Care regulator the Care Quality Commission (CQC) has called for urgent action to continue to improve access to and the operation of health-based places of safety for people experiencing a mental health crisis.
The CQC found that too many health-based places of safety are turning people away because they are already full, and some are refusing to help people who are intoxicated or exhibiting disturbed behaviour.
People detained by the police under section 136 of the Mental Health Act must be taken immediately to a safe place where a mental health assessment can be undertaken. This should be a ‘health-based place of safety’, located in a mental health hospital or an emergency department at a general hospital. They should only be taken to a police station in exceptional circumstances.
Additionally, the CQC found that too many commissioners are not adequately fulfilling their oversight responsibilities in relation to people who are detained under section 136. This limits their awareness of a key issue which should inform their commissioning decisions.
Also, too many providers were found to be failing to monitor their service effectively, making it difficult to assess whether health-based places of safety provision is meeting the needs of their localities. Many health-based places of safety were unable to provide the CQC with basic data about the use of their service or how often people were turned away or excluded.
Overall, the CQC’s findings suggest that while some health-based places of safety are effective, others are less responsive to people’s needs and require considerable improvements.
In response, the regulator has issued a series of recommendations aimed at providers and commissioners, including:
• Providers should identify areas in which national standards are not being met and work with local partners to address these shortfalls. This includes making sure appropriate arrangements are in place for young people, people who are intoxicated, or people exhibiting disturbed behaviour
• Providers should ensure that appropriate levels of adequately trained staff are available to receive an individual brought to the place of safety at all times
• Commissioners should establish whether local capacity is sufficient, and take action to drive improvements by the commissioning of services or specifying interventions that may prevent or reduce the use of section 136
• Commissioners should ensure they are fulfilling their responsibilities around multi-agency groups and policies relating to health-based places of safety
• Commissioners should ensure that ambulance arrangements for transporting people experiencing a crisis are appropriate and timely
• Health and wellbeing boards should assess local need for health-based places of safety as part of their Joint Strategic Needs Assessments.
Norman Lamb, Minister of State for Care, said: “It’s essential that people in crisis get urgent, compassionate care. That’s why I launched the Crisis Care Concordat and I’m grateful to the CQC for its valuable work to help drive up standards.
“We are seeing a reduction in the use of police cells as places of safety across the country but there is still work to do. I urge every area to sign a crisis care declaration by the end of the year because everyone, no matter their age, postcode or circumstances, should get high quality care when they need it.”
Dr Paul Lelliott, CQC’s deputy chief inspector of hospitals (lead for mental health), added: “What our survey of health-based places of safety found is not good enough. There would be a national outcry if people experiencing a physical health crisis were treated in the same way. Imagine if people who had had a heart attack or stroke, were regularly turned away from an A&E department due to a lack of staff or beds, or if people who had been seriously injured in an accident or attacked were told they couldn’t receive care because they had been drinking or were showing signs of being disturbed.
“We have found that people experiencing a mental health crisis are far more likely to end up in a police cell if a health-based place of safety is not available due to staffing or capacity problems, or has restrictions on access in place. Police are left with no option but to take a person to the police station, which is unacceptable and likely to cause additional distress to an individual who is already in a vulnerable situation.
“To give praise where it is due, we did find a number of providers with appropriate provision who were able to deliver a good service. We hope that those providers and their commissioners who were restricting access or not delivering as good a service will learn from those that are giving people the support that they need.
“We urge providers and commissioners of services and others to pay close attention to our findings and act on our recommendations.”
Mark Winstanley, CEO of mental health charity Rethink Mental Illness, reacted with dismay to the findings, saying it was “disgraceful” that so many people going through a mental health crisis were being denied care because the right services either don’t exist in their community, or are overstretched.
“If you’re experiencing a serious mental health crisis, you should be brought to a ‘place of safety’ in a health facility. But this report shows that too many people are being turned away from these facilities, because of staff shortages or lack of space. In many parts of the country, there are no health-based places of safety full-stop. As a result, thousands of people in great mental distress, including children, are ending up in police cells because there is no other support available.
“This has to change. Someone going through a serious physical health emergency would never be treated this way, yet people experiencing a mental health crisis are being put in police cells or left to fend for themselves, and it’s costing lives.
“The Government has promised more funding for crisis care, and earlier this year it launched the Crisis Care Concordat, a national agreement on how NHS Trusts, social services, and the police can work together to improve crisis care.
“But now we urgently need those organisations to put that agreement into practice, so that anyone can get high quality crisis care when they need it, no matter where they live or what their circumstances are.”