Mental health crisis care services ‘under-resourced, understaffed and overstretched’

Mind looks at damning crisis care statistics.

Mind is today releasing the results of three separate pieces of research that together paint a picture of services that are unable to support thousands of people every year, at a time when they need help the most.

Information obtained through Freedom of Information (FOI) requests to mental health trusts, a service user survey of almost 1,000 people and unpublished preliminary data from a research project at University College London (funded by the National Institute for Health Research) reveals that:

Services are understaffed: Four in ten mental health trusts (41 per cent) have staffing levels well below established benchmarks.
People are not getting the help they need: There is huge variation in the numbers of people accessing crisis care services and one in five people (18 per cent) who came into contact with NHS services in crisis was not assessed at all. Only 14 per cent of people said that, overall, they felt they had all the support they needed when in crisis.
People aren’t assessed quickly enough: Only a third (33 per cent) of respondents who came into contact with NHS services when in crisis were assessed within four hours, as recommended by the National Institute for Health and Clinical Excellence (NICE).
Services are not available all the time: One in ten (10 per cent) crisis teams still fails to operate 24-hour, seven-day-a-week services, despite recommendations by NICE.
People cannot contact crisis teams directly: Only half (56 per cent) of crisis teams accept self-referrals from known services users and just one in five (21 per cent) from service users that aren’t already known to them. This is despite NICE guidance that crisis teams should offer self-referral as an alternative to emergency services.
There is a lack of respect and dignity: Less than a third (29 per cent) said they felt all staff treated them with respect and dignity.

Mind has today launched an online tool to help commissioners and service users to understand crisis care services for mental health in their area by hosting the FOI data from their local trust. The charity is also sending a detailed briefing to all Clinical Commissioning Groups (CCGs) in England outlining where services are struggling and how they can improve.

Paul Farmer, Chief Executive of Mind, said:
"We are deeply concerned that some crisis care services appear to be struggling to support people with mental health problems when they need help the most. We know that excellent crisis care exists, but we need it available to everyone, regardless of where they live. Good services can make a huge difference to whether someone recovers from the crisis, yet Mind often hears from people who have been turned away because they ‘aren’t suicidal enough’ or who have been made to wait around for hours just to be seen by someone who can help them. An emergency is an emergency.

The NHS Mandate, released earlier this month, sends a strong message that mental health is a priority and should be put on a par with physical health in the NHS. As the structure of the NHS changes and commissioning power transfers to Clinical Commissioning Groups, there is a real opportunity to assess local crisis care services and make sure a range of good quality services are put in place. We want CCGs to use the data we are releasing today to inform how they can commission a service that addresses the needs of people in crisis."

Laura Nuttall, 22, found herself in crisis in the middle of the night. Her dad was able to call the crisis team directly and they arrived within half an hour to assess her and refer her for treatment. She says:

"Crisis can happen at any time - two o'clock in the morning, Christmas Day - and people need help when it happens. I don't know what I would have done if crisis care hadn't been available to me when I needed it. You wouldn't say to somebody with a broken leg or a heart attack that they have to wait to see a doctor during office hours. It should be exactly the same with mental health. We really need to close this gap and start seeing mental health as as important, and in need of the same amount of care, thought and urgency, as physical health."

Sonia Johnson, Professor of Social and Community Psychiatry at the Mental Health Sciences Unit, University College London, said:
"Crisis teams appear to vary greatly across the country both in their resources and in the services that they provide. A particular challenge for some is being expected to deliver an increasingly wide range of services, for instance in the casualty department. Service users and carers value home treatment but often report discontinuity of care and limited therapeutic contact with staff. We need to listen to them and ensure crisis teams have clear roles in local service systems and the resources and training they need to carry these out."

Crisis Care