Emergency care for people experiencing a mental health crisis could be set to improve after police, mental health trusts and paramedics signed a new agreement.
The agreement, the Crisis Care Concordat, aims to drive up standards of care for people experiencing crisis such as suicidal thoughts or significant anxiety. It also looks to cut the numbers of people detained inappropriately in police cells and drive out the variation in standards across the country.
The concordat, which has already been signed by 22 organisations including NHS England, the Association of Chief Police Officers and the Royal College of Psychiatrists, sets out the standards of care people should expect if they suffer a mental health crisis and details how the emergency services should respond.
It challenges local areas to ensure that:
• Health-based places of safety and beds are available 24/7 in case someone experiences a mental health crisis
• Police custody should not be used because mental health services are not available and police vehicles should also not be used to transfer patients. The aim is for the number of occasions police cells are used as a place of safety for people in mental health crisis halved compared 2011/12
• Timescales are put in place so police responding to mental health crisis know how long they have to wait for a response from health and social care workers. This will ensure patients get suitable care as soon as possible
• People in crisis should expect that services will share essential ‘need to know’ information about them so they can receive the best care possible. This may include any history of physical violence, self-harm or drink or drug history
• Figures suggest some black and minority ethnic groups are detained more frequently under the Mental Health Act. Where this is the case, it must be addressed by local services working with local communities so that the standards set out in the Concordat are met
• A 24-hour helpline should be available for people with mental health problems and the crisis resolution team should be accessible 24 hours a day, 7 days a week.
To support take-up, the Department of Health will work in partnership with the Home Office and mental health charity Mind to promote and support local responses. The Department of Health expect each locality to have agreed a Mental Health Crisis Declaration by December.
Norman Lamb, Care and Support Minister, said: “When someone has a mental health crisis, it is distressing and frightening for them as well as the people around them. Urgent and compassionate care in a safe place is essential – a police cell should never need to be used because mental health services are not available. For me, crisis care is the most stark example of the lack of equality between mental and physical health.
“The NHS and police already work well together in some areas, but it is totally unacceptable that crisis mental health care is so variable across the country. It is imperative that all areas seek to implement the principles of the Concordat as quickly as possible to ensure consistent care, no matter where you live.
“Better care for people in mental health crises will not only help those living through their darkest hours to recover – it can also save lives.”
Welcomed by the sector
The concordat has been largely welcomed by organisations in the mental health sector, but has been accompanied by calls for more funding for mental health services.
Stephen Dalton, chief executive of the NHS Confederation's Mental Health Network, said that there is already work underway in organisations across the health sector to prevent mental health crises occurring and escalating, with plans for even closer working between partners to improve access to services and to meet local, individual needs. “But the very nature of a mental health crisis means that a very vulnerable person needs a fast, individual, joined-up response,” he said.
“This is where the Mental Health Crisis Care Concordat can really make a difference, as it sets out the clear commitment of all those involved in the mental health sector to improve support for people before, during and after a crisis. It is not just a piece of paper, it's a pledge to make things better in practice.
“We are particularly pleased that the police and the Royal College of GP’s are reviewing their training programmes to improve understanding of mental health problems and to develop and deliver improved services.
“But all the will, awareness and training in the world won’t translate into real improvements in crisis care unless mental health is finally and genuinely put on a par with physical health. It is critical that the Government's and NHS’s commitment to address long-term under-funding of mental health services is delivered on, before the sector experiences an irreversible crisis itself.”
Jenny Edwards CBE, CEO of the Mental Health Foundation added: “There is simply no excuse for vulnerable individuals in a mental health crisis, not being able to quickly access safe, therapeutic and compassionate care in a suitable environment – wherever they are in the country.
“It is totally unacceptable for police cells to be used as a ‘places of safety,’ particularly in the case of children and young people, just because health services are not able to respond quickly enough.
“Mental health has always been more than an issue just for the health service alone. The health and criminal justice systems in particular, must work together to ensure high quality support for people in a crisis.”
Lord Victor Adebowale CBE, chair of the Independent Commission on Mental Health and Policing and chief executive of Turning Point said: “Last year the Independent Commission report on Mental Health and Policing concluded that mental health is core business for the police, as well as the health and social care system.
“The commitments made in the Concordat, as well as how it takes the Commission’s recommendations forward, are a welcome step in the right direction. However, they can only be delivered if we have consistency of approach across funding, leadership, integration and implementation. We look forward to working together with others to ensure that the commitments made in the Concordat become a reality as without this it is only a piece of paper.”