Commissioning quality crisis care
It’s a real struggle to meet demand for acute and crisis mental health services in today’s climate. We understand.
But people have told us that sometimes they are so traumatised by the care they received that they would do anything not to return.
Through our independent inquiry, we’ve seen some great examples of inspiring practices that could be replicated across the country.
What do people want?
People told us crisis care, in some places, could be improved if:
- people could access the help they need when they need it
- inpatient wards are safe and more therapeutict
- there was better provision for BME communities. Our inquiry found that ethnic inequalities are still entrenched.
What can commissioners do?
Government research has shown that £224 million a year1 could be saved by preventing people from reaching crisis point and improving acute and crisis mental healthcare.
Commissioners can achieve better outcomes by:
- reviewing the performance of services
- expanding care options
- holding providers to account
- tailoring models of care to your local community.
We believe, and our inquiry shows, that acute and crisis care can be excellent. Everywhere. For everyone.
To give people the care they need and deserve we need to concentrate on four key areas:
- Commissioning for people’s needs
- Choice and control
- Reducing the medical emphasis within acute care
- Include an organisation’s value base as a criterion in awarding contracts or funds and in the assessment of performance.
- Review the extent to which services are meeting people’s acute and crisis mental health needs – are they fit for purpose, are people satisfied with them, and do they provide value for money?
- Prioritise a review of commissioning for the needs of people from BME communities and develop models of commissioning in which communities can genuinely participate and define their needs and priorities; for example, using the reverse commissioning approach (see p.33 of the report).
- Commission services from a range of providers including specialist BME providers.
- Commission services for a substantial period (for example, five years) but with a genuine commitment to re-tendering where a service underperforms.
- Set clear standards, including value base, in the procurement process and conduct regular, effective performance reviews including service user satisfaction measures.
- Expand the range of options so that crisis houses and sanctuaries, survivor-led crisis services, host families, use of retreats and hotels become widely available. But plan this with communities so that different needs and priorities are reflected in the choices made – and any better ideas are captured.
- In commissioning advocacy services include those tailored to the needs of BME communities and, in England, ensure advocacy is not limited to the statutory schemes. In Wales the Mental Health Measure extends access to advocacy to all those in mental health hospitals.
- Provide clinical mediation if necessary through third-party agencies.
- Set standards for the use of crisis care plans.
- Ensure the range of services includes sufficient options for those who may not need a full statutory acute care response. This may require primary care services and community mental health teams to consider how they can support people more intensively during difficult periods rather than automatically referring to CRHTs.
- Consider what service models are most appropriate for rural communities and make adjustments where necessary. Host families may be a good rural solution for some people; a larger team of dispersed staff working shorter hours may serve a large rural area better than a team operating out of a single location; spot purchasing from a trusted bank of staff may provide more flexibility.
- Facilitate providers making flexible provision that can deliver personalised care and adjust for people’s circumstances; for example, to help people stay in employment during a crisis or to care for their children.
- Ensure that the needs of friends and families are catered for. For example, engage with the Triangle of Care programme (Worthington et al., 2010), require carer involvement in contracts and commission family support teams.
- Ensure commissioning meets the needs of marginalised groups such as vulnerable migrants, and people with multiple exclusions such as homelessness, substance misuse and contact with the criminal justice system (Mind, 2009; Page et al., 2011).
- Ensure that a wide range of effective psychological therapies are available to all including people in acute and crisis mental health services. This should include brief interventions for those who do not need indepth work.
- Ensure that an appropriate therapy is available within 28 days of requesting referral.
- Provide for psychiatric liaison services (teams) in all general hospitals and emergency departments, with resources to provide an appropriate response.
- Move away from the medical ward as the defining concept of acute care and consider basing services around other concepts, such as ‘retreat’.
- End the move to locate mental health units in Wales on general hospital sites.
- Commission and/or provide more self-referral options and a wider range of options from which people can choose, such as crisis houses and services provided by specialist providers in BME communities.
- Commission advocacy from BME groups, including to help facilitate joint crisis planning.
- Value and support organisations that use innovative approaches to working with risk, such as Dial House in Leeds and the Maytree in London.
- Ensure that commissioned services use different staff groups appropriately and that this includes peer workers and support staff.
- Facilitate a co-ordinated approach at local level to providing readily accessible, well publicised local information about what services are available, and targeted promotion to communities and groups.