A Cavendish Square Group publication 21 How London is improving mental health crisis care: Representatives from 22 organisations, including the NHS and Met police, are working together to deliver lifesaving crisis care By Dr Matthew Patrick, Chief Executive of South London and Maudsley NHS Foundation Trust The focus on mental health intensified during the first six months of 2015. The coalition government’s mental health action plan, Closing the Gap, and the introduction of waiting time targets aim to bring treatment and standards for mental health problems on a par with physical health. These developments signal the start of a culture change in the NHS that the new government must build on. But there’s still a way to go before patients experience true “parity of esteem” – the sense that a mental health need should be met with the same consistency and urgency of care as a physical health need. One initiative, the Mental Health Crisis Care Concordat, is a commitment to bridging what remains as one of the biggest gaps between the treatment of mental and physical health: emergency care. Physical traumas are considered emergencies. If a person suffers a heart attack, they know what healthcare to expect, but in the case of a mental health crisis, the care is far more variable. It can involve any one of 14 different places to get help, including accident and emergency, the transport police or homecare. Or you could be taken to a police cell as a place of safety for a mental health assessment. In 2012-13, police made nearly 22,000 detentions under Section 136 of the Mental Health Act. Across the country, two thirds of these people were taken to hospital but a third were taken to police cells – an inappropriate, confusing and distressing environment for someone experiencing a mental health crisis. London has done an exceptional job in addressing this, such that using a police cell as a place of safety would now not be considered. However, there is much more that we need to do. It’s time to rethink how we respond to individuals in crisis. We need to improve the system to provide people with the rapid and effective support and care that they deserve – whatever the circumstances in which they first need help and from whichever service they turn to first. In setting up London’s Mental Health Strategic Clinical Network, it was clear that a different approach was needed if this change was to be achieved. A whole system view was required with an integrated strategy that extends to social care, housing and employment support as well as substance abuse. What this approach delivered in relation to crisis care was the Strategic Clinical Network’s commissioning standards – a set of recommendations for commissioning mental health crisis services across London. Representatives from 22 organisations including Mind, the Metropolitan Police, the NHS, social care, housing and local councils met in spring 2015 to agree an action plan for implementation. These standards form part of London’s response to the Crisis Care Concordat. But how, exactly, will they improve people’s experience of care in a crisis and what will the future look like for patients? In the future, GPs will have access to and knowledge of local specialist mental health and social care services and be in a position to advocate on their patients behalf when referring them to these services. All parts of the health, social, welfare and education systems will work together when providing services to help patients recover, stay well and stay connected with work, family and school. Should a patient experience crisis, care plans will be in place with details of what steps clinicians and others should take. Home treatment teams will have been commissioned to provide crisis care in the least restrictive and most appropriate environment.
London Mental Health Fact Bbook
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