Liz Felton TogetherIn this guest blog, Liz Felton from Together for Mental Wellbeing, calls for statutory and third sector providers to work better together for the benefit of people in mental health crisis:

The Care Quality Commission (CQC), the health and social care services regulator, recently released a report highlighting the shortcomings in support available to people experiencing a mental health crisis. 

The report found that only 14% of people thought the care they received provided the right response and helped them to resolve their crisis, and raised important points about the need to improve crisis care and make it available to people at the right place and the right time. Tackling such a situation requires us to understand all the factors at play, including the processes for accessing support at the point of crisis and thereafter, as well as the quality of that support itself. The obvious place to start is in improving crisis care itself. The Mental Health Crisis Care Concordat is an encouraging sign that action is being taken, as are the innovative approaches we are seeing arise all over the country from street triage schemes, whereby mental health nurses support police officers on call outs, to mental health triage nurses at A&E. But while these can make strong headway in parts of the system and the country, people are still all too often falling through the gaps and not getting the support they need, which is simply not good enough. 

As a provider of mental health services, Together and many other third sector providers are used to bridging gaps between disparate health and social care systems, and providing additional support to compensate for overstretched and underfunded statutory services. The CQC’s findings are positive for third sector providers: 74% of respondents stated that local services provided by charities and volunteers provided the help people needed in a timely way and 88% reported the staff at these services treated people with warmth and compassion, compared to just 34% of A&E staff.

But neither statutory nor third sector services can solve the problem alone. To support individuals experiencing mental health issues in the right way at every point of their journey through the system, health and social care must work in tandem and treat people with compassion, regardless of the type of provider. 

Most third sector providers are by necessity flexible and responsive, and at their best they see individuals as whole people with a range of factors and circumstances impacting on their wellbeing. So rather than tackling individual discrete problems, we can develop a response to the whole person, working closely with other agencies and finding innovative ways of closing gaps in provision. We use our knowledge of working with individuals to influence the systems around them so that these are better equipped to respond to their needs in future.

Take the example of an individual who has just left an acute bed in hospital and returned to their community. They may struggle to cope with readjusting to day-to-day life and if the circumstances around the cause of the crisis haven’t changed then what’s to stop the crisis from recurring?

To prevent a recurrence we need to look beyond the crisis itself to what happens when the crisis ends. Preventing deterioration by providing adequate community support can mean that people don’t have to access more expensive services, which in turn relieves pressure on overstretched A&E departments.

But complicated referral routes and sometimes muddled communications between statutory and third sector services can mean that resources in a local area are underutilised, efforts duplicated or people may fall through the gaps altogether.

At Together we work with individuals to identify the range of their needs and work hard to ensure our services dovetail statutory provision. For example, in our community mental health services we support individuals that may have just left crisis care to manage their benefits, find a local activity to take part in and provide ongoing support to manage their mental wellbeing. 

We also work with individuals who repeatedly call on emergency services when they are experiencing a crisis to get to the bottom of what’s causing their distress and find creative ways to support them. There is also still a degree of exclusion for individuals with mental distress and a range of other needs who do not meet the criteria or thresholds that warrant statutory intervention. Our services work with these individuals to support them so that hopefully they never need to access crisis services.

Navigating through the maze of local services and provision – whether people are in crisis or not – isn’t always easy and all too often it can often leave people lost or at a dead end. Looking again at the example of an individual who has just left an acute hospital bed, ensuring that they receive support from a community mental health team to treat their mental health issue is clearly essential, but so is supporting them to build a life in their community. Therefore the next logical step is to refer them to third sector services that can provide information about the organisations, services and activities in their community. This joined-up approach will enable this individual to build resources that help them to stay well.

As resources for health and social care become increasingly limited, we need services to work collaboratively, complementing each other and responding intuitively to gaps in provision where they occur. Working together in tandem to understand the support that is available, having open lines of communication and working together to improve systems, means that ultimately we can eliminate the gaps and better support people both at crisis point and beyond.

Liz Felton is CEO of Together for Mental Wellbeing, a national charity working alongside people with mental health issues.