Crisis services

A guide explaining what mental health crisis services are available, how they can help and when to access them. Also provides guidance on how you can plan for a crisis.

Your stories

In crisis: my experience

In time for the release of the CQC's Mental Health Act report,Claire blogs about her experience of crisis care

Posted on 28/01/2014

How going to A&E helped me

Caroline blogs about how a visit to A&E helped her to realise she needed help.

Posted on 27/11/2013

How can I plan for a crisis?

We can't always predict when we might find ourselves experiencing a mental health crisis – but we can plan for one. Here are some different ways you can plan in advance for how to look after yourself in a crisis:

Informal planning with friends and family

It might seem obvious, but talking to the people closest to you about how you would prefer to manage a crisis can be a good way to plan for the future, and even prevent a crisis from happening. You don't necessarily need to write anything down for them, although you can do if you both feel it will help you remember what you've agreed.

For example, it could be useful to let them know:

  • how they can spot the signs of a crisis
  • how you would like them to help you
  • who they should contact
  • what treatment you would like
  • whether you’ve made an advance statement or decision

You could also discuss whether your friend of family member might be willing to act as your advocate (see our pages on advocacy for more information).

Luckily I had fantastic support from friends and family or who knows where I would be now!

Advance statements and decisions

In some situations experiencing a mental health crisis might mean that you become unable to make decisions about your treatment (in legal terms this is called 'losing capacity'). If you're worried that you may lose capacity to make decisions in the future, you can plan for this with:

  • Advance statements. This includes any written statement you make about what you would like to happen if you lose capacity to make a relevant decision. Advance statements are not legally binding, so health professionals aren't necessarily required to follow them, but they should carry out your wishes wherever possible. Joint crisis plans and crisis cards are both types of advance statement.
  • Advance decisions (also known as an ‘advance directive’ or ‘living will’). These are a type of advance statement which clearly set out any medical treatments you do not want to receive. They are legally binding, so a health professional must comply with your advance decision (except if the type of treatment you have refused relates to your mental health problem and you are currently sectioned under the Mental Health Act).

(For more information on what your rights are if you lose capacity, see our pages on the Mental Capacity Act.)

How do they work?

Advance statements can set out your views and preferences on a range of things, such as:

  • what treatment you would prefer
  • who you would like to be contacted in a crisis
  • your spiritual views and requests
  • your food preferences

You can write an advance statement yourself, but it might be more likely to be followed if you can write it with a local NHS Trust’s advance statement scheme. You can find out if this scheme exists near you from your care coordinator, GP or psychiatrist. Rethink Mental Illness’ page on making an advance statement explains the recommended information to include.

Advance decisions can only set out what treatment you would like to refuse if you lose the capacity to make decisions.

You can make an advance decision:

  • orally, such as by telling a friend, family member, health professional or other professional
  • in writing, such as by having a note made in your hospital or GP medical notes

However, it is better to have an advance decision written down so that its validity is less likely to be challenged by anyone.

There are some important restrictions on when an advance decision works, and when professionals have to follow it. For more information on this, see our legal page on advance decisions.

Joint crisis plan (JCP)

A joint crisis plan (JCP) is a type of advance statement that's agreed jointly between you and any mental health professionals involved in your treatment. Having a plan like this can also reduce your chances of being sectioned, as people will know how best to look after you in a crisis.

How does it work?

Someone from your care team will write your crisis plan with you, and you’ll have the final say on what’s included. You’ll also get to decide who receives a copy of your plan.

The National Institute for Health and Care Excellence (NICE) recommends that a joint crisis plan should include:

  • information on early warning signs of a crisis
  • what support you have to help you manage your crisis at home
  • where you’d like to go, if you need to be admitted to hospital
  • arrangements for childcare if you’re admitted to hospital
  • advance treatment statements, including your preferences
  • any family members you’d like to be contacted
  • contact details for your care team
  • information about 24-hour access to services

You could also include:

  • details of any medication you take
  • psychiatric and physical diagnoses
  • allergies

Crisis cards

A crisis card is a small card you can carry in your wallet or pocket which gives key details about how people can help you in a crisis, in case you become unwell while out and about.

How does it work?

Crisis cards are another type of advance statement. They can be very basic and just cover vital information about your diagnosis and who to contact in a crisis, or they can be more complex. It’s up to you what you put on your card.

If you have a full advance statement, joint crisis plan or care plan it's also a good idea to mention this on your crisis card, to make sure any health care professionals who treat you are aware of it.

Care planning (care programme approach)

The care programme approach (CPA) is a way to coordinate your care if you have severe mental health problems or a range of different needs. Under the care programme approach, a team of mental health professionals work with you to create a comprehensive care plan for how to look after you. Part of your care plan will include planning for a crisis.

How does it work?

A CPA coordinator will be assigned to manage your care plan – this person is usually a mental health nurse or someone else closely involved with your care, and they will be your first point of contact. Every care plan under the CPA should include a crisis plan which gives clear details of:

  • who is responsible for your care and support
  • which health care professionals to contact in a crisis
  • who you can contact if your care coordinator is not available
  • what should be done if your mental health gets worse
  • which services have worked well for you in the past
  • contact details for someone you respond well to in a crisis, such as a friend or family member you trust
  • other options in case your first choice of treatment is not available

Your CPA coordinator should give you a copy of your care plan. If you agree, they will also share a copy of your care plan with people involved in your care. If everyone involved in your care follows your care plan, this should ensure that any crisis is handled in a way that is both acceptable to you and most likely to be effective.

This information was published in September 2015. We will revise it in 2018.

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