The information here is for anyone with experience of mental distress, their families, friends and carers.
It is especially relevant for people who have experienced a mental health crisis in the past and want to know about the options available to them if a crisis should occur in the future.
Copyright note for Mind factsheets: Both individuals and organisations are welcome to print and photocopy any factsheet. Organisations are free to distribute them to service users and colleagues, but must ensure they always use the latest version of the factsheet, as available on the website, at the time of distribution.
Introduction
What is a crisis?
Acute mental health crisis
Other kinds of crisis
Crisis as a turning point
What are crisis services?
Services for acute mental health crises
Role of GPs
Emergency departments
Psychiatric acute wards
Crisis resolution and home treatment (CHRT) teams
Other community-based services
Crisis houses
Day services
The role of CMHTs in crisis
Telephone helplines
Making decisions about treatment before a crisis occurs
Care programme approach (CPA)
Crisis cards, joint crisis plans and advance directives
Services for mental health crises that do not meet the criteria for an acute mental health crisis
The role of GPs
Telephone helplines
Online support
Voluntary organisations
Social, personal and financial services
Further reading
Useful organisations
References
Information is given on the range of crisis services that may be available and the standards that service users have a right to expect from crisis services. This should help with decisions about which services are likely to work best and how to make contact with them in the event of a crisis.
This factsheet focuses on crisis services for adults (aged 18 years or over). Children and young people are not eligible for some of the services described. However, younger people do experience mental health crises and this factsheet may help with understanding the nature of a crisis and give guidance towards sources of help and support.
The term ‘mental health crisis’ means that a person is in a mental or emotional state where they need urgent help. Mental health crises may take the following forms:
This factsheet covers two definitions of crisis:
Medical and government policy definitions of an ‘acute mental health crisis’ emphasise a sudden deterioration in a person’s mental state that could lead to self-injury, suicide or (very rarely) harming others, and where the situation is an emergency. The person in crisis is likely to be already diagnosed as having a severe mental health problem (e.g. schizophrenia, schizoaffective disorder, bipolar affective disorder or severe depressive disorder) [1] and to already be in contact with secondary mental health services (described below) or have used these services in the past. If the person has not already received a diagnosis of severe mental ill-health, he or she may be having a first episode of a diagnosable mental health problem. Many of the ‘crisis services’ provided by the NHS and local authority social services are designed to respond to acute crises.
Many people may experience one or more episodes of mental distress in their lifetime that they would identify as a crisis, but which does not meet the above criteria for an acute mental health crisis. Any mental state that results in emotions or behaviours that are painful, out of control or unmanageable might be regarded as a crisis by the person experiencing them or those around them. A person in this state may not require – and may not be offered – the crisis services provided by the NHS or social services, but may still need to access services that they do not need at any other time, to help them resolve the crisis or to support them until it has passed.
Crises, especially acute mental health crises, can have catastrophic consequences if not managed well. [2] However, a crisis can also have beneficial outcomes if handled well: it can be a transition point; an opportunity to reassess one’s life, reach acceptance of one’s past, and maybe take a new direction. Good and sensitive crisis services can help with this process. [3], [4]
A crisis may be linked to forms of mental health care or treatment that have not proved helpful and must now be reassessed and changed. Also, a crisis, if handled well, can provide valuable lessons as to how similar episodes may be prevented or resolved in the future.
A crisis service is any service that is available at short notice to help a person to resolve a mental health crisis, or to support them while it is happening. These services can range from telephone helplines and online discussion forums to crisis resolution and home treatment (CRHT) teams (described below) and hospital acute wards. Crisis services can be provided by the public sector (NHS or social services) or the voluntary sector (charities or non-profit organisations involved in health, social care or other forms of support).
Within the NHS, crisis services may be provided by primary as well as secondary care.
Primary care is the first level of care and first point of contact with services for most people with any health problem. Services include general practitioners (GPs), pharmacies, NHS Direct and NHS walk-in centres.
Secondary mental health services are provided by mental health trusts in England and NHS trusts in Wales. Services include specialist medical care provided by psychiatric hospitals and community-based psychiatric outpatient units.
Sometimes, a crisis may be caused by a specific issue such as financial difficulties, work-related stress or a physical illness. In such situations it may be helpful to contact an organisation that offers help around the specific issue, instead of (or as well as) seeking emotional support (see ‘Useful organisations’).
