Crisis care concordat brings mental health closer to parity of esteem

Dr Geraldine Strathdee, NHS England’s National Clinical Director for Mental Health, explains why it is so crucial we get emergency mental health care right:

I am delighted the Mental Health Crisis Care Concordat launches today.

It has been created in partnership with committed leaders from across health and social care, police and justice, local government and housing. It is a call to action and driven by the needs and views of people using mental health services, and their families and carers.

This initiative brings us a big step closer to ensuring that everyone’s mental and physical health is equally valued by the NHS. Nowhere is this current gap more obvious than for people experiencing a mental health crisis.

At the moment, people in physical health crisis have a clear path to care and support, while those in a mental health crisis may have to deal with as many as fourteen different ways to try and get help.

This Concordat describes exactly how local commissioners, working with partners, can make sure that people experiencing a mental health crisis get as good a response from an emergency service as people in need of urgent and emergency care for physical health conditions.

Most importantly, this Concordat clearly describes what people have told us they need, such as:

  • When I need urgent help, both I and the people close to me, know who to contact at any time, 24 hours a day, seven days a week.
  • I feel safe and am treated kindly, with respect, and in accordance with my legal rights.
  • I have support to speak for myself and make decisions about my treatment and care.
  • I am given information about, and referrals to, services that will support my process of recovery and help me to stay well.

We are gathering information on how people in need are accessing crisis care. Our Academic Health Science Networks are gathering information on best international models of crisis services and the methods to commission these.

Our clinical leadership across NHS England, in our Strategic Clinical Networks and Clinical Commissioning Groups, are rising to the challenge of transforming care. Many providers and our Strategic clinical networks are already planning changes to their services in response to what their communities need. I’ve seen great examples and they usually include:

  • A single point of access into crisis care, with well-trained triage and tele-health workers who are supported by services which are available 24 hours a day, 7 days a week as they are for physical health crisis.
  • Home treatment teams, so that when an individual is experiencing crisis, it is possible to reduce attendance at Accident & Emergency services and admissions to acute and mental health hospitals, where appropriate.
  • High quality liaison mental health services for individuals who go to Accident & Emergency.

We’ve made sure the Concordat fully aligns with the urgent and emergency care review being led by Professor Keith Willett. The programme of work resulting from this, along with implementation of the Concordat, will lead to a significant change for people experiencing a mental health crisis in accessing services.

In discussions with the many incredible committed partners involved in developing the Crisis Concordat, we at NHS England have also committed to a number of actions to help make positive change happen faster. These include:

  • Reviewing the availability, quality and gaps in information we need to assess the level of local need for crisis care.
  • Developing a baseline assessment of what care is currently being provided and where.
  • Monitoring the effectiveness of how we respond to people who experience a mental health crisis, including those who are assessed under the Mental Health Act.
  • Developing our mental health intelligence programme so that when data is routinely available, commissioners and providers can review what is happening locally against the needs of their community and make good choices.
  • Setting standards for the use of crisis care plans in line with the Care Programme approach and NICE guidance.
  • Commissioning services so that Liaison & Diversion services and Street Triage refer individuals with existing mental health and substance misuse problems to services which can help address their needs.

If we get crisis care right, then no matter where someone is or what they are experiencing, every person is supported, safe and helped to recover. This is what we are striving for.

You can follow Geraldine Strathdee on Twitter: @DrG_NHS

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.

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  1. leigh michael charles says:

    I have been a part of the mental health system for 6 years and have had the wrong diagnoses for that period of time and have had more reason than to say that it is a horrible mistake and it should be corrected and should not be aloud to go on any further

  2. Alan Maiden says:

    My wife was taken ill with schizophrenia in 1974. She was sectioned under the Mental Health act on numerous occasions for her own safety and well being.

    The services provided by the NHS have seen little change over the years, despite the large sums of money spent.

    Who would believe that in this day and age, a patient sectioned under the MHA and admitted to a Mental Health Hospital would be responsible for contacting their GP to arrange for treatment for their physical health?

    Would anyone believe that people over the age of 65 are not entitled to be included in the Crisis Resolution and Home Treatment scheme?

    Over the years I have brought many issues to the attention of high ranking people who are responsible for mental health services to no avail. The issues were difficult to resolve so they were ignored.
    Many of the things raised years ago are brought out of the cupboard, dusted down and produced as though they are new bright ideas. They will be put back in the cupboard and left for future generations.
    All the old platitudes have been trotted out and nothing except the easy things have been attempted.
    Carers who look after a patient who suffers from mental illness are the experts on that particular patient, and are often not consulted in private.
    I could go on but now my wife is at peace, free from the torment of mental illness and poor physical treatment provided by the Mental Health Service.

  3. Jean says:

    I really hope that this concordat changes things.

    Last week I hit crisis point and was taken to hospital following an overdose. I was in hospital for 24 hours – at no point did any of the nursing staff ask how I was feeling. They were too busy. The only information I got came via text from my husband. He told me I was medically fit and that I’d had a mental health assessment which I had not. Then he was told that I was not going to see anyone from psychiatric liaison and that they would talk to me the next day (Saturday). I left hospital and the police were called by the hospital. The psych people told the staff that was not necessary as they were not going to see me anyway. The police came and did a welfare check when I got home and were horrified at the state of affairs. It had only been 3 weeks since my last suicide attempt.

    I received neither phone call nor visit from mental health services over the weekend. Nor any contact to date (Tuesday). I rang on Sunday evening and was told that there was no record of needing to contact me. I had fallen through the cracks.

    I wish that I could say this was a one off but several times promised contacts following an A&E emergency admission have not happened. A&E staff can be quite judgmental at times as can the ward staff but to be fair the hospital are trying to address this with training.

    I have lost all faith in the NHS’s ability to deal properly with a mental health emergency and yet again the police were left to pick up the pieces with one of the officers promising to speak to my local mental health team as I am not the only one who has this sort of thing happen. Quite frankly they are fed up with the lack of support.

  4. Stephanie de la Haye says:

    As a mental health clinical lead for a ambulance service I would congratulate everyone involved in producing the crisis care concordat. Though I would have liked to see the signposting of IMHA services mentioned . While under the MHA section 136 & 135 do not qualify for IMHA provision, it would have been prudent to include what is a vital service for individuals who may go on to be qualifying patients. As a member of the national IMHA review and a CQC expert inspector the earlier IMHA and other forms of advocacy can be highlighted the more chance of people understanding the role.

  5. Christine Tipple says:

    Being a church warden at Little St Mary’s church, Cambridge I am interested to know how the new C.C.C. might help us when dealing with the homeless who are often around our church and garden. Sometimes some are drunk, often with mental health problems too. Mostly we can cope with them but we do have to call the police, from time to time .They are very helpful but can only move the trouble on or take a person to a cell for the night. Could it be that both the local police and the church will be helped by this new this new initiative?