People who need urgent mental health care in England are receiving inadequate support, regulators say

People in Englandwho are having a mental health crisis are not always receiving care and supportwhen and where they need it, the regulator has found.

Ina national report out today (Friday 12 June), the Care Quality Commission(CQC) has raised concerns that public services, such as local authorities, NHStrusts and clinical commissioning groups, are failing to work together to makesure that people in their local areas have access to crisis care around theclock. Also, it found that healthcare professionals, such as those in A&E,can appear to lack compassion and warmth in how to care for and speak to peoplewho are having a crisis, including those who have harmed themselves.

As part of itsreview, CQC sought views from people who have experienced different types ofmental health crisis care. It found that while 86% of those who had receivedcare and support from charities and volunteers felt that their concerns hadbeen taken seriously by them, only 37% said that they felt this from A&E staff.This is worrying as these professionals should be trained in how to care forand respond to them. In particular, people often reported poor attitudes fromstaff towards their injuries caused by self-harm. Overall, only 14% of peoplethought the care they received provided the right response and helped them toresolve their crisis.

Although it isdifficult to determine the exact number of people who have a mental healthcrisis, more than 68,800 people were admitted to a mental health ward forurgent care in England as inpatients in 2013/14.

The experience ofa mental health crisis can include suicidal behaviour or intention, extremeanxiety and panic attacks, psychotic episodes (when people may experiencedelusions, hearing voices and a loss of sense of reality), and behaviour thatis considered ‘out of control’ or irrational to the extent that the personposes a risk to themselves or others.

When peopleexperience, or are close to experiencing, a mental health crisis, there shouldbe services available to provide urgent help and care at short notice. This includes advice from telephone helplines, assessment by a mental healthprofessional, intensive support at home or urgent admission to hospital.

CQC has reviewedthe quality of these services in England to identify what is working well andwhat must improve.  The review team inspected a sample of locations acrossEngland; received a survey return from 1,800 people who have experienced acrisis; and examined national data.

As well as stafftraining, CQC has identified that there is a clear need for better 24-hoursupport for people having a crisis, particularly during the hours of 11pm and5am, as CQC found that during these hours availability and accessibility ispoor. This means that people often have to go to A&E departments or even topolice cells while a ‘place of safety’ is found for them, rather than receivespecialist care straight away.

Dr PaulLelliott, CQC’s Deputy Chief Inspector of Hospitals (lead for mental health),said:

‘It is notacceptable for people with mental health problems to be treated differently tothose with physical health problems.

“We know thatpeople can experience a mental health crisis at any time of day or night, andso the NHS and our other public services must make sure they are equipped toprovide the specialist and urgent care that is needed around the clock. Sadlythis is not what we have found from our national review.

“What’s more, wefound that when people do receive help, hospital and mental healthcare staffare not always compassionate and caring. Worryingly, many people told us thatwhen they were having a crisis, they often felt the police and ambulance crewswere more caring and took their concerns more seriously than the medical andmental health professionals they encountered.  In particular, people whohave inflicted harm on themselves as a result of their mental distress deservethe same respect and compassion as those whose injuries are sustained byaccident.

“These findingsmust act as a wake-up call to our public services. We found some excellentexamples of services in areas joining-up and providing effective care, withstaff committed to working to make sure people in a crisis received the helpthey needed. These examples must become universal. This review was undertakenas part of CQC’s contribution to the work of the ‘crisis care concordat’ whichis mobilising local services to come together to tackle this problem.”

The report,‘Right here, right now’ has been carried out as part of CQC’s commitment to England’sCrisis Care Concordat.

Other findingsinclude:

  • Many people will go to see their local GP first when they are having a mental health crisis. The majority (60%) of people who visited their GP during a crisis were satisfied with the experience. It is vital that GPs access specialist training to help them to identify underlying mental health conditions early, in order to help prevent crises from occurring.
  • Most people reported that they came into contact with at least three different services when they had a mental health crisis. 12% said that they had come in to contact with between six and ten services, which indicates a need for them to work more closely together in areas. 
  • Encouragingly, there has been a significant reduction in the use of police custody as a ‘place of safety’ for people in crisis, as supported by figures released earlier this week by the National Police Chiefs Council. However, CQC has found that there can still be problems with people under 18 being able to access a suitable place of safety. In 2013/14, nearly a third (31%) of people under 18 who were detained, were taken into police custody.

Download‘Right here, right now’ and access other related materials here.