The COVID-19 pandemic has affected us all in different ways, and for many people it has had a negative impact on our mental health.
If this includes you, the NHS is here for you and now provides crisis support all day every day via our new all age urgent mental health helplines.
At the start of the pandemic, mental health trusts across the country had to adapt to new challenges to stay open and protect staff and patients. As part of their response to COVID-19, they set up or expanded 24/7 all ages urgent mental health helplines in just a matter of weeks, four years ahead of the original NHS Long Term Plan target. These lines are in various stages of development, with many services still developing and improving their offer and workforce.
Until March 2020, most areas did not have urgent mental health lines with 24/7 hours of operation for all ages, and access to crisis support was often restricted only to people who were already known to services.
This meant people were often left not knowing what to do, in many cases feeling they had no option but to dial 999 or to go to A&E if they or their loved ones were experiencing a crisis.
As part of their response to the pandemic, all NHS mental health trusts in England opened crisis lines in May 2020.
In just one year the NHS is estimated to have taken around 3 million calls (based on latest data collection from all mental health trusts covering April to November 2020 showing consistent levels of ~230-250k calls each month) through these lines, with around a quarter of a million calls now being taken each month.
The crisis lines have been put in place to act as a point of contact for people of all ages experiencing a mental health crisis or supporting loved ones who need urgent help with their mental health.
By providing direct access 24/7 to a team of mental health professionals offering information, advice, brief psychological interventions and a crisis response where needed, many service users and carers have been supported and their needs prevented from escalating further; fewer than 2% of the calls received between April and November 2020 have resulted in people being referred to A&E or needing a blue light response from ambulance or police.
Due to this rapid roll out, all areas will continue to improve the operation of the lines in the coming years. However, it is an important milestone in the 5-year expansion of NHS mental health crisis services in all parts of the country that people are now able to self-refer to seek support from the NHS for urgent mental health needs.
As part of the next phase of this transformation, the NHS will be looking to connect these specialist urgent mental health lines to NHS 111 in the coming years. When people dial 111, the intention is that they will be able to select a mental health option, making England one of the first countries in the world to have a clear, easy to remember 3-digit number that anyone can dial to access specialist mental health support.
Read below how Greater Manchester Mental Health Foundation Trust (GMMH) quickly rose to the challenge and set up their crisis lines within 10 days, how Tower Hamlets Mental Health Crisis Response Service transformed their lines and the expansion that took place for children and young people in Alder Hey Children’s Hospital.
Greater Manchester Mental Health NHS Foundation Trust (GMMH)
At the start of the pandemic, within a week, Greater Manchester Mental Health NHS Foundation Trust (GMMH) set up a 24/7, all-ages helpline, staffed by experienced mental health practitioners from a range of services, many of whom were shielding themselves but supported to work from home.
In their first ten days, over 1,500 calls were received, and during the height of the pandemic the call handlers received almost 550 calls per day. Since 20 March 2020, they have handled almost 30,000 calls and since its expansion in May, have supported the Greater Manchester Clinical Assessment Service (CAS) and NHS 111 service by streaming their calls and supporting the caller to a solution which helps relieve pressure on other services, including ambulance call outs and attendances at A&E.
It has undoubtedly prevented many service users and families from experiencing a crisis in isolation with no support. The main outcomes have resulted in callers being supported with crisis intervention to prevent self-harm, including suicide prevention and safety planning with the service user so they continue to be cared for at home.
One caller, who would like to remain anonymous, said: “I turned to the helpline in the middle of the night when I was feeling very low. I would like to express my gratitude to the helpline team for helping me reach my birthday. I would have not got this far without your support.”
The service has been able to intervene at a critical point in the crisis pathway and divert people, who do not need urgent physical health care or require assessment under the Mental Health Act, from attending A&E departments and potentially being admitted to an acute mental health bed. This resulted in reduced pressure on the local urgent care systems across Manchester, Bolton, Salford and Trafford and the provision of a more timely and appropriate care pathway for people in mental health distress.
Deborah Partington, Executive Director of Operations, said: “In March 2020, the 24/7 helpline was mobilised rapidly in response to the coronavirus pandemic, in order to provide professional crisis mental health support to all who needed it, at a time of increased distress for many, and of disruption to established care pathways.
“The helpline has supported those with severe mental health problems and their carers to deescalate crisis situations and refer quickly and efficiently to the correct pathways. It has also vitally taken the pressure off local urgent care services, such as A&E departments, 999 responders and acute mental health hospitals, during a time of significantly increased demand.”
Patient experience has been improved by not having to visit A&E or call on emergency services to access support when they are in a mental health crisis, by providing quicker access to the right pathway at the right time. The crisis lines have helped to avoid a high number of people abandoning calls to emergency services and waiting for a clinical call back
Tower Hamlets Mental Health Crisis Response Service
The Tower Hamlets 24hour Mental Health Crisis Line, provided by East London NHS Foundation Trust, is commissioned by Tower Hamlets Clinical Commissioning Group. The service aims to reduce Emergency Department attendances by providing support and advice to Tower Hamlets residents in a mental health crisis.
