Mental health crisis care agreement for London sets out to transform mental health care in the capital

A ‘mental health crisis care agreement’ for London is announced today – which aims to provide better access, experience and outcomes for people using mental health services in London.

The agreement, between health organisations and London Councils as well as the Metropolitan Police and the London Mayor’s office, outlines a vision that all Londoners experiencing a mental health crisis, have equal access to timely help which is best suited to their needs.

It has been developed with ‘experts by experience’, Black, Asian and minority ethnic communities, carers, the police and voluntary sector organisations. It sets out a path for keeping people safe, free from harm and able to access the care they need in the right place at the right time.

The document details plans for:

• Preventing mental health crises by supporting people to live well in their communities
• Ensuring access to timely and appropriate crisis support for those who need it
• Building on the success of the mental health joint response cars, which have been operating seven days a week across the capital for two years; and
• Introducing NHS 111 First for Mental Health, which will be launched nationally in April 2024, and will provide support for people experiencing a mental health crisis and ensure people have help to access the best care for them.

Organisations in health, social care and beyond are signing up to the agreement which pledges that assessment and detention under the Mental Health Act should only occur when detention is the only option to support someone out of crisis and should always be a last resort. Support for people in crisis will be tailored to each person’s needs and will ensure their voice, and the voices of their families and carers are central to decisions made about their care.

NHS London director of performance Martin Machray said:

“People experiencing mental health crisis in our capital should have access to safe, timely, and appropriate support. All those signing up to the concordat commit to tackling waiting times and improving outcomes for patients. Crisis support will be open-access, responsive to all our communities, available without referral and as close to people’s homes as possible”.

Chair of South London and Maudsley NHS Foundation Trust Sir Norman Lamb said:

“We know that too many people experience failures of care when they face a mental health crisis. Too many people are detained by the police and conveyed to A&E departments – and this unacceptably happens disproportionately if you are black. A&E is generally not the best place for someone in crisis. It is often not a calm environment, and it heaps more pressure on both A&E departments and on the police.

“The police commissioner, Sir Mark Rowley has been clear that too much police time is taken up dealing with people in mental health crises. The answer is to ensure that we get the right support to people in mental health crisis. This agreement is a major commitment from all the key organisations, including the police and the NHS, to work together to improve the way we support Londoners facing a mental health crisis and, by doing this, also relieve pressure on police and acute hospitals”.

Commander Kevin Southworth, head of public protection at the Metropolitan Police, said:

“This agreement is very welcome and will undoubtedly improve the support and care provided to people suffering from mental health-related illness here in London. The new concordat also complements the national policing initiative to ensure that in all such cases, the right care is delivered by the right person. We know police involvement is not always what people suffering from acute mental health illness will want, nor are police officers and staff always best-placed to help in such situations. Police involvement may sometimes lead to worse outcomes and increase disproportionality in our policing, especially amongst our Black communities. We are determined to change this and the announcement of this concordat is a really important step that will help further transform our approach to mental health care in London.”

Additionally, it sets targets to increase access to community mental health services. These include ensuring as many people as possible are seen by community mental health services within four weeks and increasing the number of people from minority ethnic groups accessing these services, while ensuring people get the most appropriate care for them at the right time.

Notes to editors

• London’s All-Age Mental Health Crisis Care Concordat can be viewed on the NHS London website

• Mental health response cars were launched in 2018 and were designed to use the skills of the mental health professional, and paramedic, to manage people safely in the community where this is appropriate. The mental health professional can complete a biopsychosocial assessment, formulate a risk assessment, and deliver brief psychological interventions to reduce distress. The paramedic can make a physical health assessment and deploy their expertise in pre-hospital care.

• Next year a new 111 First for mental health service will be launched nationally, which will direct those calling 111 with a mental health need to a specialist mental health service, instead of them undergoing an assessment by 111 health advisors using NHS pathways and algorithms, which is the existing state of play. London’s 111 First for mental health service will go live across all London ICBs by the end of quarter four 2023/24.

• The London vision is that anyone in London experiencing a mental health crisis can call NHS 111 and have 24/7 access to the mental health support they need in the community, making 111 a reliable single point of access for our complex pathways across multiple organisations. Patients and their families/carers will experience a consistent and seamless access pathway to the right mental health care and support at the right time, and in the best setting for their immediate, medium or long-term need.

• The rate of detention under the Mental Health Act for Black people continues to be higher than their White counterparts, at 344 detentions per 100k population, a c.10% increase since 2018, compared to 75 per 100k for White people; London has the second highest number of S136 detentions per 100k population for Black People.

• Too many people detained under section 136 of the MHA are taken to emergency departments in police vehicles. London is an outlier in the number of S136 that are taken to emergency departments as first place of safety, c.60%, compared to c.30% for England

• Many people face disproportionately long stays in acute inpatient settings, often out of area away from their friends, family and carer networks.

• These improvements to mental health care all have funding identified or are already funded. There will continue to be dedicated investment to deliver the 5% year on year growth in community mental health services; ED alternatives are already in place with further developments planned using national capital funding.