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Why we need better crisis care
Posted Tuesday 13 March 2012
I am keen to attend this event as I am passionate about promoting excellent crisis care. The quality of crisis care interventions, services and resources are inconsistent and they are also underfunded. This situation is made worse by government spending cuts which are a costly false economy both in financial and human terms.
When I was in acute crisis, with a severe mental breakdown, my personal experience of being on the receiving end of this care was a mixed bag of good, mediocre and poor service.
I was lucky to have been referred to an excellent consultant psychiatrist who went to great lengths to really understand what had happened to me. He was also very supportive to my wife which I appreciated. His best medication, rather than the questionable drugs he poured down my throat, was how he was with me. He was always very kind, supportive and sensitive. He had great interpersonal skills and used an appropriate CBT (cognitive behaviour therapy) approach.
What was not so good was the shabby run down day hospital he referred me to (which he apologised for). The treatment and care I got there ranged from good to poor by the nurses and occupational therapists. Of particular concern was the long periods of time services users were left on their own to support each other while staff sat in their isolated office adjoining the separate staff toilets!
Interestingly the most therapeutic member of staff by far was the most junior in terms of professional qualifications.
Why is it that mental health centres are either very shabby or modern and clinical and often unwelcoming places to visit?
People appreciate and respond far better to holistic therapeutic places such as the nationally acclaimed award winning Leeds User Led Crisis Centre and London's Maytree Centre These centres are warm welcoming environments that promote recovery. They are places where people feel safe and valued. It’s this model that we need to see replicated all over the country.
I really hope that this event can act as a spring board. We need excellent service provision in every town and city. It would make sound the financial savings in reducing mental health problems and suicide, quite apart from providing a quality humane compassionate response to those in crisis.
Mike Bush
Mike is a mental health lecturer, consultant and social worker.
From 4pm today, we'll be at Parliament to talking to MPs about crisis mental health care. You can follow the event on Twitter by searching for #crisiscare
13 Comments
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Oh god I want to run a crisis centre. I want to give people somewhere to be neutral and get that sanctuary when they are in crisis but without that ridiculous "hospital is the only option" nonsense which means that we can't admit most of the people who ask for it not because they "need" hospital per se but they need "somewhere else" and often the only option is hospital...there is no other " somewhere else".
I want a big communal room with sofas and endless tea. Quiet rooms so people can go and be private. A garden. Ad hoc therapeutic things to do. Other people to gain peer support from. Multi- disciplinary teams of staff to offer all kinds of help. And the ability to make plans with people for the next few days. A lottery win, a charitable grant...Yes supporting at home is important but people need somewhere safe and helpful to go to...
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When you open that crisis centre Liz, can I come and steal some ideas and set up my own? It sounds so lovely.
Other things I would want in my sanctuary: very few locked doors. The staff would be forbidden from talking about "security" (as in "it's for your own security" or "it's a security issue").
Also banned from the sanctuary: formal meetings where "progress" is reviewed. I know this has to go on somewhere, and I know people prefer to be involved somehow, but these meetings are draining when you are not well.
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The whole mental health service needs an overall. The treatment i have been receiving from Waveney and Norwich MHT is ridicous
Ring the crisis team and you either get an answer phone or they are too busy to see you and you get brushed off. Do they not realise its not easy asking for help in the first place.
They are sneaky, liars and offer no help at all.
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Too right Anne and the problem is Leeds and Maytree really ARE fab but that's just two services in the UK, we need versions of those across the whole country in every town/city because they provide the real crisis support that the NHS does not.
Crisis services are not serving anyone..because they can't. -
...I will say that I work in a crisis team and I know people have poor opinions of crisis teams in general...they (like anything else) vary massively in quality and personalities/theory-bases etc of staff, but we're often completely understaffed and under-resourced and simply can't help everyone who needs it...urgently the MH system needs to be sorted out and education for professionals needs a much stronger element of the service user perspective...this is very much my bag (as well as critical psychiatry...I've been a service user myself in another lifetime) but is still seen as a "specialist interest" whereas it should be the absolute basis of all professionals involved in MH...