This section describes the services available to assess, treat and care for people experiencing an acute mental health crisis. It covers recent developments in government policy and staff practices to ensure that people are kept informed about the range of services available and the standards they have a right to expect.
All services should take a person’s needs and choices into account at every stage. The only time a person can be treated against their expressed wishes is if they are sectioned under certain parts of the Mental Health Act (for more information, see Mind rights guide 3: Consent to treatment).
GPs play an important role in the early recognition of mental health problems. A GP is likely to be familiar with a person’s history and may monitor their condition through regular appointments. This makes it easier to identify and address any deterioration at an early stage, before a problem becomes an acute mental health crisis.
For many people, the GP is the first point of contact with medical or support services at the onset of a crisis. A GP can be a valuable source of support and can help the patient to put into practice self-management techniques that have worked in the past. Research shows that people experiencing an acute mental health crisis value having someone to talk to, the ability to remain as independent as possible, and recognition and respect for their personal coping strategies. [5] A patient’s relationship with their GP may meet these requirements.
If doctor and patient decide that other services are needed, the GP can provide information and advice and make referrals.
For some people facing an acute mental health crisis, especially if there has been self-injury or another physical health problem, the first point of contact with medical or support services will be the emergency department (Accident and Emergency) of a local hospital.
In order to improve services to people in mental health crisis, many emergency departments now have a psychiatric liaison team in place; 24 hours a day in some hospitals. These specialist staff members should assess the person’s condition and arrange appropriate care and treatment as quickly as possible. However, an official report [6] points out that psychiatric liaison provision is still patchy, and may not be available 24 hours a day, if at all. If there is no psychiatric liaison team, a local mental health service such as the crisis resolution/home treatment team (CRHT) should be on call to provide help, though they may take longer to arrive. The CRHT (formerly known as the crisis response team) is a statutory funded service – see below for more information). It is always best for someone going to the emergency department in a mental health crisis to have a trusted friend or family member with them for support if possible.
After assessment, a referral may be made to the local CRHT team, unless the person needs immediate hospital treatment. The CRHT team may offer support to the person at home, or may recommend inpatient treatment for a short period – for further assessment or to start treatment.
An acute ward may be the best option in the short term to prevent someone from harming themselves or the symptoms of a crisis from getting worse. It may also be helpful to give someone a break from their usual surroundings. The National Audit Office has found that some people feel a greater sense of safety and security in hospital than at home, perhaps because they feel that their mental state has been recognised, they are protected from the risks they pose to themselves or others, and they are offered respite from the difficulties or triggers they experience at home. The report also acknowledged that while some find the routine of hospital oppressive, others find it a useful way to provide structure to their day, motivation to get out of bed and a group of people with whom to socialise [7].
Hospital wards should be safe and secure with the minimum restriction necessary, offer appropriate care and treatment, and be located as close to the patient’s home as possible [8]. Single-sex accommodation in psychiatric acute wards has been recommended in national policy, [9] though this is taking time to be fully implemented.
Any patient who is admitted to hospital because of an acute mental health crisis should be consulted on their care plan, which outlines their care and treatment. The plan should name one person who will act as the care coordinator. This person should also be involved in creating a care plan on discharge from hospital, which should include ways of preventing and resolving any future crises (see ‘Care programme approach’ below).
Standards of acute care for people in crisis are being systematically improved to make the environment feel safer, more positive and therapeutic, and to raise levels of patient satisfaction. [10], [11] There are policy recommendations that acute care needs be linked with national efforts to improve race equality and access to psychological therapies. The Star Wards project (see ‘Useful organisations’) and acute care work led by the National Mental Health Development Unit (NMHDU) have added to the impetus for change. NMHDU have produced an Acute Care Declaration, [12] which sets out achievable standards for acute care, including safety, therapeutic optimism, recovery-oriented services and a specialist acute care workforce. These standards are endorsed in current national mental health policy. [13]
Research has repeatedly shown that hospital care is not always necessary or helpful to people experiencing an acute mental health crisis. [14], [15] For years, mental health service users have been calling for community-based crisis services as an alternative to hospital care. The National Service Frameworks (NSFs) for Mental Health in England and Wales supported this, saying that people experiencing a crisis should have access to 24-hour care and support, and that this should be available from community as well as hospital services. New Horizons [16], the policy that replaced the NSF in 2009, says that community-based services work well without loss of quality where CRHT teams are well established, and that CRHT teams should be the gatekeepers of admissions to acute units.
