Updates to Mental Health Crisis Care in London27 July 2023
New systems for Met Police and Community Care Pathways
Last week, the latest NHS Mental Health Crisis Care Agreement for London was shared. It outlines a continuing focus on community-based crisis care which is encouraging to see. Providers, such as Social Interest Group, are a vital part of both community and emergency care. We offer out-of-hours and 24/7 care and support in community settings, reducing pressure on emergency departments and enabling people to stay in their own homes or local area during a crisis. Data shows that people recover better in the community rather than in the hospital and our services deliver support in a way that is essential for wellbeing and maintaining relationships with support networks.
As this is a crisis care agreement, the Metropolitan Police are significant partners. Clarifying their role in crisis scenarios, particularly as the Met Commissioner recently stated that his officers would soon cease from attending MH callouts, is welcomed by SIG and our sector partners. We are meeting with senior officers in the Met over the coming weeks. We will discuss the impact of the changes announced on our services across London to ensure that our teams, Residents, and Participants receive the right support.
The London All Age Crisis Care Concordat empowers us to know how we can expect the NHS, local councils, and police to support people through mental health crises. With changes beginning from the Autumn, these measures should be in place by Spring 2024:
- Initial Support and Assessment: ‘The London vision is that anyone in London experiencing a mental health crisis can call NHS 111 and have 24/7 access to the mental health support they need in the community’ because calls will be redirected to a specialist mental health line for assessment and to be directed into the appropriate mental health pathway. This is in place of the current model in which an NHS assessment is carried out.
- Appropriate Response: ‘All six Mental Health Joint Response Cars (MHJRC) to operate 7 days a week, resulting in increased utilisation and support for people experiencing crisis… to introduce Mental Health vehicles to reduce inappropriate ambulance (or police) conveyance to Emergency Departments, all ICBs (Integrated Care Board) have committed to, and accelerated, the full business as usual model of operating MHJRCs in their area’. The MHJRC cars are unique in that they are staffed by a paramedic trained to physically assess and a mental health professional who can carry out a biopsychosocial assessment, formulate a risk assessment, and deliver brief psychological interventions to reduce distress. This model is proven to reduce admissions to hospital.
- Emergency Response: A specific call-service will be put in place across two centralised S136 hubs (North & South), available to provide bespoke advice for the S136 pathway, which allows the police to take (or keep) people at a place of safety, without a warrant, under appropriate circumstances. ‘This is to address the inequitable access for police officers when needing to consult with a mental health professional prior to applying S136; or needing advice on the correct non-S136 pathway for the individual’.
- In case of Hospital Admission: Although it is acknowledged that emergency departments are not the best place for those experiencing a mental health crisis, unless they require urgent medical attention, when this does occur, the CORE 24 standard should be followed to ensure that once a referral from an emergency department is made, patients should have a face-to-face assessment by mental health liaison service commence within 1 hour.
What we feel has not been addressed within the new Crisis Care Agreement is that Local Authority Adult Social Care Services are still operating primarily 9 am-5 pm, Monday to Friday and the gap in support for those experiencing a mental health crisis leaves them vulnerable.
The current Adult Social Care structure leaves the Police, Service Providers like Social Interest Group, and NHS Emergency departments struggling to bridge the gap in service created by the absence of Local Authority Workers for many hours each week. We are disappointed to see that no reform to core working hours for Adult Social Care departments has been agreed.