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NHS expands mental health crisis services this winter
The NHS is set to boost mental health support for people in crisis to ease demand and pressure on emergency services, as part of extensive winter plans already underway.
Dozens of mental health professionals will work within ambulance control centres and accompany paramedics on emergency call outs to treat people of all ages who are having a mental health crisis at the scene.
NHS England is investing £10 million in further support for mental health trusts this winter, with guidance published later this week asking them to deploy their staff to work in 999 call centres over the coming months.
Figures from two ambulance trusts show having a mental professional answering or responding to 999 calls could reduce the chances of a patient needing to go to A&E from approximately half down to one fifth.
Demand for crisis mental health services has increased by one third since before the pandemic and doubled since 2017.
More than 90,000 people a month have been referred to community crisis services.
While around 200,000 people a month have also called 24/7 crisis lines.
Less than 2% of people who call 24/7 mental health crisis lines then attends A&E for further support.
Mental health staff will work shifts with local ambulance trusts either providing on the scene response or triaging patients in call centres.
The head of NHS mental health services called for those in crisis to call their local NHS crisis lines through NHS 111 online or nhs.uk/urgentmentalhealth.
Last week, the NHS announced more than 40 healthcare ‘traffic control centres’ are now live. Each of the 42 integrated care systems in England now have a dedicated 24/7 operation with teams, including senior clinicians, that can respond to emerging challenges and divert ambulances to another nearby hospital with more capacity, or identify hospitals that need extra support.
The move is part of the NHS implementing the winter plan published in October, which also included the rollout of falls response services, new hubs dedicated to serious respiratory infections and additional bed capacity.
NHS Mental Health Director Claire Murdoch, said: “Getting support to people suffering a mental health crisis quickly is critical and will be even more important over the coming months when the NHS is facing a perfect storm with winter virus cases rapidly increasing alongside ongoing pressures in emergency care.
“The NHS is helping twice the number of people experiencing a mental health crisis compared to five years ago thanks to the rollout of 24/7 crisis support phone lines with tens of thousands receiving support without having to go to A&E.
“The NHS has been planning more extensively for its most challenging winter yet including having trained mental health professionals answering 999 calls and heading to the scene with paramedics to offer treatment at home.
“If you are struggling with your mental health do seek help from the NHS – you can refer yourself online to our world leading talking therapies service or if you are in a crisis, you can call your local helpline 24/7.”
The NHS is also set to roll out around 100 specialist mental health ambulances across the country over the next three years.
Two ambulance services already have these dedicated vehicles on the road including East of England Ambulance service and Yorkshire Ambulance Service.
In the East of England, the vehicle has reduced avoidable A&E attendance by 10% since rolling out a mental health joint response car.
The paramedic and mental health nurse work in partnership with the police to ensure people get the right care.
One police officer from Peterborough said: “The amount of time that has been saved is frankly astounding. Jobs that we would ordinarily attend and take 2 hours or more, were dealt with in no more than 5 minutes. We were able to cover so many more incidents with the help of the nurse, she really knows her stuff.
“I can’t see how this can be anything other than a ‘win win’ situation for us and the NHS, officers are saving time, and in turn we aren’t taking people to hospital and clogging up A&E, and their systems, and causing them more issues.”
Minister for Mental Health Maria Caulfield said: “While we’re very aware of the impact winter can have on physical health, colder weather and social pressures during the festive period can have a huge impact on people’s mental health too.
“Crisis services can be vital for so many that are suffering and can make all the difference in ensuring someone is seen and treated as quickly as possible – so it’s great that they will be bolstered by more mental health trained staff over this busy period.
“Everyone should be able to access the help they need when they need it and we’re doing everything we can to make that a reality – with £2.3 billion extra government funding for mental health services a year by 2024.”
In central London admissions to A&E will be reduced over winter with a new mental health crisis centre that opened last week.
London Ambulance Service and the police will be able to take people in crisis direct to the centre for specialist support ran by Central and North West London NHS Foundation Trust (CNWL).
Lee Byers, Associate Service Director of Urgent Care at CNWL described a shift last week at the new unit at St Charles’s Hospital, North Kensington.
The trained nurse of 18 years described how one patient arrived from A&E and said although they had not slept for 72 hours the new relaxed environment and reclining chairs meant he could sleep for one to two hours.
The patient was given five one-to-one sessions with staff and was referred to the Hillingdon Crisis House.
The patient who always attends A&E when in mental health crisis said, if ever in crisis again they would come to St Charles crisis centre instead because:
“You are seen straight away, have a full assessment which is not rushed, and you have the freedom to go out for fresh air with the support of staff.”
For people that do need to go to A&E for mental health related issues, A&E services are being supported by psychiatric liaison services in acute hospitals which have significantly increased from 2019 to 2022 with staff numbers being doubled with nearly all teams accessible 24/7.
Sophie Corlett, Interim CEO at Mind, said: “This winter is likely to be incredibly challenging for the mental health of millions of people across the country, so it’s great to see NHS England looking to address the huge pressures A&Es are already under as winter sets in.
When people are in mental health crisis, they need care and support there and then. Supporting our NHS to reduce those pressures by giving people immediate access to a mental health professional either in person or over the phone will help many people to more quickly access the type of care most appropriate for them.”
Chief Executive of the NHS Confederation’s Mental Health Network Sean Duggan OBE said: “NHS leaders of mental health services will welcome this announcement and recognise how critical it is to have mental health professionals working alongside emergency services when we know demand for crisis mental health services has doubled since 2017.
“Our members frequently raise with us their concern about the increased need for crisis care and they know A&E departments are not a therapeutic environment for people experiencing mental health crisis. Anything to reduce the numbers of people experiencing this is good news.
“These examples also highlight how important it is that we think about the role of wider public services when we think about mental health. Having a mental health nurse with a police force as they respond to calls has the potential to make what could be a frightening interaction a much more positive one for people facing mental health crisis.”
Mark Winstanley, Chief Executive, Rethink Mental Illness, said: “When people experiencing a mental health crisis are quickly met with appropriate support to help ease the distress they’re in and reduce the level of risk, it can prove lifesaving.
“It’s deeply concerning that demand for crisis support has increased so dramatically in recent years, so we welcome this additional resource and encouragement of new ways of working which will add to the brilliant work ambulance services do and improve how services can respond to people in crisis.”
Dr Sarah Hughes, chief executive at Centre for Mental Health, said: “Getting timely, compassionate and effective help is vital for someone in a mental health emergency. We hope that NHS England’s investment and resourcing of 999 call centres and paramedics will mean that more people receive a prompt and helpful response when they need it most urgently.
“Rising numbers are struggling with their mental health in the aftermath of Covid-19 and the pressures of the cost-of-living crisis. We must ensure that the whole system is fully resourced so that someone struggling with their mental health receives timely, effective support before they get to crisis point, and a compassionate and effective response when urgent help is needed.”
Dr Adrian James, President of the Royal College of Psychiatrists: “We welcome NHS England’s plans to expand mental health crisis services this winter. Having mental health professionals work within 999 call centres and accompany paramedics on emergency call outs, provides an opportunity to treat people with mental illness earlier, improve outcomes for, and the experience of, patients which also reduces pressure on beds and in A&E.
“Over the last year we have seen record referrals for mental health treatment, and during the winter months pressures on mental health services become even greater. Whilst we welcome today’s announcements, we must make sure there is an adequate mental health workforce in place, including a sufficient number of psychiatrists, and that services are not overstretched.”