Improving Mental Health Crisis Care: News & Updates
Today's conference focuses on improving mental health crisis care, delivering a new model of mental health crisis services and meeting the ambitions of the Mental Health Crisis Concordat
Following the chair's introductions, Kate Davies OBE National Director for Health & Justice, Armed Forces and Public Health NHS England opens the conference with an update on 'Developing an effective emergency response', looking at:
• developing a partnership approach
• updates from the Liaison and Diversion schemes across the UK
• developing street triage and where should street triage sit? Should street triage be part of 111?
Kate said her presentation would focus on developing a partnership approach, updates from the liaison and diversion schemes across the UK, developing street triage and where it should sit, the Prison Safety and Reforms White Paper, and the Health and Justice Performance Indicators tool and evidence and early intervention, the patient pathway, coming together through criminal justice and mental health intervention.
“Early intervention up-stream is ultimately what this is all about to me,” she said.
She talked about taking healthcare to the heart of reform, and ensuring the whole prison approach was a two-way road between commissioners and prisons and governors.
“We need to ensure we are putting patients, first and foremost, in enabling environments.”
Kate said: “The crisis care element of this is really about saying how we can get a better strategic view of how we find our way up and down the corridor of criminal justice and make sure we find ourselves in the right rooms.”
She talked about Health and Justice Performance Indicators and taking an evidence-based approach.
“I just want to emphasise that the evidence-base is getting stronger and stronger,” she said.
She said NHS England and other partner organisations had developed a set of Health and Justice Indicators of Performance (HJIPS) to support and monitor quality improvement and contractual obligations.
“We don't talk about physical health do we?” she said. “We talk about cancer and cold and flus, and respiratory disorders and everything else, so why do we keep talking about mental health, when we should be talking about the different treatments and interventions.
Kate talked about the vision for liaison and diversion services, saying: “100% of England will be covered by liaison and diversion schemes by 2021 and one of the current recommendations is to push that on even quicker.”
“Wherever you sit, whatever your involvement in mental health is, put down your silos and look at the pathways that crisis care is all about,” she said. “Because ultimately, we're all there together.”
Continuing the morning sessions is Fiona Venner Director Leeds Survivor Led Crisis Service who will look at 'Alternative approaches to work with crisis', focusing on
• why the quality of crisis care is important
• an alternative, non-diagnostic, not medical approach to mental distress
• a survivor led, person centred approach
• what people need in crisis – the five elements of effective support
She introduced her talk by saying that she believed quality of crisis care was particularly important because it was often the point that people started in the mental health system, and the impact on progress, recovery and a patient's willingness to seek help in the future, that those initial stages of crises, and what they experience during that time, can have.
She talked about the needs to improve crisis care based on the findings of Listening to Experience, an independent inquiry into acute and crisis mental health care, a report commissioned by MIND in 2017.
Fiona said the Leeds Survivor Led Crisis Service was established by a group of campaigning service users, who recognised a need for something different, in 1999 as an alternative to hospital and statutory services in acute and mental health services.
She said the service offers a number of levels of support, including a helpline, a place of sanctuary, a crisis service for BME groups, peer and social support for LGBTQ groups, and a suicide bereavement service.
Fiona talked about the value of collecting feedback from service users.
“When I'm doing presentations like this for other charities, I always emphasise that they must demonstrate the efficacies of what they do, particularly in the current NHS climate,” she said. “People can be very eloquent in altered states and distress, which just shows how important it is to always be collecting feedback from them.”
“Working with people in crisis can be so rewarding,” she said. “And being behind people at that time in their life can be so powerful.
Concluding the morning sessions is Viral Kantaria Project Manager, Adult Crisis and Acute Care NHS England who will look at ‘Improving mental health crisis care. Delivering transformation: urgent & emergency mental health care & the Five Year Forward View for Mental Health', focusing on:
• national context: MH & UEC
• the scale of the programme
• developing evidence-based treatment pathways for urgent & emergency mental health care
• progress since the Concordat & mainstreaming its legacy
Viral opened by talking about the CQC thematic review in summer 2015, which while finding some excellent examples of innovation and practice, found 'unacceptable' levels of variation in terms of how many people in crisis had received the right response.
He talked about the Mental Health Task Force, set up in February 2016, and its recommendation that by 2020/21, there should be 24/7 community crisis response across all areas that are adequately resourced to offer intensive home treatment, with equivalent models developed for children and young people.
Viral said because 'crises can be subjective', NICE developed guidance, Achieving Better Access to 24/7 Urgent and Emergency mental Health Care – Implementing the Evidence-based Treatment Pathway for Urgent and Emergency Liaison Mental Health Services for Adults and Older Adults.
“One of the issues with liaison services up until this point is that it's been a bit if a hodge-podge,” he said. “We need to ensure in the future that it is sustainable and can be embedded and delivered in the core business of the acute hospital.”
“We absolutely know that people are not going to be hitting every standard we want them to hit, but the reason why we are doing this is to get that baseline,” he said. “The expert reference group is very clear that what we need to be doing is setting those gold standards.”
“I think crisis care is one of the areas that we have, that it is very import to take a whole sector approach across both the public and the voluntary sector.”
Viral talked about some of the issues around producing similar guidance for children and young people.
“the main issue with children and young people crisis scare is that the evidence isn't really there,” he said. “There's quite a patchwork of models right now and its been quite hard to find out what's going on and where.”
He said some of the urgent and emergency care and vanguard sites have been testing models around children and young people, but that it was very much a work in progress at the moment.
Future conferences of interest:
Dual Diagnosis: Implementing the NEW NICE Guidance
Self Neglect and Adult Safeguarding
Transforming Mental Health Services for Children & Young Adults
Reducing Restrictive Practice & Interventions
Masterclass: Individual Management Reviews for Domestic Homicide Reviews & the use of Root Cause Analysis
Investigation of Deaths & Serious Incidents in Mental Health Services
Towards Zero Suicide: Preventing Suicide, Saving Lives
6 December 2016