Accident emergency 180Partnership working in Manchester is helping to support people in mental health crisis more effectively, as Thomas Farebrother, team leader at Turning Point’s Crisis Point service, explains:

Every year in Manchester several thousand people present at accident and emergency (A&E) and other healthcare services in a mental health crisis. But Manchester’s only hospital admission alternative for people in this situation is Turning Point’s Crisis Point service.

As such, we need to make the most of the resources available to us in order to effectively support as many people as we can. One of the ways to achieve this is by working closely with statutory services, like Manchester’s Mental Health Home Treatment Teams (MHHTs) and other voluntary sector providers.

For this reason I set up Manchester’s Crisis Provider’s Forum in January, to provide an opportunity for statutory and voluntary sector services to work out ways of meeting people’s needs more effectively. Sitting on the forum are: Stuart Long, manager of the North and South MHHTs; DCI Sarah Jackson, lead on Greater Manchester Police’s (GMP) vulnerability agenda; Nicky Lidbetter and Andrea Lyons, self-help services chief officer and community services respectively, representing The Sanctuary, a voluntary sector organisation; Declan Meehan, manager of Manchester’s central A&E psychiatric liaison service, and me.

Since January 2014 the forum has met seven times. The terms of reference were agreed early on and are:
• To undertake a process mapping event in order to obtain an overview of statutory and voluntary sector crisis provision across Manchester with a view to developing an integrated mental health crisis pathway
• To develop cross-agency and shared-care working to improve outcomes for clients
• To identify gaps in crisis provision and address how these might be met
• To promote and publicise the range of crisis services available to stakeholders and the public through the development of the ‘stepped care model of mental health crisis provision’
• To work collaboratively to improve outcomes for clients who access crisis services on a frequent basis and who may be in contact with GMP/other statutory services.

The forum has accomplished the first three aims, and is now in the process of feeding back findings and proposals to Manchester’s Mental Health Urgent Care Citywide System Resilience Operational Group (SRG). The forum will reconvene early in 2015 to begin a piece of work on meeting the needs of frequent repeat users of urgent care services.

Working through goals
The process mapping exercise was carried out in May and involved the MHHTs, GMP, Crisis Point, The Sanctuary and the Samaritans. This mapped out what support is currently available for people in crisis in Manchester, providing a starting point from which to begin identifying gaps in provision and how these might be addressed through shared working and additional services.

Regarding cross-agency working, a senior practitioner from the South MHHT acted as the link-worker between the MHHTs and Crisis Point and worked with me to draft plans for joint working including shared reviews and discharge planning. One of our service users recently fed back that Crisis Point and the MHHTs offer services that are ‘different but complementary’, and it is this crossover that both would like to capitalise on for the benefit of service users.

This development in shared working is essential as the number of referrals received by the MHHTs and Crisis Point far exceeds the capacity these services were set up to manage. Beyond improved shared working there is also a clear need for expansion in crisis provision and, to this end, we worked on involving service users to identify gaps in current crisis services and coming up with ways to address them.

This process started via a service user consultation event at Crisis Point’s open day on July 25. It was followed up with a more in-depth discussion of the issues raised at the event with a ‘meet the management’ day at Crisis Point on September 5, and a final larger consultation event on October 10, to coincide with World Mental Health Day, at Turning Point’s main office in Manchester. At the event Implementing Recovery through Organisational Change’s (ImROC) programme director, Professor Geoff Shepard, spoke about how in the current climate forging constructive partnerships between service users and providers and between independent and statutory services is vital.

Putting crisis on the map
Speaking about the Crisis Forum, Lidbetter said: “I feel strongly that the Crisis Provider Forum has commenced an urgent piece of work i.e. tackling the city’s mental health crisis response by getting providers together to work on a common agenda. The existence of the Crisis Provider Forum alone had resulted in putting crisis provision on the map with commissioner interest following. This can only lead to an improved crisis response for those experiencing a mental health crisis in the city of Manchester.”

Through the forum and current work with the SRG we are highlighting the importance of timely crisis intervention and collaborative working across sectors to improve the crisis care pathway.

This shared work directly reduces costly hospital admissions, as demonstrated in this feedback from a senior practitioner from Manchester’s South MHHT: “I assessed R at her home address on the day of her admission to Crisis Point… I was considering contacting the ambulance service and the police to ensure her conveyance to a safe place. This would have been very stressful for R, it would have damaged her relationship with mental health services and been unnecessarily damaging to her mental state… I discussed my concerns with staff at Crisis Point. They gave reassurance that they were familiar with this client, and they were of the opinion that she could be managed effectively. On balance this seemed like the best option open to us as R was eager to be admitted to Crisis Point. I had witnessed R becoming visibly more settled during phone discussions with staff at your service during the assessment process...

“In summary my opinion is that The Home Treatment Team and Crisis Point worked well together to avert a hospital admission which would have been stressful and potentially damaging to this client… Your service is invaluable. I am certain there are many other hospital admissions that have been averted over the last few years.”

R also wrote a letter to the Crisis Point team: “I was in crisis at Christmas and luckily I was accepted at Crisis Point, unaware I was ready to be admitted to a psychiatric ward, which would have not been helpful, going on past experience… I truly cannot thank the service enough for their commitment to me… if I were to go into hospital I probably would be there for months and be distraught and it does not help.”

We want R’s experience to be one that can be replicated for all those experiencing a mental health crisis in the area. Turning Point’s chief executive, Lord Victor Adebowale, frequently speaks out about the importance of providing greater crisis care provision, including through his chairing of the Independent Commission on Mental Health and Policing. The Commission, among a number of other recommendations, called for greater interagency working to support those in mental health crisis.

Additionally, the Crisis Care Concordat, launched earlier this year by the Department of Health, shows that this is an issue which is increasingly being given the recognition and consideration it needs.

Through the Crisis Forum and our input to Urgent Care Pathways via the SRG we hope to continue informing changes that will improve the experience of people in crisis and support the implementation of recommendations from the Crisis Care Concordat in day-to-day practice. We are on the right track but until those experiencing a mental health crisis are given equal support to those experiencing a physical health crisis we cannot say that we have achieved parity of esteem for mental health – one of the main goals of the Concordat.