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Public Services Must ‘Wake Up’ To Gaps In Mental Health Crisis Care, Warns CQC

People who are having a mental health crisis are not always receiving care and support when and where they need it, the regulator has found.

In a national report out today (Friday 12 June), the Care Quality Commission (CQC) has raised concerns that public services, such as local authorities, NHS trusts and clinical commissioning groups, are failing to work together to make sure that people in their local areas have access to crisis care around the clock. Also, it found that healthcare professionals, such as those in A&E, can appear to lack compassion and warmth in how to care for and speak to people who are having a crisis, including those who have harmed themselves.

As part of its review, CQC sought views from people who have experienced different types of mental health crisis care. It found that while 86% of those who had received care and support from charities and volunteers felt that their concerns had been taken seriously by them, only 37% said that they felt this from A&E staff. This is worrying as these professionals should be trained in how to care for and respond to them. In particular, people often reported poor attitudes from staff towards their injuries caused by self-harm. Overall, only 14% of people thought the care they received provided the right response and helped them to resolve their crisis.

Although it is difficult to determine the exact number of people who have a mental health crisis, more than 68,800 people were admitted to a mental health ward for urgent care in England as inpatients in 2013/14.

The experience of a mental health crisis can include suicidal behaviour or intention, extreme anxiety and panic attacks, psychotic episodes (when people may experience delusions, hearing voices and a loss of sense of reality), and behaviour that is considered ‘out of control’ or irrational to the extent that the person poses a risk to themselves or others.

When people experience, or are close to experiencing, a mental health crisis, there should be services available to provide urgent help and care at short notice.  This includes advice from telephone helplines, assessment by a mental health professional, intensive support at home or urgent admission to hospital.

CQC has reviewed the quality of these services in England to identify what is working well and what must improve.  The review team inspected a sample of locations across England; received a survey return from 1,800 people who have experienced a crisis; and examined national data.

As well as staff training, CQC has identified that there is a clear need for better 24-hour support for people having a crisis, particularly during the hours of 11pm and 5am, as CQC found that during these hours availability and accessibility is poor. This means that people often have to go to A&E departments or even to police cells while a ‘place of safety’ is found for them, rather than receive specialist care straightaway.

Dr Paul Lelliott, CQC’s Deputy Chief Inspector of Hospitals (lead for mental health), said: ‘It is not acceptable for people with mental health problems to be treated differently to those with physical health problems.

“We know that people can experience a mental health crisis at any time of day or night, and so the NHS and our other public services must make sure they are equipped to provide the specialist and urgent care that is needed around the clock. Sadly this is not what we have found from our national review.

“What’s more, we found that when people do receive help, hospital and mental healthcare staff are not always compassionate and caring. Worryingly, many people told us that when they were having a crisis, they often felt the police and ambulance crews were more caring and took their concerns more seriously than the medical and mental health professionals they encountered.  In particular, people who have inflicted harm on themselves as a result of their mental distress deserve the same respect and compassion as those whose injuries are sustained by accident.

“These findings must act as a wake-up call to our public services. We found some excellent examples of services in areas joining-up and providing effective care, with staff committed to working to make sure people in a crisis received the help they needed. These examples must become universal. This review was undertaken as part of CQC’s contribution to the work of the ‘crisis care concordat’ which is mobilising local services to come together to tackle this problem.”

“NHS trusts and other commissioners of care must make sure that they place a bigger focus on training staff to look after those having a mental health crisis, no matter where they are or when they need help. I feel that no NHS leaders can consider themselves to be a success while these issues go unanswered.”

As part of its national review, CQC has inspected mental health crisis care across twelve areas. Among these, CQC found crisis care and support arrangements within the London borough of Lambeth to be particularly commendable; for example, inspectors noted the way that primary and social care services, voluntary organisations and housing advice services in the area worked together to provide appropriate support, referral and triage for people in need. Also, inspectors praised the joint commissioning of preventative services between Lambeth
Clinical Commissioning Group and South London and Maudsley NHS Foundation Trust and its setting up of a ‘crisis house’ in response to the lack of available beds for people experiencing a crisis who needed inpatient care.

The report, ‘Right here, right now’ has been carried out as part of CQC’s commitment to the Crisis Care Concordat.

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