advance (for example, an advance crisis plan that names the house) and consider a host-family scheme where one exists [synthesis; Mind 2011 on Bristol crisis plans].

[uncertain]: The full Alternatives Study report and the Gilburt et al. (2010) qualitative paper are not drawn on here, so daily-routine details beyond those given by the exemplar services are not confirmed. The Sheffield service PDF is not drawn on here. Dial House is described only through Mind (2011). Practice varies a lot between houses, so always check the local operational policy.

Sources

Sources:

• Johnson S, Gilburt H, Lloyd-Evans B, Slade M (2007). Acute in-patient psychiatry: residential alternatives to hospital admission. Psychiatric Bulletin 31:262–264
• Johnson S, Morant N et al. Implementing alternatives to acute inpatient care (UCL Discovery)
• Osborn DPJ et al. (2010). Residential alternatives to acute in-patient care in England: satisfaction, ward atmosphere and service user experiences. Br J Psychiatry 197(Suppl 53):s41–s45
• Drayton Park Women's Crisis House, North London NHS Foundation Trust
• Sheffield Crisis House (Rethink / Sheffield Mental Health)
• Crisis House: eligibility and selection criteria, Sheffield Health Partnership
• Rotherham Crisis Alternative Service Specification v1.1 (2024)
• Mind (2011). Listening to experience: an independent inquiry into acute and crisis mental healthcare
• Centre for Public Impact. Maytree respite centre case study
• ELFT Bedfordshire CRHTT Operational Policy (2019/2020) (used only for context on CRHT gatekeeping)

Further reading (not drawn on), cited via the above: Polak et al. (1979), family sponsor homes; Bola & Mosher (2002), Soteria; Killaspy et al. (2000), Drayton Park; Gilburt H et al. (2010), service users' experiences of residential alternatives, Br J Psychiatry; Sweeney A et al. (2014), therapeutic alliance and satisfaction in wards and crisis houses, PLoS ONE 9(7): e100153.