Crisis care has once again become a focus of intense media and political debate. Concerns about accident and emergency services have risen to the fore, with an urgent care review under way.
There is growing evidence, however, that mental health crisis care is under especial pressure – and that when people are at their most vulnerable, the quality of care they receive is unacceptable. But these difficulties also underline ways in which we can improve mental health support and reinvest in the most effective interventions.
A report this week from four national inspectorates found that each year police cells were used some 9,000 times as “places of safety” for people detained under section 136 of the Mental Health Act. Rather than being used in ‘exceptional’ cases, it is clear that, at least in some areas, police stations are being used routinely, for an average of more than 10 hours at a time, to hold people in an acute mental health crisis.
As Lord Adebowale’s independent commission on policing and mental health concluded just last month, police forces struggle to deal with people in mental health crises and too often get inadequate support from health services at these most difficult of times.
‘The picture that emerges is one of services under pressure, struggling to support people at their most vulnerable’
Data have also been published his week showing that people who use mental health services attend A&E at twice the average rate. The Health and Social Care Information Centre calculated that two-fifths of mental health service users attended A&E at least once during 2011-12.
The picture that emerges is one of services under pressure, struggling to support people at their most vulnerable. Too many people facing a mental health crisis are ending up in A&E or in police stations. Without speedy access to specialist support, not only do they suffer unnecessary distress but the costs of poor crisis care almost always outweigh those of effective, timely intervention.
We already know many elements of what constitutes good-quality mental health crisis care. In general hospitals, liaison psychiatry teams need to be available around the clock, providing immediate access to mental health support to patients of all ages, whether they present in A&E or other parts of the hospital.
In the community, 24/7 access to crisis resolution and home treatment teams, mandated in The NHS plan in 2000, remains crucial and should not be overlooked now. When the police do need to intervene, access to liaison and diversion teams will be crucial to give officers rapid access to advice and to screen adults and children coming into police custody for mental health difficulties. And when a ‘place of safety’ does have to be found in an emergency, it cannot be acceptable that a lack of staffing in a clinical setting forces the police to detain a distressed person in a cell.
The Francis Report has shone a harsh light on the quality of some NHS care his year. It is now more apparent than ever that unless we take a ‘whole health economy’ approach to improving quality and responding to urgent care needs, including physical and mental health care together, we will fail to make the improvements that are needed to offer everyone the care they need when they need it most.