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Why we need a mental health crisis care concordat

Posted by: , Posted on: - Categories: Mental health

Who do we rely on in times of crisis?

If we’re talking physical trauma – a broken leg or a shattered hip for example – we or someone with us can call NHS 111 or 999. If we are unlucky enough to experience a car accident, house fire or serious physical assault, in most cases the emergency services – ambulance, police – will respond quickly.

We’ll be treated by paramedics at the scene and, if necessary, taken to the nearest appropriate hospital for further treatment. The police may also be involved in the immediate aftermath to mitigate further accidents or wrongdoing and will certainly interact with emergency and hospital staff to give their assessment of the situation. This vital coordination and communication between medics, doctors, nurses and police officers saves lives every day.

I’m sorry to say the outcomes for mental health crises are far less clear cut. Provision and access for those needing help has been a challenge for the sector. It's why the Government’s Mandate to the NHS included a new objective for local plans to make sure no one in crisis is turned away from services.

The Mental Health Crisis Care Concordat, launched this week, builds on this objective. The Department and the Home Office, along with 20 other signatories, including NHS England, the Local Government Authority (LGA), Association of Directors of Adult Social Services (ADASS) and the mental health charity MIND, have jointly created and agreed this document.

It sets out how police, mental health, social work and ambulance professionals should work together to help people through mental health crises. In particular, it challenges local services to make sure beds are available for people who need them urgently and that police custody is never used just because mental health services are unavailable.

The Concordat, presents a set of working principles under the following themes:

  • Access to support before crisis point – contacts and services available 24 hours a day, seven days a week
  • Urgent and emergency access to crisis care – speedy treatment by mental health professionals in places of safety
  • Quality care and treatment in crisis respect and care at all times by mental health professionals in settings best suited to the individual, with a view to longer term support if needed
  • Recovery and prevention of future crises – the provision of information and referrals to services designed to support people and help them stay well.

Turning these principles into action requires a unity of purpose at national and local level – led by local and national government and organisations, including NHS England, Public Health England, Health Education England, LGA, ADASS and the Royal Colleges.

But this is also very much a challenge of leadership for local commissioners as they strive to create systems of care and support which anticipate - and where possible prevent - crises within communities. Chief among these challenges is the Concordat’s requirement for local areas to put in place their own ‘Mental Health Crisis Care Declarations’ – obligations and standards of care driven by community need.

To support this endeavour, the Department of Health will promote a series of road show events across England, offering health, police and other local services an opportunity to meet, review local practices and agree declarations. There will also be a summit to review progress and chart future activity hosted by the Royal College of Psychiatrists.

Meanwhile, commissioners will be encouraged to share good practice on developing Joint Strategic Needs Assessments (JSNAs), and local health and service commissioning plans – work led by the LGA.

We will also work closely with voluntary sector organisations to understand and respond sensitively to inequalities of access for black and ethnic minorities in a bid to improve health outcomes for these groups.

More broadly, NHS England’s mental health partnership website will be used to support strategic clinical networks in their bid to share ‘what good looks like’ with local partners – for crisis care and mental health in general.

The Concordat contains many other actions and obligations, but at its heart is the desire to treat a crisis of the mind with the same urgency, sensitivity and coordination we expect for physical emergencies. This document is long overdue, but now that it is here, there is much work to be done – and I look forward to playing my part.

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  1. Comment by Patricia Foxworthy posted on

    Please help this to be put into practice as soon as possible- that's all I have to say.

  2. Comment by Dennis Bacon posted on

    All good and unarguable however, the reality is that too little Health and social care funding reaches existing community services and so there will need to be some willingness on the part of Clinical Commissioning Groups to shift a relatively small percentage of available money in the system to community services, and for local authorities to take as much notice of mental health as they do of say, learning disability or dementia care services. Commissioning boards in each locality should, as a rule, include; service users, providers (private as well as voluntary/3rd sector) and integrated (Health & social care) commissioners. Involve the key stakeholders in strategy, service design and development - at the beginning. Norman Lamb is the first Health Minister I have seen with a genuine desire to see mental health rank alongside physical health in terms of priority - it is not about politics for Norman it is about justice. We must support him by getting on with the job of implementation.