Crisis care, liaison psychiatry, and transition

Crisis care

As a signatory to the Crisis Care Concordat, NHS England began a major programme on crisis care, with the aim of ensuring 24/7 access to the right services for people experiencing mental health crisis. This includes £249m investment in urgent and emergency mental health liaison in acute hospitals, and investment in community crisis response.

The South West Mental Health Clinical Network is facilitating local systems across the region to transform crisis mental health services.

The Five Year Forward View for Mental Health objective states that by 2020-21, all areas will provide crisis resolution and home treatment teams that are resourced to operate in line with recognised best practice – delivering a 24/7 community-based crisis response and intensive home treatment as an alternative to acute in-patient admissions.

The network support offer includes:

  • benchmarking services against Core Fidelity 2 standards
  • clinical leadership to inform implementation of key national guidelines.

Liaison Psychiatry

Acute hospital liaison psychiatry supports patients:

  • In acute settings (inpatient or outpatient) who have, or are at risk of, mental ill health;
  • Presenting at A&E with urgent mental health care needs (particularly relating to self-harm, dementia, mood disorders, alcohol abuse, psychosis relapse and co-occurring mental health and physical health conditions);
  • Being treated in acute settings with co-morbid physical health conditions and mental ill health;
  • Whose physical health care is causing mental health difficulties;
  • In acute settings with medically unexplained symptoms.

Liaison Psychiatry services are multidisciplinary, typically comprising psychiatry, psychology, nursing and specialist roles. They aim to increase the detection, recognition and early treatment of impaired mental wellbeing and mental ill health to improve outcomes, and:

  • Reduce premature mortality associated with co-morbid mental and physical health conditions;
  • Reduce excess lengths of stay in acute settings associated with co-morbid mental and physical health conditions;
  • Reduce risk of harm to the individual and others in the acute hospital through adequate risk assessment and management;
  • Ensure that care is delivered in the least restrictive and best coordinated way.

In January 2016 the Prime Minister pledged £247 million for mental health services in hospital emergency departments, to be deployed over five years. The purpose of the pledged money is to make sure that every emergency department has mental health support and, as a global leading effort, will make sure that these services are available 24 hours a day, 365 days a year in at least half of England’s acute hospitals by 2020.

Within the South West, the Mental Health Clinical Network is developing a Liaison Psychiatry programme of work and has recently completed a gap analysis of Liaison Psychiatry Services.

Transition

In February 2011, ‘No health without mental health’, was published, which states that service transition from child and adolescent mental health services to adult services can be improved by planning early, listening to young people, providing appropriate and accessible information and focusing on outcomes and joint commissioning.

A CQUIN was developed in 2017 to apply to all community Children and Young People (CYP) mental health services providing services up to transition age (the ‘sending service’) and any relevant CCG-commissioned service the young person is transitioning into (the ‘receiving service’).

The mental health clinical network is supporting services to meet the new CQUIN requirements in 2019. This involves sharing good practice with systems, especially in relation to young people’s satisfaction and experience of transition as well as developing case studies of good practice to share with commissioners, providers, and networks.

A Transition meeting focusing on updated CQUIN requirements for 2019-21, will be held in 2019 with the aim of providing an opportunity to clarify those areas where there may be ambiguity – and to develop a shared understanding of these across agencies now so as to support the effective delivery of the transition arrangements post-2018.