People experiencing a mental health crisis do not always receive care and support when and where they need it, regulator the Care Quality Commission (CQC) has found.
Concerns about public services, such as local authorities, NHS trusts and clinical commissioning groups failing to work together to make sure that people in their local areas have access to crisis care around the clock were also raised in the CQC’s report, ‘Right here, right now’.
The report, carried out as part of CQC’s commitment to the Crisis Care Concordat, also 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. Indeed, in a survey of 1,800 people who had experienced a mental health crisis, conducted by the CQC, 86% of those who had received care and support from charities and volunteers felt that their concerns had been taken seriously by them, but only 37% said that they felt this from A&E staff. The regulator described this as “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.
More than 68,800 people were admitted to a mental health ward for urgent care in England as inpatients in 2013/14, although it is difficult to determine the exact number of people who have a mental health crisis.
For the report, CQC reviewed the quality of crisis services – including telephone helplines, assessment by a mental health professional, intensive support at home or urgent admission to hospital – in 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 a clear need for better 24-hour support for people having a crisis, particularly during the hours of 11pm and 5am, as it was 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.
Other findings of the report include:
• Many people see their local GP first when they are having a mental health crisis. The majority (60%) who visited their GP during a crisis were satisfied with the experience. It is vital that GPs access specialist training to help them to identify underlying mental health conditions early, in order to help prevent crises from occurring
• Most people reported that they came into contact with at least three different services when they had a crisis, with 12% saying that they had come in to contact with between 6 and 10, which indicates a need for them to work more closely together
• There has been a significant reduction in the use of police custody as a ‘place of safety’ for people in crisis. But the CQC found there can still be problems with people under 18 being able to access a suitable place of safety. In 2013/14, 31% of people under 18 who were detained were taken into police custody.
In response to its findings, CQC has placed a greater focus on how mental health crisis care services are provided, including within A&E departments, during its comprehensive inspections of acute NHS trusts. Also, CQC will continue to ensure that it considers the issues of people who need specialist mental healthcare while in acute hospitals, and will provide training for its inspection staff on the key issues that have been emerged.
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.
“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.
“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.”
Alistair Burt, Minister of State for Community and Social Care, said: “It is clear that there is still a long way to go to make sure everyone is treated compassionately in the right place and at the right time.
“Improving mental health care is my priority. I am clear that there is so much more to achieve and we all need to work together to achieve it. The CQC will now inspect crisis care arrangements in every service and I have asked them to continue to help stamp out poor care and help us to make sure that people with physical and mental health conditions are treated with equal importance.”
Call to action
The CQC’s report has been welcomed by leading mental health charities, but they have reinforced the need for further change.
Paul Farmer, chief executive of Mind, said: "This report is a clear call to action. Mental health services are the victim of years of neglect and funding cuts over the last few years have taken their toll, at a time of rising demand. National and local commissioners must now make mental health a priority and invest in the future of our mental health services.
"We share the CQC’s optimism that the Crisis Care Concordat is a big opportunity to address the issues raised in this review. Every local area in England now has a detailed action plan for improving the support available for people in crisis, which has been signed by commissioners, NHS trusts, the police, local authorities and other services and agencies. It has been a huge piece of work getting to this point but in a way the work is just beginning. The challenge now is for every local area to deliver on their action plan so that everyone experiencing a mental health problem gets the help they need, when they need it."
Brian Dow, director of external affairs at Rethink Mental Illness added: “This report makes for painful reading, and seems to suggest an upside-down world in which patients feel they get the worst care where they should be getting the best.
“We need a more sympathetic response. Sympathy, understanding and good quality care when a patient walks in the door of A&E, and a sympathetic system where health and social care teams along with charities work in partnership to support the person properly after they are discharged.
“What would be unacceptable for physical illness should not be acceptable for mental illness.”