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Experts urge radical action on mental health crises

Aim for 100% access to services in a behavioural health crisis and zero suicide in healthcare

Louise Prime

Thursday, 04 October 2018

Most people in psychiatric distress do not have access to the same timely and high-quality response that is available for medical emergencies, in either the UK or the US, according to experts. They have called for radical action to address inequalities and improve mental health crisis care, with the aim of 100% access to services for those in crisis and zero suicide in healthcare settings.

In their foreword to the report* published yesterday by NHS Clinical Commissioners, following an international summit earlier this year, Dr Phil Moore (chair of the Mental Health Commissioners Network at NHS Clinical Commissioners) and co-authors pointed out that people in crisis are at the most vulnerable time of their lives and do not just need services, they also need care, empathy, kindness, support and safety. And they called for action at national level – engaging health services as well as ambulance, hospital, police, judicial, social and voluntary services – in order to deliver the required transformation.

The 10 recommendations agreed by summit delegates, in the final report, include:

  • End the current fragmentation of care through an integrated, systematic approach to behavioural health crisis care at national level.
  • Actively develop crisis service alternatives to the usual emergency measures of formal assessment and psychiatric inpatient care.
  • Include special consideration to cater for armed forces veterans.
  • Embed users, peers and carers in the design and leadership of crisis systems.
  • Fully engage family and friends in crisis care, sensitively overcoming inappropriate barriers created by confidentiality or privacy need.
  • Implement a single national three-digit crisis hub number that drives easy access in which all callers are welcome, the crisis is defined by the caller, and that is promoted via intelligent social media.
The report includes the aspiration that “the aim must be to provide 100% access to services to people in a behavioural health crisis and to aspire to zero suicide in healthcare settings”, and the authors call for an approach equal to medical care to ensure an effective response to every person in psychiatric emergency. They add that in England, they aim to influence the development of the NHS long-term plan in order to facilitate improved crisis care – and they point out that significant system-wide investment is needed to deliver their recommendations.

Dr Phil Moore commented: “Change is desperately needed in mental health crisis care, but it is possible. The NHS is at a crucial moment of its development, with a tremendous opportunity to impact how we care for those experiencing the most acute behavioural health needs. We need to disrupt the status quo, and make sure services say ‘yes’ at times of behavioural health crisis.

“Crisis intervention is far more than just triage, referral and ongoing support. Kindness, empathy and safety are at the heart of our recommendations. What is clear is that the health sector cannot do this alone, it involves police, social and voluntary services. We need national commitment and leadership to coordinate all the organisations that encounter people experiencing a mental health crisis, as well as significant investment from the government to transform crisis care.”

* Be the change: Ensuring an effective response to all in psychiatric emergency equal to medical care: Recommendations from the first international summit on urgent and emergency behavioural healthcare. NHS Clinical Commissioners, October 2018.

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