Baroness Tyler: Ensuring mental health crisis care is properly funded

When people experiencing mental health crises don’t have access to the sort of timely, effective, and compassionate care that people with physical health problems do, it’s not just unfortunate—it’s unfair. The Care Quality Commission’s Right Here, Right Now report is a timely assessment of the current state of mental health crisis care and frankly it makes for pretty sobering reading.

Last year, and greatly to their credit, Norman Lamb as Minister, local government and leaders of key services signed up to the 2014 Mental Health Crisis Concordat. In doing so, they agreed to work towards making sure that compassionate and understanding crisis care would be available 24/7; that a mental health crisis would be treated with the same urgency as a physical health crisis; that people should be treated with dignity and respect in an environment that is conducive to their needs; and that appropriate follow-up services would be provided.

But as the CGC’s report demonstrates, we still have a long way to go in meeting these goals. Only 14% of those who responded to the CGC survey said that the crisis care they received provided the right response and helped resolve their crisis. Too often, appropriate services are not available in a timely manner or patients are passed between multiple services before they can finally receive help. The same survey reports that 32% of people were unsure who to contact in a crisis. As a result, many individuals turn to A&E because they have nowhere else to go.

The Concordat is clear that people experiencing a crisis should have access to support 24 hours a day, seven days a week, but local agencies consistently reported that services were not as good after 5 pm. Many services are not even open between at night or on the weekends so people have little choice but to go to A&E. It’s no coincidence that A&E admission due to mental health problems peaks between 10 pm and 7 am. But people who attend A&E are not receiving adequate crisis care— fewer than four in ten respondents gave a positive response about their experience.
 
Despite the doom and gloom, there are some encouraging examples. Many respondents reported good experiences with services provided by the voluntary sector, with 74% of those who received care from a voluntary body saying that their care was timely and 88% saying that they felt they were treated with warmth and compassion.

Street triage schemes piloted in a number of local authority areas have been effective in reducing the number of people sectioned under s136 of the Mental Health Act by having nurses accompany officers to incidents where people may be in need of immediate mental health support. This service is crucial as detentions under the Mental Health Act have increased year on year, reaching 53,000 by 2013-14.

It’s totally unacceptable that hundreds of under 18 year olds are currently being held in police cells as a so called “place of safety” – something Lib Dems have been campaigning against and the Queen’s Speech contained a commitment to stop this practice. This is clearly welcome and long overdue but a change in the law won’t be enough. The current excessive use of police cells as “places of safety” is largely the result of poor commissioning – children and young people’s crisis care services being poorly developed relative to adult services,
 
Addressing these issues properly will require clear leadership from central and local Government and mental health commissioners – something I have been calling for in the Lords. In particular I will be pressing Government to ensure that local mental health crisis care concordat plans are properly funded and implemented in all areas.