Effective Services for People (including Children) in Mental Health Crisis

Sarah McClinton, Director of Mental Health and Disability, Department of

Health

Mental health policy context•Mental illness: single largest cause of disability in the UK

o a quarter of the national burden of ill health – 1 in 6 adults; 1 in 10 u16s; 1 in 4 people at some point during their lifetime

o leading cause of sickness absence in the UK

•‘treatment gap’o most people with mental health problems in England receiving no

treatment o People with SMIs dying 15-20 years earlier

•Cost (in England) £105.2 billion each year•Cost to business just over £1,000 per employee per year or almost £26 billion

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Feb 2011

No health without mental health: A cross-

government mental health

strategy for people of all

ages

Jan 2014

Closing the Gap: Priorities for

essential change in mental health

Feb 2014

Mental Health Crisis Care Concordat: Improving

outcomes for people

experiencing mental health

crisis

Government policy documents

Oct 2014

Achieving Better Access to

Mental Health Services by 2020

Achieving Better Access to Mental Health Services by 2020

•£120m to enable setting of access and waiting time standards in mental health services for first time ever from 2015/16•Focus on IAPT, Early Intervention in Psychosis and crisis care in 2015/16•Piloting from standards in eating disorders and personality disorders•Commissioning models, payment models and data crucial – all building blocks towards parity over next Parliament

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Crisis care

•“It feels like I literally have to have one foot off the bridge before I can access services.” – service user

•“Crisis care is perhaps where the gap between physical health and mental health is most stark.” – Norman Lamb

Crisis Care Concordat

•Published in February 2014•Shared agreement & commitment between services and agencies to improve care for adults and children in a mental health crisis, signed by over 20 national statutory organisations, including LGA, ADCS and ADASS•Emphasis on partnership and collaboration•Four sub-sections:

o Access to support before crisis pointo Urgent and emergency access to crisis careo Quality of treatment and care when in crisiso Recovery and staying well

Crisis Care Concordat: effecting local change

•Mind’s online map and resources, working with DH and local areas to ensure whole country is covered by local Declarations by end of year•Declaration: one vision and principles for ensuring an effective emergency mental health response system signed by all local partners•Action Plans will subsequently build on Declarations with detail and substance•Concordat linked to CCG operational resilience plans•Norman Lamb letter to David Pearson on 21/10 seeking ADASS support in securing local sign-up and buy-in

Good practice 1

•Street triage:o West Yorkshire (DH-funded pilot): time spent by Police

Officers in dealing with 136 cases on average 2 hours, compared to 5 hours in neighbouring Division

o Nottinghamshire: number of people detained under 136 down by a quarter

•Use of police custody: 2013/14 in London: 87 people detained in cells; Jan-Sept 2014 just 17 people, 0 children. Aim to make use of cells a never event

Good practice 2

Crisis Care Concordat:

•Gloucestershire first county in England to submit a comprehensive Action Plan•Effective governance in place to draw up Action Plan: creation of Gloucestershire Mental Health Crisis Concordat Task & Finish Group co-chaired by CCG Board Chair and Expert-by-experience •Strong commitments from all local partners including responsibilities taken on by voluntary sector organisations

CYP Mental Health & Wellbeing Taskforce

•Announced in August 2014 by Norman Lamb•What help does a child with MH problems want? What and how would they access support?•Co-chaired by DH & NHS England; cross-sector membership including voices of CYP, families, carers•Aim is to maximise joined-up working across the system, rationalise commissioning and improve outcomes•Data, quality, vulnerability, inequalities•Vital role for voluntary sector and online services•Reports to cross-Govt inter-ministerial group, with final report in February 2015

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Conclusion

“I…needed to feel that someone actually cared about me…”

•People’s experiences of crisis care – good or bad – stay with them for a long time: a couple of hours, especially in childhood, can have a lifelong impact. All the more important to get it right•Aim must be to provide seamless care and support through crisis, and hope for recovery thereafter•Important steps towards ending years of imbalance between mental and physical health services

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