Crisis care in numbers

FOI data

Mind submitted a Freedom of Information request to all mental health trusts in England and local health boards (LHBs) in Wales in August 2012. The overall response rate was 81 per cent. All individual questions received at least a 50 per cent response rate unless otherwise stated.

• Staffing: Four out of ten (41 per cent) trusts in England have staffing levels below established benchmarks (roughly 14 crisis team staff for 25 service users on the caseload)[1]. This indicates that many crisis teams are under-resourced and overstretched.
• Access: There is huge variation in the number of people being referred to crisis teams (by GPs, A&E, other mental health teams, self-referrals, the police etc). The range is from 42 per 10,000 population to 430 per 10,000 population. This indicates hugely variable levels of access, and potentially demand, in different areas. This reinforces what people tell us that in some areas they are simply not getting through the door.
• Support: On average, crisis teams visit service users every three days. Visits may be more frequent in the early stages and less frequent before discharge. More than half (13 out of 25 trusts) have an average of one visit every two days or more. One trust appears to visit service users on average every 10 days. There is no national guidance on what the average should be. However, when crisis teams were first introduced, the Mental Health Policy Implementation Guide said visits should be "frequent" and that "In the early phase, several visits a day may be needed"[2]. The Royal College of Psychiatrist’s Centre for Quality Improvement has started a Home Treatment Accreditation Scheme, which states that crisis team must have the capacity to visit service users twice a day. (Response rate for the questions used to make this calculation = 43 per cent)
• Treatment options: Only twelve trusts/LHBs said they had more than one alternative option to hospital and home treatment, while five reported none. Just seven out of 28 trusts said they had one or more crisis houses (an alternative to home or hospital-based treatment which is particularly valued by people in crisis and which evidence shows has higher satisfaction rates than hospital admission). In 2007 38 per cent of trusts had two or more options.[3]
• Ethnicity: There were variations in access to crisis services for people from different minority ethnic groups. In many areas, minority ethnic groups had lower rates of access than White British people, especially Indian, Pakistani and Chinese people. Those who were referred generally had equal or higher rates of access to home and hospital treatment. In some areas, especially in London, Black communities had much higher referral rates.

UCL preliminary findings

The CORE study team mapped 218 Crisis Resolution Teams in 65 NHS Trusts in England. A survey was sent to the manager of all teams that agreed to participate. 192 managers responded to the questionnaire (response rate 88 per cent).

• Only 35 per cent of crisis teams have access to a crisis house (an alternative to home or hospital-based treatment which is particularly valued by people in crisis and which evidence shows has higher satisfaction rates than hospital admission).
• One in ten (ten per cent) of crisis teams don’t operate a 24-hour, seven-day-a-week service. NICE guidance states that crisis teams should be accessible 24/7. 81 per cent of crisis teams can offer telephone contact to service users 24/7 and 86 per cent can assess new clients at A&E 24/7, but only 39 per cent can visit service users at home 24/7.
• NICE guidance states that health and social care providers should support direct self-referral to services as an alternative to accessing urgent assessment via the emergency department. Only 55.5 per cent of crisis teams accept self-referrals from known clients and 21 per cent from unknown clients.

These data are from the preliminary findings of the National Survey of Crisis Resolution Team Practice conducted as part of the CORE Programme at University College London. The survey is independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (Reference Number: RP-PG-0109-10078). The views expressed in this briefing/release are those of Mind and not necessarily those of the research author(s) which in turn are not necessarily those of the NHS, the NIHR or the Department of Health.

From our service user survey

The survey was carried out online in October and November 2012. We had 948 respondents, of whom 78 per cent had experience of crisis in the last two years and 91 per cent had experience in the last five years.

Key findings

• Assessment: Of those who, when in crisis, came into contact with NHS services (over 600 respondents): Only 33 per cent were assessed within four hours, as set out in NICE guidance. 37 per cent were assessed after four hours and 18 per cent weren’t assessed at all. Almost two-thirds (59 per cent) of people felt that, whatever the timescales, they weren’t assessed quickly enough.
• Choice: Two-thirds of people (65 per cent) were not offered a choice of treatment and over half (56 per cent) said they weren’t give enough say in how they were treated. More than half (54 per cent) said they didn’t get the treatment they need.
• Control: Of those who had an advance statement, decision or crisis plan, only one in five (19 per cent) said these documents were considered and acted upon.
• Humanity: Only a third (29 per cent) said all the staff treated them with respect and dignity. Almost half (44 per cent) said they didn’t feel staff did everything they could to make them feel safe.
• Follow up: A third (33 per cent) had no follow up after discharge from crisis care services. Only a third (38 per cent) had follow up within a week. Almost four in ten (39 per cent) felt they were discharged too early. Only one in five (21 per cent) said they had all the support they needed after discharge.
• Support: Overall, only 14 per cent of people felt they had all the help and support they needed when in crisis.

Other survey findings

• Almost one in ten of people in crisis (nine per cent) did not seek help. Of these, a third (33 per cent) said it was because they didn’t know where to go for help, more than one in ten (14 per cent) said they had tried to access help before without success and almost one in five (18 per cent) said it was because they had had a bad experience of crisis care in the past.
• Of those who sought help, two-thirds (64 per cent) were alone at the time.
• Over a third of people (37 per cent) went to their GP for help first. Another third (30 per cent) contacted their local crisis team directly and 14 per cent went to A&E.
• A quarter of people (25 per cent) were treated at home at some point. Another quarter (25 per cent) were admitted to hospital, around a third of whom were sectioned. Only two per cent were offered a place in a crisis house. One in ten people (11 per cent) were offered no treatment at all.
• After being discharged, almost two-thirds (62 per cent) were given a telephone helpline in case of further crisis.