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What makes a good mental health crisis plan?

Miles Rinaldi Head of Recovery and Social Inclusion South West London and St Georges Mental Health Trust spoke at today’s Improving Mental Health Crisis care conference on:

• co-production of crisis plans with service users
• an exemplar crisis plan and good practice standards
• developing an effective crisis planning process

Miles commented; “how people are treated when they are in crisis is a very important issue… At the point when people are in crisis collaboration can often break down… Trust is a key issue.”

In his presentation he covered:

Policy and Guidance 
•    NICE (2011) Quality Standard for adult mental health
–    People who may be at risk of crisis are offered a crisis plan (QS 9).
–    People are actively involved in shared decision-making and supported in self-management (QS 3).
–    People in hospital for mental health care, including service users formally detained under the Mental Health Act, are routinely involved in shared decision-making (QS 10).
–    Mental Health Act code of practice – chapter 17.

Crisis plans:
What the person wants to happen if they are in crisis and need others to take care of them and keep them safe
Different from other plans:
•    Care plan = a person’s assessed health and social care needs that promotes recovery by focusing on improving outcomes that mattered 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

What is a joint crisis plan?
•    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).

Miles went onto say that even if you develop a great crisis plan it is not just developing them that is important but implementation and getting clinicians to use them. Evidence shows that they are often not well used. 

What is clear from the research evidence:
•    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.

Miles talked about their approach to developing collaborative crisis plans that incorporate shared decision making.

Developing collaborative crisis plans:
Collaborative crisis plans have to be negotiated, agreed and shared with others ... and the negotiation is a critical part of the process.  
Hence the need for a collaborative process.

The full presentation is available for download at the end of this page.

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:

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: Miles Rinaldi Full Presentation

30 April 2015


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