In this guest blog, Thomas Farebrother, team leader at Turning Point’s Crisis Point service, outlines how partnership working in Manchester is helping to support people in mental health crisis more effectively:
Every year in Manchester several thousand people present at emergency and other healthcare services in a mental health crisis. Turning Point’s Crisis Point service is Manchester's only hospital admission alternative for people in this situation. 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 we can do 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, and me, Crisis Point’s registered manager. This month, Declan Meehan, manager of Manchester’s central A&E psychiatric liaison service, also joined the forum.
Since January the forum has met 6 times. We agreed on our terms of reference early on, which are:
1) 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
2) To develop cross-agency and shared-care working to improve outcomes for clients
3) To identify gaps in crisis provision and address how these might be met
4) To promote and publicise the range of crisis services available to stakeholders and the general public through the development of the ‘stepped care model of mental health crisis provision’
5) 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.
We have been working through these goals, as follows:
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 is now acting as the link-worker between the MHHTs and Crisis Point and we are working together to draft plans for joint working including shared reviews and discharge planning. This is an initiative we would recommend all areas adopt to increase smooth transitions between services. 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 the people using the services.
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. To this end, we have started work on involving people who use our services in identifying gaps in current crisis provision, 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. We followed this up with a more in-depth discussion of the issues raised on the day with a 'meet the management' day at Crisis Point on September 5, marking Turning Point's 50th anniversary. A final, larger consultation event at Turning Point's main office in Manchester is planned for October 10, to coincide with World Mental Health Day.
Through the forum 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 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.
To find out more visit www.turning-point.co.uk/crisis-point.aspx