A CRHT team is a multidisciplinary team, usually including a psychiatrist, community psychiatric nurses, social workers and support workers. The main aim of the team is to provide service users with the most suitable, helpful and least restrictive treatment possible, in order to prevent or shorten hospital stays. [17] As gatekeepers to acute admission, they have to decide whether or not they can provide an alternative to admission for a particular patient, and can also offer home support to enable the person to leave hospital more quickly.
CRHT teams are now provided for adults (aged 18–65 years) experiencing an acute mental health crisis that would be likely to result in hospitalisation without the involvement of the team.
The CRHT team assesses the patient’s needs, manages the risks of them being at home instead of in hospital, helps with self-help strategies, offers psychological and practical help to deal with problems, and administers medication. They are available 24 hours a day, seven days a week, for the clients they care for. CRHTs also work with family, friends and carers. They have a good knowledge of local services and can help the person in crisis to learn from their experience in terms of crisis prevention and management.
Service users usually appreciate and prefer CRHT teams, though this depends on whether they consider they are receiving good emotional and practical support. Of course in some cases people want or need time away from their home. However, service users (and their families) generally appreciate knowing that support is available 24 hours a day. In most cases where compulsory treatment is not needed, service users’ preference for home or hospital is followed. CRHTs are seen as largely successful in reducing hospital admissions for people in acute mental health crisis and enabling shorter hospital stays for those admitted.[18]
The CRHT services are meant to be comprehensive – which is the case in most urban areas. However, in some areas, particularly rural ones, teams struggle to provide a full service. [19], [20] Different methods of crisis intervention are being considered for people living in isolated settlements. [21]
Crisis services continue to be a high priority for both the Department of Health and the Welsh Assembly Government, so CRHT teams are likely to play an important part in crisis provision for the foreseeable future.
In 2008 the National Audit Office reported that few alternatives to hospital are available to CRHT teams who are seeking alternatives to hospital for people in crisis, other than the therapy and support that the CHRT staff provide. The Office wanted to see greater availability of short-term respite care, crisis accommodation and acute day hospitals. A few of these services do exist, and are described below.
Over the past 10 years, organisations have developed and evaluated different ways of delivering local crisis services. [22] The results from these research projects, and continuing development work at local level, have led to a range of community-based crisis services across England and Wales. Some of these services are provided by the voluntary sector and others by partnership between social or health services and voluntary sector groups. The best of these draw on the experiences of people who have had acute mental health crises; indeed, some crisis services are user-run.
Information about local facilities can be obtained from GPs, community mental health teams (CMHTs), local NHS trusts, NHS Direct and Mindinfoline. The main types of community-based crisis services are described below.
Crisis houses offer intensive short-term support so that people can manage and resolve their crisis in a residential (rather than hospital) setting. Many crisis houses have been set up in direct response to demand from mental health service users as a preferred alternative to hospital treatment [23].
Crisis houses usually provide a small number of beds, often for a group with specific needs, such as women, people from a black or minority ethnic group or people facing a particular kind of mental health crisis. Overnight accommodation is provided, usually for a specific period of time. Day services are also often available, providing opportunities for contact with other residents and staff. Staff who work in crisis houses are in contact with community mental health workers and have a good knowledge of local services.
People are usually referred to crisis houses by their CMHT or CRHT team. Some crisis houses give the opportunity to self-refer, particularly for returning residents. All new residents are assessed before admission, to ensure that they fit the criteria for the crisis house, such as willingness to abide by house rules regarding behaviour to other residents. If residents are taking medication, they are usually expected to do so without staff supervision. The criteria for admission and length of stay, and terms and conditions of residence, vary between crisis houses. Satisfaction levels with crisis houses are very high. [24]
Day services help patients who don’t need residential care but who need support during the day to manage a crisis. The term ‘day services’ covers a range of activities and settings, from drop-in centres provided by local voluntary organisations (such as local Mind associations) to units in hospitals. Some crisis houses also have a ‘guesting’ service for users who visit during the day but do not stay overnight.
Day services can include counselling, other therapies such as art therapy and activities, such as gardening. They may also provide opportunities to talk to others or to have peace and quiet. The staff have a good knowledge of local services and close links with the local CMHT.
A person experiencing an acute mental health crisis may wish to use these services daily or less often. They may use services for the full duration of opening hours or at certain times of the day.
