Right Here Right Now: The CQC on the state of crisis care
by Susanne Gibson
The Crisis Care Concordat was launched in February 2014 with the aim of improving the quality and availability of help and support for people experiencing a mental health crisis; support before reaching crisis point, urgent access to safe, respectful and effective care in an emergency, and support for recovery and the prevention of future crises. While the Concordat has been agreed at national level, the emphasis is on implementation locally, with all those agencies involved in crisis care – the NHS, local authorities, agencies within the criminal justice system – working together to meet the needs of mental health service users.
Twenty-five national bodies have signed up to the Concordat, including the Care Quality Commission (CQC). To support its commitment to the concordat, the CQC has undertaken a review of crisis care. The report on the findings – Right Here, Right Now was published earlier this month and makes for interesting and informative reading. Click here for the summary version.
The headline finding is a mixed picture. The report explains: “There are clear 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”.
First, the good news. Many people reported good experiences of seeking help in a crisis. More than half of the respondents to the CQC survey had experienced a caring and empathic response from GPs, ambulance staff and police, with volunteers and charities being given the most positive evaluation. The CQC also found examples of innovative practice, particularly around multi-agency working which lies at the heart of the Concordat mission. For example, street triage schemes have been piloted in a number of areas, with mental health nurses accompanying police officers to incidents involving people who are believed to need urgent mental health support. This helps to ensure that the most appropriate help is accessed, and early indications are that the schemes have led to a substantial reduction in the use of section 136 of the Mental Health Act.
However, the experience of receiving care in A&E departments and from specialist mental health services was far less positive than contact with other agencies, with less than half of people giving a positive response to statements including ‘I felt I received the help I needed in a timely way’ and ‘I felt my concerns were taken seriously and listened to.’ Crisis Resolution Home Treatment Teams seem to be struggling to provide the frequency and consistency of support that is required. It is also speculated that the number of people re-attending A&E for a mental health condition, as well as the numbers presenting at A&E with self-harm injuries, may indicate a lack of multi-agency working and problems in the wider system.
Another problematic area highlighted in the report is the inequality in provision for children under 16, for example in the absence of out-of-hours services for children. Indeed, lack of parity is a theme running through the report, with one of the key messages being a need for equality and fairness in provision, against the current picture of considerable variation in the quality and availability of care. Depending on where you live, what time of day or night it is, and which agency you turn to for help, you may receive very different experiences of care.
There are some limitations with the CQC review, acknowledged in the report. These include needing better data and more data to record BME experiences and experiences of people with disabilities. The review covers 2011-2014, and therefore doesn’t capture the work that has already and continues to be put into practice by those signed up to the Concordat.
At the McPin Foundation we are evaluating the local implementation of the Crisis Care Concordat. This includes an evaluation of the impact of the crisis care concordat in four areas; London, the Wirral, Gloucestershire, and Cambridgeshire. And like the CQC, we also want to ensure that the voices of those who have experienced a mental health crisis or have cared for someone in crisis are heard. Our initial survey received 552 responses, we will be repeating this again in 2015. We will also ensure we communicate to all our supporters through our newsletter the findings of this evaluation. Will the crisis care concordat lead to better multi-agency working locally?
Susanne Gibson, Senior Researcher, The McPin Foundation.