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I know however bad I get I wont get help. Knowing that Its now up to me to decide whether I want to continue putting up with this existence. I'm 50 and finished. When I was young and a Christian I used to pray that if I ever get an illness please dont let it be mental. Well I got waht I dreaded and it ruined my life. However the entity in my head can't stoppe laughing knowing he is the victor
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I'm in Cornwall where day hospitals are unheard of and the local day centre is closed most of the time I'm lucky to have a good CPN but the crisis care is totally hit and miss and too many times a miss leading to a deterioration in my mental health to the point where hospitalisation becomes the only option but then to be told there are no psychiatric beds in the county. On entering the local ward, if you are lucky enough to get a bed, the staff though good in the whole are spread worryingly thin, nursing people who have been left to get too deeply into their illnesses. The ward when it opened was an open ward but for the last few years it has become more and more secure, a locked ward in all but name. The situation in the mental health services down here is extremely bad and getting worse. I don't think its the fault of the people who provide the services but the fact that there are no options when in crisis apart from hospital and the fact that once in hospital people are either left to their own devices or become so traumatised they need constant supervision. This situation is rediculous in this so called modern country. Its inhumane to let it continue
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I agree with almost everything that's been said so far. People get serious mental health problems usually because they don't come from secure, loving homes in the first place. They often have trauma, abuse, neglect or broken attachments. Our mental health system then offers more broken attachments and often neglect. Some of the professionals are wonderful (including many in crisis teams) but the system isn't based on psychological care but a medical approach so relationships aren't valued by the system just "reviews" and "monitoring". Staffing is too thin to allow secure relationships to develop. Often the crisis team ends up being the scapegoat because the whole system is in crisis and people who need proper continuous care in a place of residence (understanding, compassion and, yes, tea) are being left in relatively isolated situations in the community. This is a false economy. If we did it right it would be cheaper, not a revolving door. Anyway, also thoughts go to Linda - hope you can hang on! My thoughts are with you for what they are worth.
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I read Mike's piece and the comments with great interest. Please don't blame doctors and and the (so-called) "medical model". Doctors, particularly psychiatrists (always with exceptions) really value relationships and continuity of care but the repeated re-organisations of the NHS, under resourcing and a tendency to move away from integrated to fragmented care are politically imposed and likely to get worse with privatisation. I am now retired but I used to work with Mike in the days before crisis teams; but our integrated multi-disciplinary team could (even in the bad old days!) provide emergency assessment and support, generally within 24 hours. Indeed, when challenged as to why they referred some people with mainly social issues to the mental health team, the answer from some local GPs was that they could get an immediate response from us whereas with social services they might have to wait two weeks before an urgent referral for an old person was even "allocated". Well, I'm retired now from clinical practice (and some may say "just as well") but I think it's a mistake for different professional groups, service users and carers to be "having a go" at each other when we all need to do the best we can with what we've got, despite being re-organised every few months! (And, by the way medication can be useful, too; but it is never the answer by itself!)
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Your blog Mike certainly highlights some very important factors - namely the climate/culture which a person is received into when in need of care. It is clear that a humanistic, person centred approach is needed. This can occur anywhere - even in shabby buildings. Bright decor and smart furniture etc helps although I feel money should be spent first on staff training, making sure that individuals in need of care and support are met by carers who are sensitive to their needs, and actually do care.
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You talk a lot of sense Mike. I think ultimately the real long term answer lies beyond the mental health system, in the kind of society that we live in. The current one drives people crazy. I can imagine a co-operative world where people in trouble are picked up early, and friends, neighbours, strangers even, are all looking out for each other. We'd all be educated about 'mental health' and know what to do to help - I don't think it's as complicated as psychiatry claims. How to get from here to there is another thing, but I think it starts with our relationships, and reaching out for each other outside our comfort zones. That's my hope anyway.
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Crisis care delivered in huge organizations with multiple and conflicting agendas is always going to be a struggle. I agree that we should not be placing blame at any single profession's door, but the reality is that in the NHS we are medically dominated and that historically this has led to an 'illness' service, that therefore requires treatment, in 'beds' that are owned by medical teams. The advent of community care and the changes in society have made in-patient services completely different with a high proportion of drug/substance abuse which has led staff to have a basic mistrust of people - contrary to the conditions of a therapeutic relationship. We have lost sight of mental distress and the need for promoting well-being which takes time. Now the focus, ironically, has become a 'quick fix' whilst ticking all of the Risk protocol boxes and the Paris or whatever recording systems. It is interesting that there has been a call for 'evidence based' care when the evidence is already there about the power of therapeutic relationships. It would be ideal to have a range of crisis centre type facilities and I suspect this would be in the voluntary or private sector rather than the NHS. I worked in acute services some time ago, am a retired MH Nursing lecturer and a staunch supporter of service user and carer involvement in all aspects of education and the planning and commissioning, delivery and monitoring of services.
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There is tremendous power in witnessing, with great compassion and without judgement, the story and the inner pain of a fellow human being. Trust and a real heart-to-heart connection can be quickly built up. It can often allow a person’s own inner healing mechanisms to start to work, especially by helping them to get in touch with past or present distress, and help them to start releasing the associated old blocked emotions, especially sadness, loss, anger and fear.
When someone is in crisis, these memories and feelings are much nearer the surface, and I believe this is a great opportunity for the person to obtain some deep healing, as opposed to numbing and suppressing the feelings with medication.
Wonderful organisations, such as the Leeds Survivor Led Crisis Service, help to facilitate this healing process. They are proving that their approach works, they are also cheaper to run than traditional mental health services and, in my opinion, they should be taken as a model of good practice, which should be duplicated by setting up at least 3 or 4 similar services in every major city.
Message for Linda – Have you tried a Hearing Voices Self-Help Group (they are run by voice hearers for voice hearers)? To find your nearest group contact Hearing Voices Network, www.hearing-voices.org, tel 0114 271 8210.
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