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What makes a good crisis plan?

Miles Rinaldi, Head of Recovery and Social Inclusion, South West London and St Georges Mental Health Trust discusses what makes a good crisis plan? positive risk taking and collaborative crisis planning at today’s conference. In his presentation Miles discussed:

  • co-production of crisis plans with service users
  • an exemplar crisis plan and good practice standards 
  • positive risk taking and collaborative crisis planning
  • developing an effective crisis planning process
  • ensuring access to support before a crisis  
     

Miles Rinaldi’s full presentation is available for download at the end of this page.

Miles gave a practical presentation on how to implement a mental health crisis plan and overcoming challenges and barriers, making reference to the NICE guidance:

NICE (2011): A crisis plan should contain:

  • Possible early warning signs of a crisis and coping strategies
  • Support available to help prevent hospitalisation
  • Where the person would like to be admitted in the event of hospitalisation
  • The practical needs of the person if they are admitted to hospital (e.g. childcare, care of other dependants, including pets)
  • Details of advance statements and advance decisions
  • Whether and the degree to which families or carers are involved
  • Information about 24-hour access to services
  • Named contacts.
     

Miles said “the focus needs to be on what the person wants to happen if they are in crisis and need others to take care of them and keep them safe”

Miles went on to look at the difference to other plans:

  • Care plan = a person’s assessed health and social care needs that promotes recovery by focusing on improving outcomes that matter to the person
  • Personal recovery plan = what the person will do for themselves
  • Crisis plan = what they want others to do for them in a crisis


Miles explained; "The Joint Crisis Plan is an advance agreement between service users and their care team regarding service user preferences for treatment and practical arrangements in the event of future mental health crises. A joint crisis plan aims to empower service users while facilitating early detection and treatment of a relapse. A joint crisis plan has to be negotiated and agreed (for it to be a joint crisis plan).”

“Service users like having crisis plans - the completion process, content of the document and quality of experience – much is known.”

“In a time of crisis, crisis plans are all too often not followed by mental health services. - Little is known about access and honouring crisis plans”

“The quality of crisis plans mirrors the quality of the process whereby which they were developed.”

What helps and hinders when in crisis?

What helps?

  • Maintaining wellbeing (comfort, personal safety, self-management, being active, staying connected, normalisation).
  • Importance of personalised medicine and support (access and availability of services, types of support and services, role of family).

What hinders?

  • Passivity / apathy (doing nothing, uncertainty, withdrawal from supports)
  • Lack of autonomy (intrusiveness, lack of respect, decision-making)
  • Pressures (work, housing, family, temptations)

 

Miles concluded his presentation by emphasising again how important implementation is, he said; "it's one thing to have the crisis plan developed but need to have an integrated implementation system to ensure they are used...it's also important to learn from use of the crisis plans through review and update after crisis." 

Miles Rinaldi Biography:

Miles Rinaldi is the Head of Recovery and Social Inclusion at South West London & St George’s Mental Health NHS Trust.  He has established employment services using the individual Placement and Support approach to help people with mental health conditions gain and retain employment which have been recognised as models of good practice.  He has also been working to implement a recovery focused approach across his organisation and established the first Recovery College in England.  He is also a consultant on the national Implementing Recovery though Organisational Change (ImROC) programme.

Miles has also worked on mental health policy in the Social Exclusion Unit (Office of the Deputy Prime Minister), the Department of Health, the Prime Minister’s Strategy Unit (Cabinet Office) and in the Department for Work and Pensions.  He has conducted service evaluations and research with over 25 peer reviewed journal publications and book chapters.

Future events of Interest:

Positive and Proactive Care Meeting the New National Guidance on Reducing Seclusion
Tuesday 20 October 2015 
Hallam Conference Centre, London

Smoking Cessation in Mental Health
Tuesday 20 October 2015 
Hallam Conference Centre, London

Deprivation of Liberty Safeguards: Ensuring Compliance in Practice
Tuesday 17 November 2015 
Hallam Conference Centre, London

Information Sharing in Mental Health
Friday 27 November 2015 
Hallam Conference Centre, London

Violence and aggression: short-term management in mental health, health and community settings: Implementing the New NICE Guideline
Friday 27 November 2015 
Hallam Conference Centre, London


Download: Miles Rinaldi"s full presentation

15 October 2015

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