As a signatory to the Crisis Care Concordat, NHS England is delivering a major workstream on crisis care to make sure people get the help they need when they are experiencing a mental health crisis.
NHS England’s crisis and acute care workstreams have been set up to support the commissioning and provision of high-quality, responsive, 24/7 accessible mental health services for people who may be seriously ill and need of urgent support.
- As outlined in Implementing the Five Year Forward View for Mental Health, this includes: £249m new funding over four years from 2017/18 to expand liaison mental health in acute general hospitals so that people in emergency departments or inpatient wards receive timely, skilled and compassionate assessment and treatment. This additional funding will enable at least 50% of acute hospitals to provide a minimum of ‘core 24’ mental health liaison 24 hours a day, seven days a week. This is part of an ambition to ensure all acute hospitals offer integrated mental and physical health care. The bidding process for Wave 1 of the transformation funding for urgent and emergency liaison mental health services is now live.
- £400m for crisis resolution and home treatment teams (CRHTTs) from 2017/18 to deliver a 24/7 crisis response and intensive home treatment in communities and homes as a safe and effective alternative to inpatient hospital admission in line with recognised best practice.
- Testing new models of care through the eight Urgent and Emergency care Vanguards, building on the work to embed crisis care into the Urgent and Emergency (UEC) programme
- Embedding mental health crisis and acute care into key national levers available to NHS England, such as the NHS Planning Guidance, the annual winter readiness programme, and the CCG Improvement and Assessment Framework.
- Developing evidence-based treatment pathways for crisis care. This includes clinically informed referral-to-treatment pathways, recommendations on quality standards, publication of implementation guidance, improving national datasets and establishing quality assessment and improvement networks.
NHS England has commissioned NICE to deliver a programme of implementation support which is being provided by the National Collaborating Centre for Mental Health (NCCMH). NCCMH is working with national experts, including people with lived experience, to develop evidence-based treatment pathways for urgent and emergency mental health care. These include:
- 24/7 urgent and emergency mental health liaison in acute hospitals (e.g. in emergency departments and adult inpatient wards), with a helpful resources document.
- Urgent and emergency mental health response from blue light services (e.g. police. Ambulance).
- Urgent and emergency 24/7 community adult mental health response (e.g. crisis teams, crisis lines, primary care).
- Urgent and emergency 24/7 mental health response for children and young people (e.g. acute hospital liaison and community crisis response).
In spring 2017, the Royal College of Psychiatrists’ College Centre for Quality Improvement (CCQI), will launch a year-long national quality assessment and improvement scheme in partnership with NHS England and publish accompanying tools. The scheme will support urgent and emergency mental health services to benchmark themselves against the standards described in the pathway guides and to improve. All services will be expected to complete the self-assessment in 2017/18 and take part in a scoring and validation process.
More than 20,000 people took part in the national engagement exercise for the Mental Health Taskforce in 2015 and they were clear about the need for acutely ill people to get care as close to home as possible with stronger support and care available in the community. In response, NHS England will be investing in home treatment teams to offer an intensive, therapeutic alternative to inpatient hospital admission. Evidence shows that the right level of support outside of a hospital can help to improve recovery, and also ensures beds are available for those who are seriously ill and need inpatient care.
NHS England accepted the recommendation from the Mental Health Taskforce’s Five Year Forward View for Mental Health to eliminate inappropriate out of area placements (OAPs) by 2020/21. As a first step, NHS England, the Department of Health, NHS Improvement, and NHS Digital, have worked with stakeholders to agree the first national definition of OAPs and is aiming to establish a new national data collection to allow us to understand the extent of the practice and with a view to having eliminated the practice by 2020/21.
NHS England is working with NICE and the NCCMH to develop an evidence-based treatment pathway for acute mental health care. This will include a focus on managing pressures in the acute care system including bed management, reduction of delayed transfers of care and elimination of inappropriate OAPs.
The Commission on Acute Adult Psychiatric Care (Feb 2016) highlighted the complex factors which put pressure on the acute care system, including capacity within CRHTTs, delayed transfers of care from inpatient settings and the provision of suitable housing for people with acute mental health needs. NHS England will be issuing a full response to the Commission’s recommendations by the end of 2016/17.