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Delivering the transformational NHS England Mental Health Crisis Model

Dr Steven Reid Consultant Liaison Psychiatrist CNWL NHS Foundation Trust opened today’s Improving Mental Health Crisis care conference looking at:

• the key elements of the Mental Health Crisis Care Model
• what metrics do we have to measure the baseline and progress
• the role of tele triage and telehealth
• moving forward the agreed NHS England consensus approach to mental health crisis

Dr Steven Reid opened the conference discussing new models of crisis care in mental health in line with the NHS England model for mental health crisis care.

Summary of progress to date and the route map 
The care of people in mental health crisis

What is the current baseline in England
–    We have the data and need to now produce CCG by CCG reports 
–    We need as a priority a ‘State of England’ mental health acute care pathway and crisis care 
–    Economic remodelling tools as were used in London 
–    Evaluate the current front runner case studies - NTW, NWL, South West

What are the Big Transformation ideas that can deliver at pace
–    Implement spend to save liaison psychiatry to reduce admissions, OPC attendances, 
–    Implement spend to save Crisis home treatment teams to reduce admissions, LOS.

What is NHSE doing in 2014/5 to expedite
–    We have been working on plans in the SCNs, and AHSNs, and with DH/MIND concordat programmes with 25 community agencies engaged 

Where could the financing come from 
–    Maximise +++ prevention of crises which is possible with work with police, fire chiefs, housing LGA, tele triage 
–    A great deal is spend to save reengineering, estate sales, bed and OPC reductions with money into CCG commissioned care 

What do we need to do to commission 
–    We have a draft expert commissioning pack that needs a governance process 
–    We will be providing commissioning training to 200 CCG MH leaders What do we need to do to implement and deliver to national standards
–    We need NHSE revised MH governance process and a MH crisis care SRO

Dr Reid said the mental health crisis concordat had brokered new collaborations across the country. 
We need to think about prevention from cradle to grave said Dr Reid, it is incredibly important.
Dr Reid also discussed the development of direct access and triage service including the development of tele triage and tele health. 
The evidence base for crisis resolution and home treatment teams is not robust but 37% are not commissioned 24/7.
Liaison psychiatry has been blossoming over the last couple of years – liaison psychiatry for acute trusts:
Baseline key facts summary:
•    Liaison psychiatry teams have an expanding evidence base demonstrating clinical and cost effectiveness 
•    45% of acute trusts now have a liaison psychiatry service  
•    There are clear standards and ‘fidelity’ criteria for optimal safe, effective care and commissioning value & an accreditation network 
•    Benefits through reduced readmissions and length of stay
•    As well as the crisis care pathway they accrue benefits in other areas – LTC, MUS 
2014/2015 Announcements  that can be made: 
•    Liaison psychiatry to be included in the NHSE 7 day service review 
•    Liaison psychiatry teams have been commissioned or capacity increased as part of the Better Care Fund and winter pressures monies and System Resilience funds 
•    £40 million access funds includes commissioning of more liaison psychiatry teams & a workforce development programme 

Sometimes a crisis does require a bed:
The NHS England Beds Time Series shows that 
–    From 1988-2010 there has been a reduction in beds from 
•    67122 in 1987/88 to
•    25503 in 2009/10

–    The bed number continues to reduce and in 
•    Q1 2010:  there were 23,515 beds (April to June that year).  
•    By Q4 2011: there were 22,268 available beds 
•    Reduction of 1247 

In 2012/2013, demand for acute beds rose for the first time in 10 years

What is it like to be a person in crisis in England in 2020:
•    Access to support before crisis point
•    When I need urgent help to avert a crisis I, and/or people close to me, know who to contact 24/7. People take me seriously and trust my judgement, and I get speedy access to a service that helps me get better.
•    Urgent and emergency access to crisis care
•    If I am in mental health crisis this is treated as an emergency, with as much urgency as if it were a physical health problem. 
•    If I have to be taken somewhere, it is done safely and supportively in suitable transport.
•    I am seen by a mental health professional quickly and do not have to wait in conditions that make my mental health worse.
•     I then get the right service for my needs, quickly and easily.
•    Every effort is made to understand and communicate with me, to check any relevant information that services have about me, and to follow my wishes and any previously agreed plan.
•    I am safe and treated kindly, with respect, and in accordance with my legal rights. If I have to be held, this is done safely, supportively and lawfully, by people who know what they are doing.
•    Anyone at home, school or work who needs to know where I am has been informed and I am confident that arrangements are made to look after anyone who depends on me.
•    Treatment and care when in crisis
•    I get support and treatment from people who have the right skills and who focus on my recovery, in a setting that is suited to my needs.
•    I have support to speak for myself & make decisions about my treatment & care.
•    If I do not have capacity to make decisions about my treatment & care, any statements of wishes, or decisions, that I made in advance are checked & respected, & I am able to have an advocate. 
•    Recovery and staying well / preventing future crises
•    I, and/or people close to me, have an opportunity to reflect on the crisis, and to find ways to manage my mental health in the future, with support if needed. We have an agreed strategy for how I will be supported if my mental health gets worse in the future.

Dr Reid concluded with challenges for 2020

  • Money
  • Technology
  • Outcomes
  • Patient experience
  • Workforce development

Dr Reid’s full presentation is available for download at the end of this page.

Steven Reid is a Consultant Psychiatrist with Central and North West London NHS Foundation Trust. After training in psychiatry at St George’s, London and some time as a research fellow at the Institute of Psychiatry at King’s College he moved north of the Thames where when not banging the drum for the better integration of physical and mental health, he is to be found loitering in the corridors of St Mary's Hospital, Paddington in his job as a liaison psychiatrist. Of late he has been working with UCL Partners looking at new models of crisis care in mental health.

Future conferences of interest:

Smoking Cessation in Mental Health
Monday 11 May 2015 
Hallam Conference Centre, London

Information Governance in Mental Health: Implementing Caldicott2 & the New Code of Practice on Confidential Information
Monday 11 May 2015 
Hallam Conference Centre, London

Stronger Code: Better Care Implementing the Changes to the Mental Health Act Code of Practice
Tuesday 12 May 2015 
Hallam Conference Centre, London

Masterclass: The Mental Capacity Act and Advance Decisions
Wednesday 13 May 2015 
Hallam Conference Centre, London

Improving the Quality of Perinatal Mental Health Services
Tuesday 19 May 2015 
Hallam Conference Centre, London

Improving Physical Health for People with Mental Health Conditions
Wednesday 20 May 2015 
Colmore Gate Conference Centre, Birmingham

Psychosis & Schizophrenia in Adults
Monday 8 June 2015 
Hallam Conference Centre, London

Foundation Certificate in Dementia: 2 Day Interactive Training Course
Monday 15 June 2015 — Tuesday 16 June 
Hallam Conference Centre, London

Psychological Therapies for Severe Mental Illness
Wednesday 1 July 2015 
ICO Conference Centre, London

Implementing the national objective to end Prone/Face Down Restraint: Examining Restraint Positions in Practice
Tuesday 22 September 2015 
ICO Conference Centre, London

Download: Dr Steven Reid full presentation

30 April 2015


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