'One of the most visible differences in mental health services today compared with the 1990s is the development of crisis resolution teams'

Amid the recent retrospectives on the last 10 years of the NHS, the keenly observant may have been able to spot the odd fleeting reference to mental health. However, despite the lack of press coverage, there have been significant changes.

One of the most visible differences in mental health services today compared with the 1990s is the development of crisis resolution teams. Crisis services at Camden and Islington Mental Health and Social Care trust were among the first to be set up before the national service framework and have been a major success over the past eight years.

Fit for the future

But is a model developed in the late 1990s right for the future? Following a detailed review in 2006, there is now a case for the teams to reposition and refocus by joining with accident and emergency liaison services and inpatient services.

Camden and Islington hopes to create an integrated and streamlined working model between its crisis teams and A&E liaison services, alongside the development of a mental health Hospital at Night service for providing medical cover in out of hours. The model will also strengthen the gate-keeping role of the crisis service.

The trust currently has four crisis resolution teams and three A&E-based mental health liaison teams. The proposal to link these staff will require closer working relationships with emergency social workers and will develop a key role for crisis teams in facilitating early discharge. The trust is also determined to improve the crisis response to GPs as part of this proposal, which is designed to help the trust deliver the following outcomes:

  • treating patients in the least restrictive environment consistent with their clinical and safety needs;
  • further reducing inpatient admissions and pressure on beds;
  • ensuring equal access to an alternative to admission for patients and families.

In addition to improving service users' experience and caring for people at home wherever possible, this approach will allow the care trust to prevent unnecessary admissions and reduce the average length of stay.

Reforming night services

Implementing a mental health Hospital at Night model will include a review of senior house officer posts. Presently, these doctors provide medical cover at night by working 'waking nights', during which they are not supported by a team structure and are obliged to make decisions in isolation.

This is stressful for them and can have a detrimental impact on the following day's work on the wards.

Time spent by senior house officers on night shifts is also time spent away from the wards they are responsible for. Introducing the hospital at night model would aim to improve on this system by having them on-call at nights, disturbed in emergencies only.

The proposal would improve these doctors' working conditions by providing them with a team structure. It would allow them more time on their wards and enable them to better co-ordinate work with ward managers. As a result, continuity of care for service users would improve..

David Lee is director of strategic development at Camden and Islington Mental Health and Social Care trust.