Emergency care for the mind
This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government
Care and Support Minister Norman Lamb explains why mental health crisis care is essential.
A mental health crisis can strike anyone, anytime, regardless of age or circumstance. In these critical moments, how we as citizens, care workers, medical professionals and the police react to and support people in the midst of psychological trauma can have a profound effect upon the course of their lives.
People with broken legs need quick responses - that’s why we have ambulances and A&E departments - but so too do people in mental health crises. To achieve this we need to put mental health and physical health on an equal footing. This requires concerted action to challenge entrenched attitudes or cultures. We must make sure people get speedy access to safe and compassionate care in the right environment.
Indeed, the surroundings in which someone receives help are just as important as who delivers it. Too often people in crisis face being locked up in police cells. This can be a deeply traumatising experience. This is not a failing of the police, but it is the way the system traditionally works. If you get picked up by the police in a moment of crisis, perhaps late in the evening, the default has often been to put you in a cell overnight.
With the best will in the world, the police do not have the training, knowledge or resources to assess the situation and determine appropriate next steps. If they have no mental health professional on hand and no known place of safety to which the person can be transferred, then the nearest police station with capacity is the only option. And it has always been that way.
But this simply cannot be justified in a civilised society. It is intolerable that some parts of the country have insufficient arrangements for places of safety for vulnerable children. Our police should not have to decide that confinement to cells or police vans for hours at a time is the best option, just because the NHS cannot react quickly enough. To feel criminalised when already in the depths of despair is something no one should experience.
The Mental Health Crisis Care Concordat was launched earlier this year to improve the responses people receive from services.
It sets standards in mental health crisis care for the first time. Signed by over 20 national organisations it asks regional police, health and care services to sign up to joint local crisis care declarations. In other words, they need to spell out the services and support they will offer and coordinate for those experiencing psychological distress.
It sets an ambition that this year we should halve the number of people ending up in police cells at a time of mental health crisis - and end the practice of placing children in cells. The deadline for completing declarations is 31 December. Many areas have already declared, but I want to see all plans in place by 15 December to ensure we have blanket coverage right across England by the end of the year.
The Concordat is clear that local mental health services need to be available 24 hours a day, seven days a week. At the first Mental Health Crisis Care Concordat summit held in London earlier this month – at which I was delighted to speak – I was encouraged by the strong consensus on this point, particularly from police leaders. The desire from the top to help ensure we have good quality crisis care 365 days a year is a massive shift in understanding and commitment – and I applaud it wholeheartedly.
This brings me to the subject of street triage – an initiative I am convinced has played a significant part in influencing the police and others to see the merits of emergency mental health services. In the nine pilot areas where it has been deployed – where police work alongside mental health professionals who are available for advice and support – detentions under section 136 of the Mental Health Act have dropped by an average of 25 percent.
Some areas are performing even better. The West Midlands and Oxfordshire pilots have reported reductions in the use of section 136 by 36 and 38 percent respectively. In almost all cases, street triage schemes are reporting no use of police stations for those with mental health issues whatsoever. This can only save time, costs and enhance mental health outcomes for the individuals concerned.
So where next for the Concordat? I now expect local areas to draw up action plans to show how each area of England will reduce the use of police cells further. I want to see greater reductions in the number of people in mental health crises who find themselves facing locked cell doors, especially those under 18. I also hope enhanced information sharing between the police and our health and care services leads to speedier analysis, decisions and interventions, saving and enhancing the lives of many more of our citizens.
You treat a wound quickly before it gets infected and the damage becomes permanent. Let’s treat the mind in the same way and help prevent a lifetime of needless suffering.