Day services may be used in combination with care provided by an unpaid carer (e.g. a family member) and contact with a GP or CMHT. Day services can help a person to resolve their crisis and learn self-management techniques that may be helpful in the future.
Day centres funded by the state are currently undergoing change to become more individualised, flexible and inclusive and not based on a particular building, although there will still be a place to go to find out about what is available. The principle is to provide greater access to general community resources, and new services will be more aware of service users’ choices and preferences, including some services that are user-led. [25]
CMHTs normally work during office hours and are therefore not set up to deal with acute mental health crises, which can happen at any time and need rapid intervention. However, some people are able to manage a crisis in the community with support from their CMHT along with additional support from people such as their GP, family members and carers.
Most CMHTs provide some coverage outside traditional office hours. Care coordinators have flexibility to increase their visits during times of crisis. [26] In addition, service users at risk of an acute mental health crisis should have a named contact and/or a helpline number to call at any time of the day if they need help outside the CMHT’s hours.
Telephone helplines can provide essential support to someone in an acute mental health crisis, particularly if they provide 24-hour cover.
The most well-known helpline for people in an emotional or mental health crisis is Samaritans. Helplines allow the caller to talk through his or her emotions and explore options with the aid of confidential and non-judgemental support. Sometimes the caller may ask for information. The helpline operator will either provide it directly or direct the caller to an appropriate organisation.
Helpline operators should not influence callers in their beliefs or attitudes, or direct callers towards particular courses of action. The operator will enable the caller to make sense of his or her situation and work out possible solutions. If the caller is at risk of suicide or in despair, some helplines (such as Samaritans) offer follow-up calls.
Several national charities for specific mental health problems operate telephone helplines out of office hours, or example No Panic (for panic and anxiety-related problems), Rethink (for severe mental health problems) and b-eat (the Eating Disorders Association) (see ‘Useful organisations’ for details).
Most voluntary-sector mental health helplines have drawn together in a network organised by the Telephone Helplines Association, which provides training, sets standards and links the helplines, enabling callers to access someone to talk to at any time and providing a safer and more comprehensive service. The helplines also link with NHS Direct, which is enabled to refer callers with mental health issues to a local helpline of an approved standard.
CRHT teams and CMHTs may also provide telephone support specifically for people at risk of an acute mental health crisis. In these cases, the service user will be given the helpline number by a member of their CRHT team or CMHT. A person who calls their designated helpline number may be able to manage and resolve their crisis by talking to the helpline operator, either through a single call or at scheduled times over a period of days or weeks. If the caller needs more support or treatment, the helpline operator should make immediate referrals to appropriate local services.
Although this section has focused on the telephone, most organisations that provide helplines also provide support through other media such as email and textphone. This is important for service users who are have a hearing impairment, or simply prefer not to talk directly to another person.
Someone in an acute mental health crisis may not be able to make or communicate choices about their treatment and care. Service users can state their preferences in advance, in the ways described below.
CPA is the name for care planning for people who use secondary mental health services. Care plans agreed between health and social services and service users were a statutory requirement in England and Wales for everyone in secondary mental health care until relatively recently. However, guidance produced in 2008 [27] reduced the coverage of CPA to those formerly on an enhanced level CPA, i.e. those more at risk or with more complex needs.
This means that some people who used to have a care plan will no longer be formally expected to have one, though this does not stop more informal care and crisis planning being arranged between service users, carers and care providers.
Every CPA should include a crisis and contingency plan which gives clear details of who is responsible for addressing elements of care and support, and who to contact. Copies of the plans should be provided to the service user, his or her GP and any other significant care provider, if this is appropriate and agreed by the service user. The plan should cover what action needs to be taken when the person’s mental health is deteriorating, the services that have worked well in the past, and the name of an individual who the service user responds to well in times of crisis. It will also cover contingency plans if the first choice of treatment or intervention is not available. This should ensure that any crisis is tackled in a way that is both acceptable to the service user and most likely to be effective.
The CPA is essential in laying out care needs and entitlements. Any person who has a CPA should be involved in its development, and should see the written plan on completion.
The contents of a CPA should be followed by the CMHT and others involved in a service user’s care. If the service user is not satisfied with any of these points, they should take their complaint to their CMHT in the first instance. If the issue is still not resolved, they should go to an advocacy service. More information on advocacy can be obtained from Mindinfoline or Mind’s booklet, The Mind guide to advocacy.
