Our News – Crisis Care in England: Where next?

our news CCC logoEarlier this year, The Mcpin Foundation completed its brief evaluation (click here to read the summary and here to read the full report) of the local implementation of the national Crisis Care Concordat. The underlying approach of the Concordat was to improve partnership and multi-agency working; recognising the range of statutory and non-statutory agencies involved in crisis care, the role of family and friends, and working to ensure that crisis support is as effective as possible. Through interviews, observations, an analysis of local area action plans and two surveys with service users and carers, we were able to begin to identify what had worked well and where there was still further work to do, as well as making a number of recommendations.

“I really enjoyed working on this project. Talking to people involved there seemed to be a real commitment to achieve change despite the difficulties that professional cultures or system barriers might pose. It did feel to me as an evaluator that people were trying hard to make the concordat an opportunity to fix some long standing problems” Susanne Gibson.

It was clear that the Concordat had been successful in encouraging local areas to develop partnership working across a range of areas, incorporating prevention and recovery into conversations and plans as well as the delivery of urgent care to people experiencing or at risk of a crisis. One particular area of success was the reduction of the use of police cells as a Place of Safety for people experiencing a mental health crisis by more than 50%. Further, we were pleased to discover from our survey that there had been some significant improvements in service users’ experiences of crisis care in the twelve months between November 2014 and November 2016. While this is from a relatively small sample, and we can’t say whether it’s the result of the concordat directly, it is nevertheless an encouraging result.

However, not all of the experiences reported by our survey respondents were positive, and it was also acknowledged in the interviews with key stakeholders in local areas and with members of the national steering group that there was still a great deal of work to do to ensure that care for those in a mental health crisis is given parity of esteem with care in a physical health crisis. One of the concerns expressed both in the interviews and by our survey respondents was how far the momentum of the Concordat would be maintained into the future.

“I feel that on paper the recommendations are very positive and beneficial but have serious concerns and doubts about its implementation, due to cuts and lack of funding.” (Survey Respondent)

While this is a very real concern, two recently commissioned reports may help with this momentum, picking up on a number of areas identified for further improvement.

‘Old Problems, New Solutions: Improving Acute Psychiatric Care for Adults in England’ is the report from the independent Commission on Acute Adult Psychiatric Care, set up by the Royal College of Psychiatrists in January 2015. Responding to the twin problems of inadequate access to acute psychiatric care and provision of care and treatment in the community, it makes a number of recommendations. These include ensuring that people who are acutely ill do not have to travel long distances for care, and that there is a maximum four-hour wait for admission or acceptance of home-based treatment following assessment. Working in partnership to share information and resources, and to find innovative ways to deliver services is also emphasised, as is the importance of co-production not only in receiving care but also in service design, provision, monitoring and governance.  In line with the Concordat evaluation, the report also stresses the need for good quality data to improve services and ensure accountability.

‘The Five Year Forward View for Mental Health’, a report from the independent Mental Health Taskforce, commissioned by NHS England also made recommendations for achieving parity of esteem between physical and mental health  not only for adults but also children and young people. It is widely recognised that mental health care, including crisis care for children and young people has been a ‘Cinderella service’ even within mental health services, for example with particular concerns over the lack of locally available inpatient services. Although this lack of provision was addressed to some extent through the Concordat, with all local area action plans including actions to improve provision, it is clear that this is an area that requires considerable additional resources and attention; something that again was acknowledged in our interviews. It might also require radically different ways of responding, and systems that allow different solutions to emerge. In line with the report of the Taskforce, our evaluation recommends that the lack of parity in services for children and young people is addressed, including looking at ways to move beyond a model that expands existing adult services to one that takes into account the specific needs of children and young people who are experiencing a crisis. At the heart of this approach would be the voice of young people. We encourage far more co-production in research and service development with young people, their parents and front line practitioners whose expertise is needed for solutions to emerge.

It is clear that care for people experiencing a mental health crisis still requires improvement and it is essential that the good work begun by the Concordat is continued. But how? McPin Foundation is looking for opportunities to work with existing and new partners, especially those involved in research that seeks innovative solutions to transform the experiences of people in crisis. Do you have ideas of research you would like to see delivered in the area of crisis care? Do get in touch.