What does the NHS long-term plan mean for mental health crisis care?

There’s been a lot of talk about the NHS 10-year plan since it launched at the beginning of the year.

As England’s largest charity provider of mental health services, we’ve been delving into the detail and thinking about what it will mean for the many tens of thousands of people we support: Those severely affected by mental illness; people living with lifelong and complex conditions like schizophrenia or a personality disorder, which often have a very profound impact on day to day life.

It’s them we had in mind when going through the 134 pages of a plan that we feel that, if delivered, could improve and save many lives.

The section of the plan we have been particularly interested in is the one about emergency mental health support. As a provider of crisis services working in partnership with the NHS and local authorities in the community, we hear first-hand about what currently works and what doesn’t.

Many people have told us that when they have felt suicidal and been really worried that they might seriously harm themselves, they go to accident and emergency. That’s also where we advise people to go when we are asked, as this is currently the only nationwide crisis care for all physical and mental health emergencies.

But so often it is not the best place for them, so the person who is suicidal is sent home with a leaflet or is told to come back in the morning when it’s less busy. Since 2009-10, there has been a 94 per cent increase in people going to A&E for a psychiatric condition, and emergency departments simply can’t cope.

And that’s why the NHS 10-year plan’s commitment to “increase alternative forms of provision for those in crisis” is a cause for optimism. What we have isn’t working.

Community services

The plan says that community services like crisis cafes provide a more suitable alternative to A&E for many people experiencing a mental health crisis. And to be clear, anyone in acute danger, for example if they have taken an overdose, or is in the midst of a psychotic episode, should absolutely still go to A&E.

Critics of this model may say that outsourcing care away from NHS services isn’t the right way forward, and whereas those are understandable concerns, what we always come back to is what the people we support tell us: the current system isn’t working, and often the more unwell you are, the longer you wait for care

We are talking about the people who are experiencing intense suicidal thoughts, who are very much in crisis, and need immediate support to ensure they are safe and don’t hurt themselves. Crisis cafes and similar services already exist but it’s luck of the draw whether you have one in your area. The NHS plan is committing to expand them and improve signposting so that people get the right care when they need it.

For those who still need to go to A&E, new waiting times introduced from next year will mean that people do not face long waits for the emergency care they need.

All of this means that in the future, if the long-term plan is fully delivered, anyone in crisis will be able to call NHS 111 and be directed to the mental health support that is right for them 24/7. That might still be A&E for people who need urgent medical attention, or it might be a community cafe or safe haven.

We know these services are effective because, as a provider, we see how our staff who are specially trained in mental health are able to support people through crises. Together with the person, we are able to establish what they need to get them to a place where they feel safe and well. That might include emotional support, and practical help with day to day things. That’s not something A&E can offer – or should offer.

Critics of this model may say that outsourcing care away from NHS services isn’t the right way forward, and whereas those are understandable concerns, what we always come back to is what the people we support tell us: the current system isn’t working, and often the more unwell you are, the longer you wait for care. This can’t go on, and an alternative look at crisis care could be the start of the solution.

For more information go to www.rethink.org