For more information about the CPA, see Mind rights guide 6: Community care and aftercare.
Crisis cards, launched by the pioneering mental health service user organisation, Survivors Speak Out, have been used in the voluntary sector since 1989. The crisis card is designed to be carried with the user, and is usually small enough to fit into a wallet or pocket. It gives details of a nominated person to be contacted in a crisis; information about the care the holder would like in a crisis, and any other information they feel would be useful. The aim of crisis cards is to make it easier for service users to advocate for themselves if they are unable to express their wishes in a crisis.
Following research, [28], [29] there is now wide acceptance of the underlying principle of crisis cards, which has been further developed into advance statements and advance agreements (such as joint crisis planning).
Advance statements, also known as advance decisions, are written statements, usually drawn up with the support of an advocate or social worker, which set out personal values and preferences about future treatment, and in some cases state a wish to opt out of certain types of treatment, such as specific medications or ECT. Although the Mental Health Act 2007 gives psychiatrists the authority to override such statements if they believe a specific treatment is needed, an advance statement should help to ensure that a patient’s preferences are taken into account. For more information about advance statements and directives, see our briefing on Healthcare and welfare/personal care decisions under the Mental Capacity Act 2005.
Advance agreements or joint crisis plans are negotiated between service users, psychiatrists and others involved in treating mental health issues, and they have been shown to reduce compulsory admissions. [30] As with advance statements, these agreements help people to make known their views about treatment, so that these can be taken into account if the person loses their capacity to make informed choices at some future time. Such agreements represent plans that the mental health team is expected to carry out as far as possible. Research has shown that the use of joint crisis plans reduces compulsory admission and treatment of patients with severe mental illness. The Institute of Psychiatry has developed a template for a joint crisis plan, available on their website or by contacting the Institute (see ‘Useful organisations’).
Anyone can experience an episode of mental distress in which emotions or behaviour become painful, out of control or unmanageable, even if they do not have a severe mental health problem (i.e. a doctor would find them basically mentally well even if they are currently going through an emotional or psychological crisis). In such instances, a person would not usually be referred to statutory mental health crisis services (such as inpatient psychiatric wards, CRHT teams or community-based alternatives to hospital admission).
An emotional or psychological crisis of this kind can happen to people with a range of mental health problems, as well as those who have had no previous contact with health services for a mental health problem. In a situation of crisis, a person may feel an intense need for greater emotional support and help than can be offered by family or friends, and seek services that they would not need at any other time.
This section describes the actions that can be taken by or for someone going through a crisis that is not diagnosed as a mental health problem.
The GP’s role described above for acute mental health crises is equally applicable to a situation in which a mental health crisis is not ‘acute.’ In fact, if a crisis is not ‘acute’ it is much more likely to be managed at primary care level, without the involvement of secondary services.
In addition to regular appointments with their GP, patients may be offered access to a counsellor or therapist, either directly through the GP practice, or through being referred on to an Improving Access to Psychological Therapies (IAPT) service. [31] It is now national policy to encourage improved access to talking therapies, though such services are not (at the time of writing) available in all areas; moreover, the treatment offered is most likely to be cognitive behaviour therapy (CBT), which has the strongest evidence base of effectiveness. [32] GPs may also prescribe medication, such as antidepressants. Antidepressants are not the answer for everyone, and may not address the underlying cause of a crisis, but they may be helpful in the immediate short term. See Mind’s booklet Making sense of antidepressants for more information.
GPs can also give advice on lifestyle factors that may be having a negative effect on mental health, such as diet and exercise, or refer people to an appropriate specialist or for assessment by secondary mental health services.
Referral to secondary services for a mental health problem does not necessarily mean that a patient needs to use secondary services to manage an immediate crisis. Primary care staff, including GPs, and the other services listed in this section may provide sufficient help and support until a referral comes through or the crisis has passed.
Whether a patient chooses to contact secondary services will depend on a number of factors, including the availability of other services in the area and what has worked in the past. The GP and some telephone helplines services, including NHS Direct, can help a person decide whether they need to use secondary services.
Telephone helplines can be a good resource for immediate support. They can be particularly important when:
The Samaritans’ helpline is available to anyone in distress or despair, as are the helplines of national charities that focus on specific mental health problems. Local helplines may cover particular areas – details can be found online, in Yellow Pages or in other local directories. See the section on telephone helplines above for more information.
