Providing crisis care
It’s a struggle to provide more services for more people with fewer resources. It’s really tough right now. We understand that.
Sadly, as our inquiry heard, the pressure on staff in some places has dehumanised crisis care.
However, we’ve seen some great examples of inspiring practices that could be replicated across the country. Here are just two great and inspiring examples:
What did people say?
- People are not getting immediate access to help
- People want to be cared for by someone who is warm and empathetic, who treats them with respect and keeps them safe.
- People want their own definition of being in crisis to be trusted
- People want to be involved in their crisis plans
- Listening to and learning from patients’ experiences will empower their journey to recovery
What can providers do?
You can achieve better outcomes to meet the diverse needs of all the different communities in your area by:
- making sure people can access service when they need them
- make sure patients are treated hospitably
- providing a range of care options: this is essential and will deliver value for money
- ending face-down restraint. It can be dangerous and life-threatening. It should stop.
We believe, and our inquiry shows, that acute and crisis care can be excellent. Everywhere. For everyone.
Read our recommendations
To give people the care they need and deserve we need to concentrate on four key areas:
Humanity
- Think of people using hospital and other building-based services as guests as well as recipients of care. What standard of hospitality are you offering – in terms of welcome, comfort, cleanliness, atmosphere and food?
- Invest in the care and working environments as needed.
- Ensure that services offered are appropriate and effective and tailored to meet individual needs, and that they promote wellbeing and recovery.
- Adopt and encourage a style of leadership that is engaging – with a focus on serving, enabling and including people.
- Make equality and human rights central to the organisation’s ethos and practice and make this meaningful in practice; for example, in how performance is assessed and through patient information.
- Recruit and develop staff on the basis of their values and personal qualities as well as their skills.
- Encourage and support staff through regular supervision, reflective practice, adoption of easy wins and celebration of good work.
- Reinforce boundaries that allow for warmth and ordinary social interaction as well as professionalism.
- Motivate and develop staff through planned rotations; the advantage of this for ward staff includes seeing people in the context of their day-to-day lives and when they are less unwell.
- Support teams where there has been a serious incident and ensure there is effective learning for the whole organisation as well as accountability.
- Take robust action in the cases of staff whose behaviour is detrimental to the recovery, wellbeing and human rights of those in their care.
- Commit to working without violence and, in England, consider training in approaches such as Respect and Studio III. The All Wales NHS Violence and Aggression Training Passport and Information Scheme already teaches face-to-face safe holding where a hands on intervention is required.
- Ensure that mixed sex accommodation (see p.16) is eliminated and that safety and privacy are prioritised. Where possible offer the option of exclusively single-sex wards.
- Continually check how you are doing through feedback from people using the service. Use a range of mechanisms to ensure that all are enabled to take part; for example, exit interviews and independently facilitated group feedback. Mind can advise you on this.
- Ensure outcome measurements are used routinely including service user satisfaction.
Commissioning for people’s needs
- Consider the types of service provided and how you can expand the range of options in line with local needs and preferences – these may include crisis houses, non-residential crisis services, host families, retreats, hotels, peer/survivor-led services.
Choice and control
- Carry out joint crisis planning with people who may need to access acute care again in future. Ensure it is negotiated in a structured way that empowers the person whose care it is and allows them final sign off. Involve any friend, family member or other supporter the person wishes to include and ensure buy-in from the whole care team.
- Approach risk assessment, or safety planning, in a similar recovery-oriented way that sets out to understand the person’s own perspective on what they need in order to be and feel safe.
- Provide for more direct access into secondary mental health services for those who have previously been service users (this will be mandated in Wales under the Mental Health Measure).
- Allocate funds for teams to spend in flexible, personalised ways for those service users who do not choose the full personal budget or direct payment route.
- Support and equip staff teams in positive risk-taking.
- Ensure that service users moving into more secure provision have a care co-ordinator they trust, who can support them through this transition and back into non-custodial care when possible.
- Agree to a change of consultant when requested, unless there is a good reason not to do so
Reducing the medical emphasis within acute care
- Consider the mix of staff and how they are used – where specific healthcare professionals are needed, where support workers could be more helpful, where direct lived experience of mental health problems will be of particular value.
- Consider ways of strengthening community links; for example, through well planned visits, or involving people such as educators, artists, health trainers and volunteers in wards and other services.
- Develop the role of peer supporters and recruit from BME groups.
- Support the leadership of non-medical clinicians and team managers.
- Ensure maximum availability of psychiatrists for the decisions and input for which they are needed.
- Develop support roles (peer or otherwise) for people who need sustained social contact during their crisis.
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