December 2005 Crisis Survey results
Fourteen of Fifteen Health Boards responded (State Hospital is not included in this
survey)
The survey covered the following key aspects (see Annex A for full questionnaire)




Current service provision
Planned service provision
Access routes to services when someone is in a crisis (known or unknown to
services)
Access routes to services for the carer of someone in a crisis.
Details were also invited of analysis undertaken or planned locally of service
effectiveness. Good practice examples were also invited.
Current and planned service provision
All NHS Board areas stated they currently provide crisis services that work
effectively in partnership with other services, provide alternatives to admission and
take into account the views of service users and carers.
Twelve Board areas provide community based services
Two areas are planning to move their hospital based teams to the community in the
near future.
Current service provision
16
14
Number of NHS Board areas
12
10
8
yes
no
planned
6
4
2
0
community based
partnership
working
alternatives to
admission
views of users
and carers
24hrs7days
A&E liasion
Area-wide
carer support
Service characteristics
1
Seven Boards provide 24/7 access.
Four Boards have plans to do so.
One Board provides “some” out of hours cover following evaluation that suggested
little demand for complete 24/7 cover.
Ten of the eleven areas provide carer support through their existing crisis services.
Access to services- time of access
Seven Boards completed the second half of the questionnaire - routes and times of
access in areas with no dedicated crisis service1
Access to services in a crisis
7
Number of NHS Board areas
6
5
known
unknown
carer
4
3
2
1
0
24 hrs 7 days
9-5pm
Time
Access Routes2
The GP was the most commonly listed first point of contact for both users and carers
in a crisis.
Most areas listed national helpline numbers such as Breathing Space and
Samaritans as additional first line contacts.
2
Only 7 areas completed this question (see Annex A for details.)
2
Access points differed slightly if the client was known to services. In some areas the
client has direct access to inpatient care/assessment (if part of their CPA,) or direct
access to their Community Psychiatric Nurse (CPN) or Community Mental Health
Team (CMHT) in the first instance.
One area provides a crisis centre/house whereas some provide visiting support to
those in crisis.
Access routes for carers to access support while cared for is in crisis included GP,
A&E and national telephone helplines.
Service type by client group
8
7
GP
OOH
Samaritans
Breathing Space
CPN
inpatient services
CMHT
A&E
crisis centre/house
short stay community flat
crisis team
ESWS
hospital based unscheduled care team
direct to ward
NHS 24
other
Number of NHS Board areas
6
5
4
3
2
1
0
known
unknown
carer
Client group
Approaches to crisis service delivery
A range of crisis provision was noted provided by the voluntary sector, local authority
and NHS Boards- some in partnership:



Home/visiting teams -IHTT3, NACS4, EAST5; Borders and South Lanarkshire
pilots.
Services providing residential/overnight accommodation - FIRST,6 Edinburgh
Crisis Centre (opening April/May 06.)
Extension of existing day service (Orchard Crisis Service, Lothian.)
3
Intensive Home Treatment Team, (Forth Valley)
North Ayrshire Community Support Service (Ayrshire and Arran.)
5
Elderly Assessment and Support Team (Fife)
6
Flexible, Intervention Response and Support Team (LAMH, Lanarkshire)
4
3
Some Board areas focus on extending/restructuring existing services



Psychiatric input to out of hours care services (LUCS,7 West Lothian)
Extension of existing mental health homecare services (East Ayrshire)
Extension of hospital based out of hours teams (Fife)
Other areas are in the process of whole system redesign/restructuring or the
development of local area strategies to inform service development.
Area analysis of the effectiveness of crisis response/alternatives to admission
These include:







7
Analysis of uptake of community support services/community alternatives to
admission;
Independent evaluation of services- e.g. the Stirling University evaluation of
the Orchard Crisis Service;
“Before and after” analysis of admission rates;
“Before and after” analysis of average length of stay
User/carer satisfaction questionnaire;
Referrer questionnaire; and
Evaluation of uptake of previously established 24/7 crisis service.
Lothian Unscheduled Care Service
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Annex A
CRISIS SERVICES SURVEY
NHS BOARD AREA:
A. DEFINITION:
Mental health crisis services that include 24/7 access to:

Community based services with links to the key care agencies and to secondary
NHS care where required.

Secondary and community based services that work collaboratively to address
prevention, intervention and recovery.
Where crisis arises:

Services that provide prompt and effective intervention (including social support and
medication management) in all settings.

Services that are user and carer focused and help reduce duration of crisis, avoid
hospital admissions where appropriate and shorten hospital stays.
(Examples include, but are not restricted to, telephone crisis response, walk-in services,
crisis outreach and crisis residential services).
B. Does your current service:
Yes No Planned? (Please
give dates)
1. Provide community based services with access to
hospital admission?
2. Work in partnership with other agencies? (Multi
(agency/multi disciplinary?)
3. Provide alternatives to hospital admission?
4. Take the views of service users and carers into
account in the planning and implementation of the
service?
5. Operate 24/7?
6. Work within the local A&E?
7. Cover the whole NHS Board Area?
8. Support Carers during a crisis?
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C
If you do not provide, or plan to provide a mental health crisis service within
the definition outlined above please provide additional information below:
(1) Can service users known to your mental health services access help?
Yes
No
24/7
9-5
Other times
(Please specify)
(2) What services can they access? (E.g. GP, Out of Hours Service, Crisis House, The
Samaritans)
(3) Can service users not known to mental health services access help?
Yes
No
24/7
9-5
Other times
(please specify)
(4) What services can they access? (e.g., GP, Out of Hours Service, Crisis House, The
Samaritans)
(5) Can Carers (known or unknown to mental health services) access help?
24/7
9-5
Other times
(please specify)
(6) What services can they access? (e.g., GP, Out of Hours Service, Crisis House, The
Samaritans)
D
What analysis has been or is made of effectiveness of alternatives to hospital
admission?
E
Please add any other comments you may have or crisis services/good practice
you wish to highlight
6