The Care Quality Commission (CQC) report right here, right now launched today (Friday 12 June) shows that there are variations in the help, care and support available to people in crisis and that a person’s experience depends not only on where they live, but what part of the system they come into contact with.
Fewer than four in 10 respondents gave a positive response about their experience in A&E when asked whether they felt listened to and taken seriously, whether they were treated with warmth and compassion and if they felt judged. Those coming into contact with specialist mental health services were only slightly more positive.
In comparison GP, ambulances and the police were all perceived to provide more caring and empathetic responses to people in crisis. Volunteers and charities received the most positive responses from those who come into contact with them. The gap between the voluntary and statutory sectors was reported to be substantial.
The review – a national overview of crisis care
As a signatory to the Concordat, CQC committed to providing a national overview on crisis care. The CQC carried out a thematic review of the quality, safety and effectiveness of care provided to people experiencing a mental health crisis by regulated providers and providers/ agencies with responsibility for operating the Mental Health Act 1983.
The thematic review also included an exploration of local area commissioning arrangements to look at how organisations are working together to develop pathways of care that put people who use services at their heart.
The review included acute and mental health hospitals, community-based mental health services, GPs and primary medical services, and ambulance providers.
The review is based on data drawn from:
- National data review published November 2014
- Call for evidence –spring 2014
- Survey and map of health-based places of safety - published report October 2014
- CQC local area inspections – 13 local area inspection winter 2014/15
This work on crisis care is the first in a series of CQC thematic projects which look at health and care provision across a local area, and that focus on how well services are integrated.
The CQC explored whether:
- Responses to people experiencing a mental health crisis varied across the country.
- The quality of the response people received was a matter of concern.
- A lack of joined-up working between different agencies was putting people at risk.
The report focused on people who experience a mental health crisis and:
- Require access to and support from specialist mental health services.
- Present to accident and emergency departments (with a particular focus on people who self-harm).
- Are detained under section 136 of the Mental Health Act.
The quality of care experienced by a person in crisis varied depending on where they lived and when they sought help. Many people have experienced problems in accessing help at the time they need it and in getting the right help when they have a mental health crisis. We found this reflected in:
- The attitudes of staff towards people when they were in crisis. For example, staff not judging people in crisis, not treating them with respect or compassion, or not taking the time to listen to carers’ concerns.
- The accessibility and availability of care at all times. This includes people being able to access the service they need at any time of day and night.
- The quality of services that are offered, and their responsiveness to people’s needs. For example, whether services are following evidence-based models of good practice and are set-up to meet the needs of their local population.
- The implications for safety, particularly in risks associated with self-harm. For example, making sure that people are treated quickly and compassionately to prevent the crisis from getting worse or prevent them from hurting themselves or others.
Across the country local services are developing innovative approaches to the challenge of providing a high-quality response to people in crisis. More can be achieved where these innovations work in partnership and services are integrated around the needs of the person in crisis.
The CQC recommend that representatives of local Crisis Care Concordat groups should:
- Ensure that all ways into crisis care are focused on providing accessible and available help, care and support for all those who require it at the time they need it.
- Hold commissioners to account for commissioning crisis services that deliver a quality of care based on evidence-based good practice and that is in line with the Concordat key principles.
- Engage with local, regional and national partners to make sure that innovative approaches to improving the experiences of those in crisis are shared within, and across, local areas.