Effective Services for People (including Children) in Mental Health Crisis

1. Effective Services for People (including Children) in Mental Health Crisis Sarah McClinton, Director of Mental Health and Disability, Department of Health

2. Mental health policy context Mental illness: single largest cause of disability in the UK 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 ‘treatment gap’ 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

3. Government policy documents Feb 2011 No health without mental health: A cross-government mental health strategy for people of all ages Jan 2014 Closing the Gap: Priorities for essential change in mental health Feb 2014 Mental Health Crisis Care Concordat: Improving outcomes for people experiencing mental health crisis Oct 2014 Achieving Better Access to Mental Health Services by 2020

4. Achieving Better Access to Mental Health Services by 2020 £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

5. Crisis care • “It feels like I literally have to have one foot off the bridge before I can access services.” – service user • “Crisis care is perhaps where the gap between physical health and mental health is most stark.” – Norman Lamb

6. Crisis Care Concordat • 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: • Access to support before crisis point • Urgent and emergency access to crisis care • Quality of treatment and care when in crisis • Recovery and staying well

7. 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

8. Good practice 1 • Street triage: • 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 • 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

9. 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

10. 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

11. 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