In recent years, the internet and email have proved good sources of support for people experiencing mental health crises. These resources have the advantage of being available 24 hours a day, seven days a week to those with internet access. The most useful online resources contain information that is accurate, correct and up-to-date, and support services that are likely to improve mental health.
Many people in a crisis also find it helpful to make contact with others who have had a similar experience. Online discussion forums can be useful in enabling people to overcome isolation, gain moral support and learn practical tips for coping with and resolving their crisis.
A word of caution: online resources are not necessarily subject to the same quality control as telephone helplines. Anyone with the skills and equipment can create and maintain a website. Problematic websites include those that do not promote recovery or healthy ways of managing a mental health problem, but are aimed at triggering negative behaviours, thoughts and feelings – the latter has been associated with certain websites for people with eating disorders and those who self-harm. Such websites can cause considerable mental distress, and make the original problem more difficult to manage. They are likely to be counterproductive and possibly dangerous to someone in a crisis.
Websites that provide interactive facilities such as discussion forums that are not adequately moderated may also be best avoided. ‘Moderation’ is the assessment of content before it appears on a public forum. Individuals who contribute to discussion forums will usually have their contribution assessed by an individual or group that maintains the forum and is responsible for quality control. The aim of moderation is to prevent information that is offensive, false or likely to cause harm from being publicly available. The issue of moderation is controversial, however, and some argue that it inhibits the free exchange of views. Ultimately, each individual has to decide whether to use an unmoderated discussion forum. It is important that choices are fully informed and likely to provide help in managing a crisis.
Some basic points should be to borne in mind when assessing the quality of a website:
Online facilities provided by NHS Direct, Mind and other leading national charities in mental health provide high-quality information and support services. In addition, they often provide links to other relevant websites, including those created and maintained by mental health service users. These linked websites should have been assessed for their quality and relevance. It is important to bear in mind, however, that no organisation can be responsible for the content of external websites.
Local voluntary organisations involved in mental health, such as local Mind associations, may be able to help someone through a crisis by providing information, advice, counselling and/or other day services. Most of the crisis houses set up by the voluntary sector offer self-referral specifically for people who do not wish to go through their GP or Emergency department referral system when in a crisis (see ‘Other community-based services’ above).
Information about what is available locally can be obtained from your GP, CMHT or local NHS trust, or by contacting Mindinfoline.
Causes of crises, and factors that can make a crisis difficult to manage, are too numerous and too varied to cover in this factsheet. Particular areas of a person’s life that can directly cause or trigger a crisis include:
Organisations that give information and support in these specific areas may be useful if such issues have contributed to a crisis (see ‘Useful organisations’). Mind also publishes factsheets and booklets on many of these issues.
Mind booklets
The following booklets are available from Mind (available on Mind’s website at www.mind.org.uk/information) or to purchase from Mind Publications on 0844 448 4448, from the online shop, or via publications@mind.org.uk:
b-eat (beat eating disorders)
103 Prince of Wales Road, Norwich NR1 1DW
tel: (admin): 0300 123 3355
adult helpline: 0845 634 1414 email: help@b-eat.co.uk
youth helpline: 0845 634 7650 email: fyp@b-eat.co.uk
web: www.b-eat.co.uk
The leading UK charity for eating disorders. Coordinates a network of self-help groups and individual postal, telephone and email contacts.
Hafal
Head Office, Suite C2, William Knox House, Britannic Way, Llandarcy, Neath SA10 6EL
tel: 01792 816 600
email: hafal@hafal.org
web: www.hafal.org
The leading organisation in Wales working with individuals recovering from severe mental health problems and their families.
Institute of Psychiatry (IoP)
Kings College London, De Crespigny Park, London SE5 8AF
tel: 020 7848 1000
web: www.iop.kcl.ac.uk
For templates of joint crisis plans.
MDF The Bipolar Organisation
Castle Works, 21 St George’s Road, London SE1 6ES
tel: 0845 434 9970
email: mdf@mdf.org.uk
web: www.mdf.org.uk
MDF the BiPolar Organisation Cymru
22–29 Mill Street, City of Newport NP20 5HA
email: info@mdfwales.org.uk
web: www.mdfwales.org.uk
The leading UK charity for people with bipolar affective disorder (manic depression). Runs self-help groups and gives access to safe, secure online discussions via the website.
