Transforming mental health crisis care

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.

Dr Geraldine Strathdee OBE,

Dr Geraldine Strathdee, OBE, MRCPsych, is the National Clinical Director for Mental Health, NHS England, a consultant psychiatrist in Oxleas NHS FT, and Visiting Professor, Integrated mental health education programme at UCL Partners.

For over 20 years she has held senior roles in mental health policy, regulation and clinical management, at national and London regional levels, and advises internationally on mental health service design and quality improvement, while working as a practising clinician. She has been involved in transformational large scale service development programmes, moving services from hospital based, to 24/7 home care and primary care models, in roles which have included: the Trust Director of Clinical services in Oxleas NHS FT (2005-2007), Director of Service development at the Sainsbury Centre for Mental Health and Senior Lecturer, UMDS ( 1995-1998). She was the National Professional Adviser in mental health to the Healthcare Commission and the Care Quality Commission (2005-2012).

Her particular commitment is to the translation of policy and best practice evidence into front line routine clinical practice, empowering service users to reach their potential, and staff to maximise their time to care. She is passionate about the development of leadership competencies and using information to enable informed decision-making.

As London SHA Associate Medical Director (2009-2013), with responsibility for mental health, she led transformational change through the development of clinical networks for dementia and primary care mental health CCG leaders, developed ground breaking commissioning support care pathway profiling informatics tools, and high impact educational programmes. She was awarded the prestigious RCpsych Psychiatrist of the Year award in 2012.

Clinically, she has worked in a wide range of primary care, inpatient and community services, and latterly with people with complex and multiple needs, as a Consultant Psychiatrist for the Bromley Assertive Community Treatment team in Oxleas. She is committed to providing services which enable services users to live in their own homes, develop their own personalised care plans and self management expertise to achieve recovery, while at the same time working with community agencies to deliver coordinated, responsive, care pathways.

Service evaluation and research interests: Her teams have won awards for their use of technology in improving care, using patients as experts in staff training and leadership awards for new Ways of Working, the redesign of roles. Her research interests have included the fields of primary care mental health, evaluation of community services and dual diagnosis. Current research interests include the evaluation of competency based leadership programmes and clinical networks to drive transformational improvements, and high impact educational programmes.