Improving London's Mental Health Crisis Care
Over the last few years, Rethink Mental Illness has been campaigning for better provision to support people who are experiencing a crisis and we are pleased to hear about some progress which has been made in the London area through the Healthy London Partnership programme.
The number of Londoner’s experiencing mental health crises is continuing to increase with section 136 detentions increasing by 19% in the last two years and some patients wait long periods of time, in some cases up to twenty-two hours, in the back of an ambulance or police vehicle unable to access the care they need.
Over 75% of section 136 detentions occur out of hours yet only two of London’s 20 sites have appropriate 24/7 staffing. Most people who arrive at a Health Based Place of Safety as an s136 patient must wait while staff are called from inpatient wards.
A&E departments are often used as the default when sites have no capacity to accept new patients. On average, half of the patients taken to A&E are waiting longer than 12 hours in a distressing environment.
One of our experts by lived experience told us:
“I was at home and I started to feel extremely agitated and was having very serious suicidal thoughts. I phoned my crisis team but I could barely speak, I felt cold and numb inside. I put the phone down, packed my bags, grabbed my dog and jumped on a train to get as far away as possible. I didn’t get very far. At the next station three police officers got on the train and I was detained under section 136. Three officers sat with me at the train station while we waited for the ambulance to arrive. My main concern was my dog, I was extremely anxious, distressed, and worried about who would care for my dog but a police officer kindly phoned my friend to come and collect her, the police officers also agreed to look after her in the meantime which was really reassuring.
When I finally arrived at the place of safety for an assessment it was closed, I was waiting ages with officers outside the door. After a while a nurse came and opened up the door and I wasn’t even acknowledged. No one said hello to me or reassured me, I was made to feel like I was wasting the nurse’s time.
The experience got worse when I was dumped alone in a cold room. No one talked to me for hours and hours. I was alone and scared. I am a diabetic but no one asked about my medication or medical history. Occasionally a member of security would look through the window; it was like being in a goldfish bowl. When the staff did come and see me I was made to feel like there were better things they could be doing on the ward. My crisis just got worse and worse in a place where I was supposed to be cared for.
After I had my mental health assessment the staff decided to discharge me. I wasn’t involved in any discussion about my care, I was never asked any questions, and I just felt like they wanted to get me out the door as quickly as possible. At that point I just wanted to get away from the place as quickly as possible but I was worried I might fall into crisis again as I had no support.
If this was my first experience of being detained under section 136 I would have lost trust in health staff and services and I would have been reluctant to seek help again.
A couple of days later I called the nurse from the crisis team to thank her for alerting the police, she saved my life.”
In response to London’s service users telling us that the care they receive does not meet even the basic expectations of dignity, respect and high quality compassionate care, Healthy London Partnership consulted widely to develop guidance for a pan-London pathway for patients detained under s136 along with a specification for the Health Based Place of Safety sites where they receive care. This was launched by the Mayor of London in December 2016.
London’s crisis care system is now focussed on ensuring it meets the new standards, and service users and carers are involved to ensure the work continues focusing on the needs of patients and improving their care.
A key part of improving crisis care is ensuring patients have access to a Health Based Place of Safety 24/7; this includes skilled, specialist staff around the clock. There are currently twenty Health Based Place of Safety sites in London. The demand across these sites means dedicated staff cannot be available at all sites 24/7. Therefore, the team is exploring how these sites might be configured differently across London to improve the pathway for individuals detained under s136 and meet the key standards set out in the guidance.
New Health Based Place of Safety site configuration options have been developed. These proposals take into consideration a range of factors including, improving patient and carer experience, maximising staff experience, areas of high prevalence of s136, and proximity to other mental health and acute services.
These options are now being discussed locally with stakeholders involved in the crisis care system to consider how a new model could work for local areas and what further work might be needed to support this. Feedback from these discussions will help to establish the preferred site configuration across London, which will be consulted on in 2018.
How can you get involved?
We encourage you to share this information to help outline why the quality of care for patients detained under s136 in London needs to improve.
Getting involved with local service user groups and Trust patient forums will be the best way to ensure any changes in the model of care meet the needs and expectations of the service user and carers going forward.
To receive future updates on London’s crisis care programme or if you have any questions, please email firstname.lastname@example.org or visit the Healthy London Partnership website.