NHSCC and RI International publish recommendations for urgent and emergency mental health care

Care for people in mental health crisis does not adequately address the needs of the community it is intended to serve, according to a major international report published today.

The report, ‘Be the change: Ensuring an effective response to all in psychiatric emergency equal to medical care,’ published by NHS Clinical Commissioners, the independent membership organisation for clinical commissioners in England, and RI International, a US-based healthcare organisation, outlines ten recommendations that if fulfilled would make urgent and emergency psychiatric health care ‘minimally adequate’, and calls on governmental agencies, policy makers and health and social services to take radical action to address inequalities and improve mental health crisis care.

The recommendations were agreed by delegates at an international summit in May 2018, hosted by NHS Clinical Commissioners and RI International, which brought together commissioners, providers and clinicians including GPs, paramedics and psychiatrists; service users; civil servants; and first responders such as ambulance workers and police officers from both the UK and USA. The summit found that despite cultural, system and geographic differences, the challenges faced in both countries were remarkably similar.

The ten recommendations, aimed at government, policymakers and those implementing health and social services, are to:

1. End the current fragmentation of care through an integrated, systematic approach to behavioural health crisis care at the national level.
2. Actively develop crisis service alternatives to the usual emergency measures of formal assessment and psychiatric inpatient care.
3. Include special consideration to cater for armed forces veterans.
4. Implement an integrated health information exchange capable technology solution to enable seamless care across organisations.
5. Develop balanced scorecard dashboards that display real-time, meaningful data and outcome measures that support continuous quality improvement.
6. Embed users, peers and carers should be embedded in the design and leadership of crisis systems; peer support staff should be trained and integrated in crisis service delivery.
7. The zero-suicide aspiration should be owned by governmental agencies, policy makers and those implementing health and social services.
8. Family and friends should be fully engaged in crisis care and inappropriate barriers created by confidentiality or privacy need to be sensitively overcome.
9. Implement a single national three-digit crisis hub number that drives easy access in which all callers are welcome, the crisis is defined by the caller, and which is promoted via intelligent social media to get the word out to those who need it.
10. Significant system-wide investment is needed to deliver these recommendations.

The report also concludes that the aim must be to provide 100% access to services to those in a behavioural health crisis and to aspire to zero suicide in healthcare settings. It calls for an approach equal to medical care to ensure an effective response to all in psychiatric emergency.

Dr Phil Moore, chair of NHSCC’s Mental Health Commissioners’ Network, said: “Change is desperately needed in mental health crisis care, but it is possible. The NHS is at a crucial moment of its development, with a tremendous opportunity to impact how we care for those experiencing the most acute behavioural health needs. We need to disrupt the status quo, and make sure services say ‘yes’ at times of behavioural health crisis.

“Crisis intervention is far more than just triage, referral and ongoing support. Kindness, empathy and safety are at the heart of our recommendations. What is clear is that the health sector cannot do this alone, it involves police, social and voluntary services. We need national commitment and leadership to coordinate all the organisations that encounter people experiencing a mental health crisis, as well as significant investment from the government to transform crisis care.”

David Covington, President and CEO of RI International, said: “Both the USA and UK have exemplars of innovative crisis care, but largely people in psychiatric distress do not have access to the timely and high quality response available for medical emergencies. Our aim was to convene different stakeholders from different countries, so we could learn from each other and spark a global effort on crisis care.  There is an international network and learning community for the zero-suicide approach and we want to do something similar for crisis care.”

Download the report and find out more about the international summit at which the recommendations were agreed.