The Crisis and Acute Mental Health Care report by Centre for Mental Health says that people in a mental health crisis are facing a postcode lottery of care, with certain groups, including children and young people, sometimes unable to access care suited to their needs.
The report summarises research from the NIHR Policy Research Unit in Mental Health about ways of supporting people in a mental health crisis. The report sets out the evidence about community-based alternatives to hospital care, which enable people to get support closer to home. However, it finds that the provision of alternatives to hospital care is inconsistent, and what's commissioned doesn't correspond with the available evidence of what's effective.
In addition, the report says that rising levels of need for emergency mental health care, coupled with short-staffing and dilapidated buildings in inpatient services, are placing current systems under major pressure. And too often, people's experience of inpatient care can be coercive and re-traumatising.
The report finds that major investment in services, staffing and buildings is needed to move towards compassionate and timely care in a crisis. However, it also cautions that superficial changes or tokenistic attempts at reform will fail to achieve systemic change.
Andy Bell, chief executive at Centre for Mental Health, said: ‘Acute and crisis care are essential elements of our mental health care system. At their best, they save lives and are there for people when they most need urgent help. Too often, however, people struggle to get help in a crisis, and many report that their experiences of crisis care and hospitalisation create traumas of their own.
‘We urge the NHS to invest effectively in mental health crisis care, addressing gaps in provision and updating estates which are no longer fit for purpose. But we also need a radical rethink of inpatient and crisis care to achieve the Government's ambition of shifting treatment from hospital to communities. To do this, the NHS needs to invest in what works and ensure provision is consistent across the country.
‘At a time of limited budgets and rising need, we urge the Government to invest in evidence-backed interventions to better support people in a mental health crisis. Before embarking on plans to build new ‘mental health emergency departments', it must ensure that investment is used wisely to provide the right help in the right places.'
In response, Rebecca Gray, NHS Confederation mental health director, said: ‘This briefing shines a welcome light on the challenges currently facing crisis and inpatient mental health services and support.
‘NHS and voluntary, charity and social enterprise (VCSE) providers have worked together to significantly expand crisis provision, including crisis houses and assessment centres, psychiatric liaison services in acute hospitals and phone lines. The commitments in the Government's 10-Year Health Plan - such as new Mental Health Emergency Departments, expansion of 24/7 neighbourhood mental health care centres and assertive outreach teams - can also build on existing work to provide more proactive care and keep people well and out of hospital.
‘But we know that due to demand outstripping capacity the needs of many individuals, such as children and young people, people with learning disabilities and autism, as well as minoritised communities, are not being met.
‘All parts of the system – including ICBs as strategic commissioners, providers in mental health, ambulance and acute services – must work together to support the development and expansion of the most effective, evidence-based pathways for crisis support, including VCSE provision.'
