The focus on mental health has become much greater in recent years and there has been national recognition that mental health crisis care needs to improve. The care and support to someone experiencing a mental health crisis should be equivalent to that for someone presenting with a medical or surgical crisis.
Here, Dr Nick Broughton, Chair of Urgent and Crisis Care, London Mental Health Strategic Clinical Network and Medical Director, West London Mental Health NHS Trust explains the steps being taken to improve mental health crisis care in London.
The mental health Crisis Care Concordat is a national agreement signed last year by over 20 services and agencies involved in the care and support of people in crisis. It is a commitment by these agencies to work together in order to improve outcomes for people experiencing a mental health crisis.
The concordat focuses on four main areas – access to support before crisis point, urgent and emergency access to crisis care, the quality of treatment and care when in crisis, and recovery and staying well/ preventing future crises.
A central part of London’s response to the concordat is the work that the strategic clinical network for mental health has undertaken. The network, following extensive consultation and a comprehensive review of the evidence available has produced comprehensive standards for the future commissioning of urgent and crisis care. These standards are incorporated in the Crisis Care Concordat action plans that have now been developed by the capital’s 32 clinical commissioning groups.
The standards were set out in a commissioning guide published in October 2014. They cover multiple areas including: crisis telephone helplines; the role of the third sector; emergency departments; crisis care and recovery plans; Section 136, police and mental health professionals and integrated care, among others.
These standards build on work that is already ongoing across the capital, including street triage services.
Street triage schemes allow a police officer attending a call out to a person in crisis to telephone a mental health professional directly, at any time of the day or night in order to access expert advice on how best to assess and handle the situation.
If the person in crisis is already receiving mental health support, relevant information will be shared with the officers to aid their decision making and response. In some areas, mental health professionals accompany officers to mental health related calls outs to carry out face-to-face assessments and assist the officers in their direct management of the situation.
The scheme should lead to people receiving appropriate care more quickly, leading to better outcomes and a reduction in the use of Section 136, a police power under the Mental Health Act to take a person to a place of safety. Evidence shows that street triage schemes can reduce the use of section 136 powers by as much as a third.
A recent College of Emergency Medicine survey found that too many people are taken to emergency departments out of hours when experiencing mental illness rather than physical health care problems. In general however, Greater London has a good track record in providing places of safety for people in a mental health crisis. However, more work is needed to ensure people are able to get the right care in the right place out of hours as well as during working hours.
The move to a 24/7 mental health service is fundamental to delivering the Crisis Care Concordat and Londoners should expect to have access to a 24 hour a day helpline to provide advice and support if they experience a mental health crisis.
The challenge we now face is ensuring the effective implementation of these new standards and that will take time, resources, co-ordination and collaborative working.
A London wide commitment to inter-agency collaboration is evident already through, for example the improvements seen in relation to the use of S136. Through close working between the police and London’s provider mental health Trusts police cells are now rarely used as places of safety.
Still, we need to build on the good practice that is emerging in the capital and ensure that it becomes the norm everywhere, at all times, so that Londoners can be sure they will get the care they need when and where they need it.