Mental Health Helplines Partnership (MHHP)
14 Swan Court (Office 7), Cygnet Park, Peterborough PE7 8GX
tel: 01733 563 956
web: www.mhhp.org.uk
MHHP is a charity that works in partnership with the providers of mental health helplines.
NHS Direct
tel: 0845 4647
email: via website
web: www.nhsdirect.nhs.uk
For information and advice on any health problem, including the services you may need to contact. Available 24 hours a day. It has a mental health section providing advice about what to do if you or someone close to you has a mental health problem.
NHS Choices
web: www.nhs.uk
Comprehensive NHS website providing information about NHS services and medical advice.
No Panic
93 Brands Farm Way, Telford TF3 2JQ
helpline: 0808 808 0545 (10am to 10Pm everyday; night-time anxiety crisis line – answer phone only)
email: ceo@nopanic.org.uk
web: www.nopanic.org.uk
Charity to help those with panic attacks, phobias, obsessive compulsive disorder, anxiety disorders and tranquiliser withdrawal.
Rethink
Rethink, 89 Albert Embankment, London, SE1 7TP
tel: 020 7840 3188 or 0845 456 0455
email: info@rethink.org
web: www.rethink.org
The largest charity for severe mental health problems in England. Runs 13 regional helplines.
Samaritans
Chris, PO Box 9090, Stirling FK8 2SA (information, help and postal support)
helpline: 08457 90 90 90
email: jo@samaritans.org
web: www.samaritans.org.uk
Available 24 hours a day to give support to people experiencing distress or despair. The contacts above can put you in touch with your local Samaritans branch.
Star Wards
Ana at Bright, 25 Bickerton Road, London N19 5JT
tel: 020 7263 9632
email: ana@starwards.org.uk
web: www.starwards.org.uk
Star Wards works with mental health trusts to enhance the daily experiences and treatment outcomes of mental health inpatients.
Citizens Advice
Myddleton House, 115–123 Pentonville Road, London N1 9LZ
tel: 020 7833 2181
web: www.citizensadvice.org.uk
www.adviceguide.org.uk to find nearest CAB office
The leading UK charity giving free information and advice on legal, financial and other problems. Advice is available face to face or by telephone. Some bureaux also offer home visits and email advice.
National Debtline
Tricorn House, 51–53 Hagely Road, Edgbaston, Birmingham B16 8TP
freephone: 0808 808 4000 (9am to 9pm Mon–Fri; 9.30am to 1pm Sat)
website: www.nationaldebtline.co.uk
For people with debt problems in England and Wales.
Parentline Plus
helpline: 0808 800 2222 (24-hour)
email: via website
web: www.parentlineplus.org.uk
Provides information, self-help groups and support on parenting for anyone involved in bringing up children.
Rape Crisis (England and Wales)
email: info@rapecrisis.org.uk
web: www.rapecrisis.org.uk
Online resource to provide information so that survivors of rape and domestic violence can get the help they need, including details of nearest Rape Crisis centre.
Relate
tel: 0300 100 1234
email: via website
web: www.relate.org.uk
Provides counselling and other support services on relationship problems for individuals, couples and families. Local centres can be found via the website.
Shelter
88 Old Street, London EC1V 9HU
tel: 0845 458 4590 (general enquiries)
housing advice helpline: 0808 800 4444
supporter helpdesk: 0300 330 1234 (9am–8pm Mon–Fri; 9am–1pm Sat)
email: info@shelter.org.uk
web: http://england.shelter.org.uk or http://cymru.shelter.org.uk
Leading national charity for advice and support on homelessness and housing problems.
Women’s Aid
Head Office, PO Box 391, Bristol BS99 7WS
tel: 0117 944 4411 helpline: 0808 2000 247 (24-hour)
email: helpline@womensaid.org.uk
web: www.womensaid.org.uk
The main national charity working to end domestic violence against women and children. Provides refuges across England and Wales.
[1] Department of Health. 2001. Mental Health Policy Implementation Guide.
[2] Minghella, E., Ford, R. et al. (1988). Open All Hours: 24 hour response for people with mental health emergencies. London, Sainsbury Centre for Mental Health.
[3] Slade, M. (2009). Personal Recovery and Mental Illness. Cambridge, Cambridge University Press.
