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Crisis care in Wales

Thursday, 18 May 2017 Sara Moseley

Sara, Director of Mind Cymru blogs about the changes to crisis care in Wales resulting from the Crisis Care Concordat.

Sara tweets at @SaraMoseley1

Before the Assembly elections, eighteen months ago, over 700 people in Wales – the vast majority of them with experience of a mental health problem – told Mind Cymru what they most needed to see change. Top of the list was timely access to help and support. Without this, many had become more and more unwell. Some had reached crisis point. All the other mental health charities in the Wales Alliance for Mental Health - see the same need. And because of this all of us are absolutely focused on doing everything we can to work for better support and understanding.

We know from our independent enquiry Listening to Experience that it's possible to receive excellent care during a mental health crisis.

This type of care often involves lots of agencies working together and it requires a really responsive, personal level of support. Often this just doesn’t happen. At its worst, the trauma of being detained in a police cell or just not getting the right help quickly can be as damaging as being ill.

In December 2015, 29 national bodies involved in health, policing, social care, housing, local government and the third sector across Wales – including the Wales Alliance for Mental Health – signed the Mental Health Crisis Care Concordat, agreeing to work together better to make sure people experiencing a mental health crisis get the help they need when they need it.

I agreed to independently Chair the Welsh Government’s Task and Finish Group until April 2017 on behalf of the third sector so that we had the best chance of working in partnership across Wales focusing on some really tangible things:

  • We wanted to reduce the use of police cells
  • Increase the use of safe places in and out of hospital.
  • Get professionals trained and informed about mental health.
  • Learn from each crisis and from the whole programme so we knew what needed to happen next to continue to make things better.

As far as I was concerned this was (I hoped) a big step on the way, not the final destination.

Today, as we come together in City Hall, we can share the progress we’ve made and also what we have learnt to take us onto the next step. We hope that by working with Public Health Wales as we are today, we can use what we have learnt to catalyse a national mental health improvement programme.

What's changed?

In 2014/15, 54 children, some as young as 12 were detained in police cells. This reduced to eight in 2015/16 and in 2017 (to date) this has stopped completely.

In 2013/14 around a third of the 1,700 instances of police using the Mental Health Act ended up with people being kept in police cells. Over the time we have been working this has more than halved to just 12%, with people now being taken to ‘health-based places of safety’ instead. This is a real achievement in preventing people being criminalised when they ill.

Other things haven’t shifted. Lots of people say that what they need when they are in crisis is a safe and caring place to go until they recover – not a hospital but a sanctuary. We haven’t yet seen such places being developed. Charities, police and Crime Commissioners and Local Health Boards have a challenge on their hands in the current financial climate, however I am hopeful of establishing partnerships and commitments at the meeting today.

We’d also like to have seen more consistent and open information about the experiences of people in crisis and the outcomes for them through reviewing crisis cases. This has to be part of the next steps we take. Still, too many people do not get the right help at the right time. At today’s event, we must have a frank and open discussion about what we need to do better.

What next for the Concordat?

A focused approach with leadership and drive can work, but if we are to truly transform the way in which we help those experiencing a mental health crisis we have to innovate to tackle those issues that have proved hard to shift.

The overall cost of mental health problems in Wales has been estimated to be £7.2 billion a year. It directly effects a quarter of us every year and is intertwined with physical health, our economy and with wellbeing for us and our children.

We must shift our focus to prevention, earlier intervention and recovery as well as humane and appropriate care at the point of crisis. We have established a momentum for change and now have the opportunity to build on what we have done, to learn and to use of the structures and initiatives we have in Wales. By working together and involving people who have personal experience of care, or the lack of, during a crisis, we can build on this momentum and make real change in the years to come.

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