How we’re working to improve crisis care in Wales

Last year, the National Assembly for Wales’ Health, Social Care & Sport Committee launched an inquiry into mental health in policing and police custody. The Inquiry focussed on how well police, health and other services work together to prevent those of us with mental health problems being taken into police custody during a mental health crisis.

"The Committee report debated in the National Assembly today marks an important milestone on the path to transforming crisis care and prevention in Wales."

There have been a number of inquiries and reports on crisis care in recent years, including on suicide prevention and the emotional and mental health of children and young people, with a range of recommendations.

As Mind Cymru, we have provided evidence and briefings to Assembly Members, ensuring the voices of our beneficiaries are heard and seeking to secure lasting change. As a result, improving mental health support and specifically crisis care are now among the top priorities for the Welsh Government. However, now needs to be the time that all partners urgently work together to improve the experiences and response to mental health crisis.

Sadly we have seen an increasing number of people being detained by the police in recent years. In the five years to 2019, the number of people detained using Section 136 of the Mental Health Act rose by almost a third. Reaching more than 2200 in 2018/19, including more than 100 children and young people below the age of 18.

Our beneficiaries have told us that they often find it difficult to access the support they need, when they need it, feeling they are sometimes bounced between services; unable to access mental health teams out-of-hours yet turned away from A&E – only to be detained later by police during a crisis.

The Committee looked at why the number of detentions are rising and produced a report with 11 recommendations, many reflecting our evidence, which go much further than the use of Section 136, they shine a spotlight on a crucial question; how can services work together to prevent mental health crises?

Central to the Committee scrutiny was the Mental Health Crisis Care Concordat, an agreement between the Welsh Government, police, health boards, councils and others to improve the support people receive during a mental health crisis. The Concordat was signed in 2015 and achieved some immediate successes, including initially reducing the number of people detained by police and encouraging a wider dialogue between the key organisations working with people in crisis. However, there is much more work to be done to realise the Concordat’s ambitions.

One of the four key principles underpinning the Concordat is access to support before crisis. It recognises both the need to ensure that when people experience a mental health crisis they are able to access urgent support and to make sure people can access the help they need long before reaching the point of crisis.

The Committee report recognises more needs to be done to secure greater access to early-intervention services by improving out-of-hours support. In addition to this, the Committee calls for a wider range of support services to be available, including more Crisis Sanctuary services. Fortunately, some progress has already being made in this area. For example, the Twilight Sanctuary in Llanelli – which is run in partnership by Llanelli Mind and Hafal. The first of its kind in Wales, the service is open Thursday to Sunday from 6pm to 2am.

"It offers a place of sanctuary for people when their mental health is deteriorating, providing short-term support to anyone who needs it."

For those who do access support, many don’t have an effective plan in place to know what to do if their mental health starts to deteriorate. Care and treatment plans, introduced by the Mental Health Measure 2010, have a specific section dedicated to crisis planning which should outline what someone should do if they feel their mental health is deteriorating to the point of crisis. Used effectively, care and treatment planning is a great opportunity to prevent crisis by empowering people to recognise the early signs and to know where they can access additional support. Yet we know that all too often, these plans are left incomplete or simply direct people to the emergency services. We were pleased to see the Committee’s recommendation to ensure that these plans are used to their full potential.  

"Following this report, we now need the Welsh Government, police, health and other partners to take forward these improvements at pace."

Doing so will require partnership-working, effective early intervention and recognising the role each organisation plays but keeping the person at the centre of the response. In-turn it will lead not only to reduced detentions under Section 136 but act to prevent mental health crises by ensuring compassionate and effective support for anyone experiencing a mental health problem. We will continue to hold Welsh Government and partners to account on improving responses to mental health crises as well as focussing on providing quick, accessible support early to prevent crises happening.