Effective Services for People (including
Children) in Mental Health Crisis
Sarah McClinton, Director of Mental
Health and Disability, Department of
Health
Mental health policy context
• Mental illness: single largest cause of disability in the UK
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‘treatment gap’
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a quarter of the national burden of ill health – 1 in 6 adults; 1 in 10
u16s; 1 in 4 people at some point during their lifetime
leading cause of sickness absence in the UK
most people with mental health problems in England receiving no
treatment
People with SMIs dying 15-20 years earlier
Cost (in England) £105.2 billion each year
Cost to business just over £1,000 per employee per year or almost £26
billion
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Government policy documents
Feb 2011
Jan 2014
Feb 2014
Oct 2014
No health
without mental
health: A crossgovernment
mental health
strategy for
people of all
ages
Closing the Gap:
Priorities for
essential change
in mental health
Mental Health
Crisis Care
Concordat:
Improving
outcomes for
people
experiencing
mental health
crisis
Achieving Better
Access to
Mental Health
Services by 2020
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Achieving Better Access to Mental
Health Services by 2020
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£120m to enable setting of access and waiting time standards
in mental health services for first time ever from 2015/16
Focus on IAPT, Early Intervention in Psychosis and crisis care in
2015/16
Piloting from standards in eating disorders and personality
disorders
Commissioning models, payment models and data crucial – all
building blocks towards parity over next Parliament
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Crisis care
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“It feels like I literally have to have one foot off the bridge
before I can access services.” – service user
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“Crisis care is perhaps where the gap between physical health
and mental health is most stark.” – Norman Lamb
Crisis Care Concordat
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Published in February 2014
Shared agreement & commitment between services and
agencies to improve care for adults and children in a mental
health crisis, signed by over 20 national statutory
organisations, including LGA, ADCS and ADASS
Emphasis on partnership and collaboration
Four sub-sections:
o Access to support before crisis point
o Urgent and emergency access to crisis care
o Quality of treatment and care when in crisis
o Recovery and staying well
Crisis Care Concordat: effecting local change
• Mind’s online map and resources, working with DH and local
areas to ensure whole country is covered by local
Declarations by end of year
• Declaration: one vision and principles for ensuring an
effective emergency mental health response system signed
by all local partners
• Action Plans will subsequently build on Declarations with
detail and substance
• Concordat linked to CCG operational resilience plans
• Norman Lamb letter to David Pearson on 21/10 seeking
ADASS support in securing local sign-up and buy-in
Good practice 1
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Street triage:
o West Yorkshire (DH-funded pilot): time spent by Police
Officers in dealing with 136 cases on average 2 hours,
compared to 5 hours in neighbouring Division
o Nottinghamshire: number of people detained under 136
down by a quarter
• Use of police custody: 2013/14 in London: 87 people
detained in cells; Jan-Sept 2014 just 17 people, 0 children.
Aim to make use of cells a never event
Good practice 2
Crisis Care Concordat:
• Gloucestershire first county in England to submit a
comprehensive Action Plan
• Effective governance in place to draw up Action Plan:
creation of Gloucestershire Mental Health Crisis Concordat
Task & Finish Group co-chaired by CCG Board Chair and
Expert-by-experience
• Strong commitments from all local partners including
responsibilities taken on by voluntary sector organisations
CYP Mental Health & Wellbeing Taskforce
• Announced in August 2014 by Norman Lamb
• What help does a child with MH problems want? What and
how would they access support?
• Co-chaired by DH & NHS England; cross-sector membership
including voices of CYP, families, carers
• Aim is to maximise joined-up working across the system,
rationalise commissioning and improve outcomes
• Data, quality, vulnerability, inequalities
• Vital role for voluntary sector and online services
• Reports to cross-Govt inter-ministerial group, with final report
in February 2015
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Conclusion
“I…needed to feel that someone actually cared about me…”
• People’s experiences of crisis care – good or bad – stay with
them for a long time: a couple of hours, especially in childhood,
can have a lifelong impact. All the more important to get it right
• Aim must be to provide seamless care and support through
crisis, and hope for recovery thereafter
• Important steps towards ending years of imbalance between
mental and physical health services
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