Meeting the Mental Health Crisis NeedEbony Chapman
“There’s been a lively Twitter debate recently (started by NAViGO’s Assistant Director for Acute Services, Ellie Walsh), about how to make it easier for people in a mental health crisis to get the help they need.
Having managed crisis services, I don’t believe they really work. In fact, they’re probably the major area of concern for all mental health service providers.
For a start, these services stole the best acute staff. Since then, they’ve faced huge criticism and bad press because of deaths, poor access and an increased use of mental health beds (often not needed, as ward managers will confirm). I’m pretty sure all crisis service providers are constantly on edge with justifying their existence and learning lessons, due to factors (usually sad) placed at their door.
Let’s be honest. The world has changed, as has the type of person seeking our help. Demand has over-stretched us all, not helped by the many “inappropriate” cases. Investment in liaison services to meet A&E targets has put even more stress on a dwindling service.
We’re lucky at NAViGO in not having that many vacancies, but it can be difficult to get staff to work in the crisis service. Why? Because they feel constantly under pressure and unable – or more notably incapable – to deliver.
The one thing we can all do is question. Why do people with mental health problems go to A&E? It’s the last place I’d want to be, yet we’re all seeking money to put services into acute hospitals. They’re geared around a medical model to which we know we can’t recruit and which doesn’t allow for a settled workforce.
So is it possible to meet demand? Actually, yes – because it’s not just about doctors, psychologists, nurses and approved practitioners. We have support staff, social care workers, third sector colleagues, therapists, volunteers, and former service users who are experts by experience. We don’t use our total people resource effectively because under current thinking, the computer says NO.
Admittedly, it’s easier for NAViGO. As a social enterprise providing NHS services, we’re not subject to the challenges many others face. We took action and set up our own urgent care centre at our mental health acute site. Our approach is straightforward:
- Encourage people in mental health crisis NOT to go to A&E.
- Partner with the police and ambulance service so they promote the same message.
- Focus on getting the right person to see those seeking help – and if necessary, keep them safe by admitting them to the beds we have available.
- Support the acute trust with individuals who, for instance, may have overdosed – but as much as we practically can, keep our distance.
The point is that we provide alternatives. Most crises arise from factors other than a mental health issue – relationships, money, homelessness, substance misuse, social isolation, and so on. But our message to people in North East Lincolnshire is: if you need help, come to us and we will do our best for you.
Is it busy? Of course, and it’s not always plain sailing. But surely it’s better to work with vulnerable people as early as possible, rather than slamming too many doors in their faces?
Nationally, we need to go back to the drawing board. I was one of those who originally believed crisis teams were the answer, but my view has changed. If the interest is out there, I’d love the chance to put things right by creating a care model that deals with the day-to-day reality of individuals’ problems – rather than thinking of them as a purely medical challenge.
Let’s aspire to deliver all urgent mental health care away from A&E. Then we can make an impact that is both meaningful and safe.”
About the author
Mike Reeve, Director of Operations at NAViGO Health and Social Care CIC
Base | NAViGO House (HQ)
Speciality | Adult Acute Mental Health