[4] Gray, P. (2006) The Madness of Our Lives: Experiences of mental breakdown and recovery, London, Jessica Kingsley
[5] Faulkner, A., Petit-Zeman, S. et al. (2002). Being there in a crisis, Mental Health Foundation. London, Mental Health Foundation, Sainsbury Centre for Mental Health.
[6] Academy of Medical Royal Colleges (2008) Managing Urgent Mental Health Needs in the Acute Trust: A guide by practitioners, for managers and commissioners in England and Wales
[7] National Audit Office (2008) Crisis Resolution and Home Treatment: the service user and carer experience p. 18, London: National Audit Office
[8] DH (1999) National Service Framework for Mental Health, London: Department of Health
[9] NHSE, (2000). Safety, privacy and dignity in mental health units. Guidance on mixed sex accommodation for mental health services, London: Department of Health.
[10] SCMH (2006),The search for acute solutions: Improving the quality of care in acute psychiatric wards. London, Sainsbury Centre for Mental Health.
[11] Healthcare Commission (2008), The pathway to recovery: A review of NHS acute inpatient mental health services, Healthcare Commission.
[12] NMHDU Acute Care Declaration leaflet, National Mental Health Development Unit, http://www.nmhdu.org.uk/news/new-declaration-enshrines-acute-care-quality-care-for-all/?keywords=acute+care+declaration
[13] DH (2009) New Horizons: A Shared Vision for Mental Health, London: Department of Health.
[14] Minghella, E., Ford R. et al. (1988). Open All Hours: 24 hour response for people with mental health emergencies. London, Sainsbury Centre for Mental Health.
[15] Faulkner, A., Petit-Zeman S. et al. (2002). Being there in a crisis, Mental Health Foundation. London, Mental Health Foundation, Sainsbury Centre for Mental Health.
[16] DH (2009) New Horizons: A Shared Vision for Mental Health, London: Department of Health.
[17] National Audit Office (2007). Helping people through mental health crisis: The role of Crisis Resolution and Home Treatment services: London, National Audit Office.
[18] National Audit Office (2008) Crisis Resolution and Home Treatment: the service user and carer experience p. 18, London: National Audit Office
[19] Onyett, S., Linde, K. et al. (2008). Implementation of crisis resolution/home treatment teams in England: national survey 2005-2006. Psychiatric Bulletin vol. 32, pp 374–7.
[20] Swindlehurst, H. (2005). Rural proofing for health: a toolkit for primary care organisations. Llangollen, Institute of Rural Health.
[21] Onyett, S., Linde, K. et al. (2008). Implementation of crisis resolution/home treatment teams in England: national survey 2005-2006. Psychiatric Bulletin vol. 32, pp 374–7.
[22] Faulkner, A., Petit-Zeman, S. et al. (2002). Being there in a crisis, Mental Health Foundation. London, Mental Health Foundation, Sainsbury Centre for Mental Health.
[23] Faulkner, A., Petit-Zeman, S et al. (2002). Being there in a crisis, Mental Health Foundation. London, Mental Health Foundation, Sainsbury Centre for Mental Health.
[24] Faulkner, A., Petit-Zeman, S et al. (2002). Being there in a crisis, Mental Health Foundation. London, Mental Health Foundation, Sainsbury Centre for Mental Health.
[25] CSIP/NIMHE (2006). From segregation to inclusion: Commissioning guidance on day services for people with mental health problems. London, Department of Health.
[26] Department of Health. (2002). Community Mental Health Teams - Mental Health Policy Implementation Guide. London, Department of Health.
[27] Department of Health (2008). Refocusing the care programme approach: policy and positive practice guidance. London, Department of Health.
[28] Henderson, C., Swanson, J. et al (2008) A typology of advance statements in mental health care, Psychiatric Services, 59: 63-71.
[29] Henderson,C., Flood, C. et al (2004) ‘Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial’ BMJ 329 (7458) 136-8.
[30] Henderson,C., Flood, C. et al (2004) ‘Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial’. BMJ 329 (7458) 136-8.
[31] Improving Access to Psychological Therapies – NHS website: http://www.iapt.nhs.uk/
[32] Improving Access to Psychological Therapies – NHS website: http://www.iapt.nhs.uk/
This factsheet was written by Rachael Twomey, Mind Information Unit, April 2006, and updated by Jan Wallcraft, March 2010.
Dr Jan Wallcraft is a freelance researcher and consultant on service user perspectives in mental health.