NHS Voices blogs

Towards an international declaration around mental health crisis care

Expert insights on the international initiative for mental health leadership.
Phil Moore

11 September 2019

So, here’s the question. If I was at the lowest point in my life, distressed, disorientated, depressed, perhaps with some loss of contact with reality because of my mental state, what would I want to happen to me? 

If I was injured in a car crash or having a heart attack, the services would be on the spot to stabilise me, scoop me up and take me for help. In fact, we have come to expect that as the norm. And the hospital services are geared up to accept me and channel me through a quality-assured management and treatment process. 
Whereas, in a psychiatric emergency, the norm is too often delays, detainments and, also too often, denial of service. Or at least, long periods spent waiting in an emergency department.
It’s not that the will, commitment and passion are not there in so many of the professionals who are involved. They frequently give way over and beyond any norm, as do so many health and social care professionals. The problem is our services and investment have fallen way behind other aspects of health care. And it is taking time to rectify that imbalance, even though stunning progress has been made. The fact that stunning is not yet enough is an indication of how bad things had become!
Worse, in many places around the world, the norm is police intervention, a police cell and even prison. Such was the case in the UK until the last few years and we are not entirely free of this, even now after years of reforms. Many places are making the use of a police cell as a place of safety a never event. 
All the services that respond to urgent and emergency mental health crises have the same issue. Where do I take this person for appropriate and safe care, for themselves and others? All too often A&E, the emergency room, is the easy solution. But not a great place if you are distressed, disorientated, depressed and worse. The lowest point in your life. We really do not provide the best services for people who are in crisis.
Of course A&E staff do a sterling job and psychiatric liaison services help. But A&E? Noisy, busy, overstimulating, disorientating, doing their best to cope with urgent trauma and medical emergencies. Not a great place to be.
In September this year, 64 experts from 9 countries met in Washington DC at the second global urgent and emergency mental health crisis care summit. 
We spent the two days working on what might be the strongest content for an international declaration around mental health crisis care. Crisis care that comes to anyone, anytime, anywhere. I would not want crisis services with gaps that I can fall through. We need a continuum that picks people up from the moment they feel they’re in crisis, right through their treatment and into recovery and the support that continues beyond. 
This was a coming together of huge expertise, huge experience to put together our joint brain power to say how can we design something that will influence governments to put in place the right policies and the right procedures so that we can get mental health crisis care properly operating in all areas around the world.
We plan to publish the declaration in the spring of 2020. We hope it will influence nations to commit to improved crisis mental health care and the investment these will require.

Conference2nd Crisis Global Conference, International initiative for mental health leadership, Washington, September 2019