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Why crisis care needs to change

Tuesday, 01 October 2019 Charli

Charli is a Policy and Campaigns Officer here at Mind. Her blog looks at why we need to improve people's experiences of crisis care, and why this goes further than just reviewing the Mental Health Act.

Changing the law around when people are sent to hospital for their mental health is a good first start to improving mental health crisis care but if we really want to see changes in the number of people being detained in hospital under the Mental Health Act ('the Act') it is important that we also consider the stages before someone gets really unwell.

In this blog we will explore how having earlier access to crisis care can significantly reduce the need for the Act.

What is a mental health crisis?

There is no one set definition for what a mental health crisis is; it is highly personal to each individual case – but some people would describe it as a mental health emergency that poses a direct and immediate threat to your physical or emotional wellbeing.

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Where the current system falls short

A recurring theme from our engagement work was that even at the point of crisis, help was not always accessible – often because of the lack of services available and their restrictive opening hours. There is also a lack of joined up services which can make those of us with complex needs feel lost in the system.

"You're played ping pong with and you get lost in the system. People are crying out for help and not getting it."

It's really disheartening to hear about the challenges that people experience when trying to use mental health services – it's no surprise that many of us present late with our mental health problems and don't get the help we need until there is little option other than to be treated in an inpatient setting.

Minority groups disproportionately affected

I have been particularly moved by the effect that inadequate crisis support has on minority communities – we are disproportionately represented under the Mental Health Act, yet early help continuously fails to include services that work for us. Evidence suggests that Black people are more likely than their White counterparts to enter mental health services through the criminal justice system instead of through primary care. This reinforces the desperate need to design mental health services that are informed by Black and Minority Ethnic (BME) groups and for there to be BME representation in the workforce from senior levels down.

What does the Mental Health Act Review say?

The Mental Health Act Review recognises that the increase in people being detained under the Act may mean that professionals have got better at identifying people who may need inpatient treatment, but the stretch on resources means that they have got worse at being able to provide interventions to prevent detention.

"You need earlier interventions. You have to get to the point where you snap, or they see you snap, and then they have to make a major decision whether to section you."

It feels almost in vain that Approved Mental Health Professionals (AMHPs) are required to consider alternatives to detention when assessing someone for admission under the Act, because they are so limited by what options are actually on offer that many people end up getting sectioned anyway.

Rightfully the Review as well as the NHS Long Term Plan recommends that there should be more accessible and responsive mental health crisis services and community-based mental health services that respond to people's needs and keep them well.

What does effective crisis care look like?

Effective crisis care support should be timely, individually tailored and widely accessible when a person first starts experiencing distress. If you are in a mental health crisis you should not be left to ruminate with your thoughts in the chaos of a busy emergency department and detention in hospital should only be used as a last resort.

An example of an alternative provision to hospital is Maytree: a residential sanctuary for people who are suicidal. Another exemplary crisis service is Hert Mind's Nightlight crisis service which offers overnight stays to give people added support to help resolve their crisis.

But of course good crisis care does not replace the urgent need for effective, supportive mental health services which are accessible to people when they first need them. The Mental Health Act Review plays an important role in addressing how people are treated while in hospital but reforms of mental health care extends far beyond the Act. Service provision in the community needs to be inclusive, accessible and patient-focused to prevent people from reaching such a critical stage in their mental health that they experience crisis in the first place.

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