The Listening to experience research findings was released by leading UK mental health charity Mind this week.
Hundreds of patients and professionals told Mind's inquiry panel of crisis experts that while excellent crisis care does exist, there are problems with inpatient hospitals and community crisis teams including people struggling to get help, staffing problems, poor quality care environments and not enough treatment provided to help people recover.
Over a million people use secondary mental health services including acute and crisis care, and 107,765 people were admitted to psychiatric units in the last year alone, an increase of 5.1 per cent on the previous
As crisis services face increasing demand and the National Health Service (NHS) comes under pressure to save money and improve efficiency, Mind asked for qualitative feedback on whether existing services are meeting people's needs in a crisis. Feedback was extremely mixed with more negative experiences than positive.
Some of the worst examples included:
• Eligibility thresholds too high: Mind heard from some people who asked for help to avert an impending crisis, but were told they weren't yet ill enough to qualify for help.
• Calls for help go unanswered: A number of patients left messages on crisis help lines and no one responded; many spoke of long delays before receiving responses; inadequate advice was given to suicidal people such as being told to have a warm bath, hot drink or go for a walk.
• No help to recover: Many people in hospitals felt that nothing was done to help them recover. This includes people wanting any form of talking therapy or counselling, and not being able to get it. Existing research shows that only 29% of people in hospital receive a talking therapy.
• Quality of life in hospital: Overcrowding, lack of cleanliness, being denied access to outside space, bad food, nothing to do. One person commented on being cut off from family and friends, with only one phone call allowed per day.
• Staff attitudes and availability: Many people reported stressed and overstretched staff that were often unavailable, leaving distressed people with no one to talk to. Some patients reported taunting and verbal abuse from staff.
• Capacity issues and avoidable tragedies: Overcrowding and over occupancy in some hospitals putting pressure on bed space meaning people couldn't be helped. One psychiatrist told us of 10 avoidable suicides due to patients being denied access to hospitals because of bed shortages and admissions policies.
• Staff time: Some staff were frustrated that they didn't always have enough time to give patients one-to-one support, and some said they spent so much time assessing people, little time was left for treating them. Existing research shows that in mental health hospitals, 66% of nurses consider staffing numbers to be insufficient.
People also told the inquiry about experiences of exemplary care, where they attributed the actions of caring staff teams and well-thought out treatment to saving their lives, and the investigation visited forward-thinking crisis services that focused on quality for patients even when resources were stretched.
However, there was much frustration about the sheer inconsistency of care, with some people expressing concerns about having to move away from an area where they knew they could get excellent crisis care.
Combining existing research6 and investigation findings, Mind is setting out a series of recommendations on how crisis care should be improved to give the best possible treatment to some of the most vulnerable people in NHS care:
• A review of effectiveness of care: Commissioners should review whether local services are meeting people's mental health needs. This includes whether people are satisfied with them and sufficiently helped to recover, and whether they provide value for money.
• Improvements to wards: Hospital wards should be therapeutic environments, where people can get respite in treatment somewhere that is safe, clean, comfortable, and hospitable. Hospitals should be considered 'retreats' for care, not containment.
• Improving service range: Commissioners should expand the range of crisis services available, for example to include crisis houses, host families, service user led crisis services, and retreats. An increase in services where people can self-refer, rather than having to wait until their mental health gets bad enough to meet current high eligibility thresholds.
People should be consulted and involved in planning how they are treated in a crisis, so they can provide information on what they find helpful, and what doesn't work for them. Services should be mindful of the needs of all the people they serve, for example culturally appropriate services for BME communities.
• Availability of talking therapies: Government and commissioners should ensure that psychological therapies are available to all people using acute and crisis services, within 28 days of referral.
• Staff attitudes: Staff should be recruited not just on clinical skills, but personal qualities such as compassion, caring and sensitivity to the need of people with mental health issues. Managers
should take action where staff are abusive.
• Restraint practices: In some hospitals, staff still physically restrain patients, including face down which has lead to avoidable deaths. A ban should be introduced on using face down restraint.
Paul Farmer, Chief Executive of Mind said:
"Mental health crises need urgent treatment, yet our investigation found that far from receiving the instant, 24-7 response we expect for physical health emergencies, people experiencing mental health emergencies can be faced with long waits, poor quality care and in some cases are unable to access help at all.
The distressing and highly sensitive nature of mental health crisis means that it is even more important that people are given a seamless emergency response, safe environments and that staff have the time to give them care and emotional support.
People told us that what they most wanted in crisis wasn't complicated, but simply being able to get treatment when they needed it, therapeutic hospital environments, personal safety, someone to talk to, and something to do.
The sheer simplicity of what is missing shows that there is some way to go before all mental health services are delivering on the fundamentals of good care for people in mental distress.
However, we know from the excellent practice we heard about that high quality, effective crisis care is achievable.
The challenge now is ensuring that it happens everywhere.
As the health service faces major changes, Mind is looking forward to working with providers and professionals to help achieve a vision of crisis care that is built on human values, and learns from existing best practice to provide the best possible care."