The service is the first point of access of the newly transformed Tower Hamlets Mental Health Crisis Pathway. The Crisis Response team operates a 24hour support phone line and face to face clinical assessment service. The line has been in operation since October 2018 however in line with the transformation the service expanded in January 2020 to become the Crisis Response Team.
If someone calls the line and their preference is to use a language which the call handler cannot speak or understand, they have the option to contact the Language Shop in Newham who finds someone to speak the required language, then the call handler calls the person in crisis back and has a three-way conversation.
The crisis line has become a first point of access to the crisis services available in Tower Hamlets. The service user is offered the support, help and direction to the most appropriate service to ensure it meets their needs and urgency at the time.
They are supported throughout and provided with strategies to build resilience in managing and preventing crises in the future. For example, once they speak with the crisis line this could then result in attending the local mental health crisis hub near A&E or referral to the crisis café for recovery focused interventions and crisis plan. Following this, another assessment is undertaken which could then include referral to talking therapy, medication prescription or referral to their GP.
The crisis café, known as the Together Café, was set up in May 2020. There have been temporary adaptions made to the crisis café model during the pandemic to meet the social distancing guidelines. The café is designed to be walk in and self-referral. Due to social distancing, the flow of people attending the café had to be managed carefully to ensure the environment is safe for the person in crisis and staff. A referral system was introduced initially via the crisis line and then via the wider crisis teams and video sessions were offered for those preferring an online contact.
One caller, who would like to remain anonymous, said: “Thank you for all your help as I was being pushed from pillar to post and felt no one was helping me.”
From May 2019 to April 2020, the crisis line received over 7,400 calls. From April 2020 to March 2021, they have now received over 11,000 calls.
The service transformation taking place in Tower Hamlets is an example of the NHS Long Term Plan investment taking place now in all parts of the country to improve mental health crisis services for all ages.
Melanie King, Tower Hamlets Crisis Pathway Service Manager, said: “Our aim when we set up the 24/7 crisis line was to provide more support and better access for people in Tower Hamlets who found themselves isolated, overwhelmed or in need of support for their mental health than we had in place at the time.
“As the service has developed so have the resources we have access to and the line is now a Freephone 0800 number which has made access to support easier. East London had some of the highest rates of coronavirus which meant people felt fearful, alone and isolated. It was hard for many to stay positive to an alarming backdrop of negative statistics and upsetting human stories.
“I am glad that the team were here to talk to people at an early stage, to be a friendly and helpful voice in the darkness, and help people to develop strategies to cope, direct them to our local services and/or voluntary sector services that could help.”
Alder Hey Children’s Hospital NHS Foundation Trust’s Crisis Care Line
Alder Hey Children’s NHS Foundation Trust quickly rose to the challenge and transformed their service from a single point of access team which operated from 8.00-20.00 on weekdays and 10.00-16.00 on weekends, to a 24/7 crisis care service. This is in addition to providing follow up appointments within 72-hours of patients being admitted and next day virtual community assessments. This means the service can quickly and efficiently respond to the needs of children and young people (CYP) and ensure that they are continuously being supported throughout the COVID-19 pandemic and beyond.
The crisis care line aims to reduce Emergency Department attendances by providing support and advice to young people under the age of 18 who are in a mental health crisis and the adults around them in residence in Liverpool, Sefton, and Southport and Formby. At the start of the pandemic in March 2020, Alder Hey set up a 24/7 freephone, open access CYP focused urgent mental health helpline, staffed by experienced mental health practitioners from a range of services. Since March 2020, their urgent mental health line has received almost 5,000 calls. The line has also supported local voluntary sector services and NHS 111 by enabling calls from local voluntary sector services and NHS 111 to be passed directly to the crisis line if needed.
The service is the first point of access of the newly transformed Crisis Response Team. The team operates a 24hour support phone line, virtual and community face to face clinical assessment service, working into the A&E department to provide timely mental health and risk assessments to young people.
It has undoubtedly prevented many service users, families and carers from experiencing a crisis in isolation. Over this period there has also been a reduction in the number of presentations to A&E due to a mental health crisis and over a 50% reduction in the number of young people needing an admission to hospital. The main outcomes have resulted in callers being supported with crisis intervention to prevent self-harm, suicide prevention and safety planning with the service user and their families, so they continue to be cared for at home and in their local community.
A couple of service users, who would like to remain anonymous, said: “The crisis care team were really helpful, kept us well informed and really helped us out.”
“Everything which could be done was done, and we were happy with that. The things which were put in place were absolutely fantastic.”
A parent, who would like to remain anonymous, said: “I attended my GP for an appointment because I was worried about my daughter. The GP asked me to go home and call the crisis care team with my concerns. At first, I felt as though the GP was just ‘passing me on’ because he couldn’t help, but after speaking with the Crisis Care Team, I understand why he advised this. They couldn’t have been more helpful. I was extremely upset and frustrated during the call but the lady I spoke with made me feel calm and less stressed. The work they do is fantastic and I’m just so happy that such a team exists, especially with the increase in mental health that’s currently all over the media.”