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Transforming mental health crisis care – Dr Geraldine Strathdee

In the first of two blogs, NHS England’s National Clinical Director for Mental Health, Dr Geraldine Strathdee, looks at crisis care innovations in action:

People and their families have previously told us that mental health crisis care required significant transformation.

People said they were not clear where to access support in a crisis, what number to ring, and where they could go to get ‘compassionate skilled assessment of their needs, and treatment’.

Parents and families told us of their sense of powerlessness to get the right help in time, and the heartbreak of the deaths of their loved ones through suicide.

The Crisis Care Concordat was launched in February 2014, and for the first time in England’s mental health history, the 22 agencies responsible for crisis response came together at national level to plan improvement. The NHS England Urgent and Emergency care review prioritised mental health crisis care as part of its Parity commitments.

In the first year, something truly phenomenal happened. In every local community, across the country, literally hundreds of front line leaders formed action-planning groups.

These included experts by experience, carers, CCGs and local government commissioners, police, transport, schools and fire services, third sector, NHS 111, ambulance, A&E, primary care, specialist community and acute trust liaison mental health providers, Strategic clinical networks, Academic health science networks, housing and social services, alcohol and drug services.

By December 2014, local action plans had been developed and commitments signed for year-on-year improvements.

As the CQC report published on Friday shows, there is a great deal to be done to transform crisis care. The commitment to change, the numerous examples of innovation and transformation, and the willingness to share best practice across the country gives real hope that significant progress can, and is being made.

The Crisis Care Concordat website shows the plans and the successful innovations across the country.  There are so many excellent examples of leadership, service redesign and improvements that it would be impossible to name more than a few for illustrative purposes.

In line with the Five Year Forward View new models of care and transformation these blogs will pick out a sample that demonstrate:

  1. Good governance: through setting measurable standards of care and outcomes
  2. Empowering people and their families through information
  3. Prevention through identifying and addressing causes in every local area JSNA
  4. Improving timely access to the right care and suicide prevention
  5. Out of hospital home care
  6. Acute hospital A&E and liaison mental health teams

Illustrative examples of each of these include:

Good governance: through setting measurable standards of care and outcomes

Mind called for standards to be set for the four components of good crisis care:

  1. Access to support before crisis point – making sure people with mental health problems can get help 24 hours a day and that when they ask for help, they are taken seriously.
  2. Urgent and emergency access to crisis care – making sure that a mental health crisis is treated with the same urgency as a physical health emergency.
  3. Quality of treatment and care when in crisis – making sure that people are treated with dignity and respect in a therapeutic environment.
  4. Recovery and staying well – preventing future crises by making sure people are referred to appropriate services.

NHS England London Strategic Clinical network has published the London partnership measurable standards of this model of crisis care.

Empowering people and their families through information

NHS Choices has had a major focus on providing information on mental health. The website, developed in collaboration with experts by experience, communication experts and front line staff, now provides information on how to tackle crisis, develop personal self-help and resilience strategies and find the best treatment and services in every area.

Prevention through identifying and addressing causes in every local area

Every agency that responds to mental health crisis is working together to identify and record the causes of mental health crisis in a consistent way. This is to inform the local authority and CCG’s Joint Strategic Needs Assessment (JSNA) and enable Health and Well Being Boards to put in place high impact Prevention strategies. An excellent example of a JSNA, that includes mental health prevention and crisis care, is that of Kingston.

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