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People’s experiences of help, care and support during a mental health crisis

Attitudes to mental health are changing fast. In the last four years it is estimated that two million people have developed a more positive attitude towards mental illness.

However, there is still a long way to go until a person experiencing a mental health crisis receives the same response as someone with a physical health emergency.In February 2014, the Coalition Government announced the launch of a new agreement called the Crisis Care Concordat. This is a challenge to those responsible for commissioning, providing and delivering the services to commit to a set of core principles around crisis care, to make sure that people get the help they need when they are having a mental health crisis. The Concordat has been signed by more than 25 national bodies, including CQC.

As part of our commitment, we agreed to review the quality, safety and effectiveness of care provided to those experiencing a mental health crisis. Throughout we have put people at the heart of the issue and sought to understand whether people were being offered the right care, at the right time, and if they were being given the information they needed, as well as what they felt about the attitudes of those providing help, care and support.

Our findings show that there are clear variations in the help, care and support available to people in crisis and that a person’s experience depends not only on where they live, but what part of the system they come into contact with.

We found many examples of good crisis care, but our work has also shown that far too many people in crisis have poor experiences due to service responses that fail to meet their needs and lack basic respect, warmth and compassion. This is unsafe, unfair and completely unacceptable.

We asked people to share their experiences with us. What they told us presents a challenge for everyone responsible for ensuring people in crisis receive the best possible help, care and support. Commissioners, providers and those delivering services must all recognise the role they have to play in providing the right kind of services and making sure that they are accessible at the times when people need them.

There is a distinct gap between people’s perceptions of how they are treated by staff working in accident and emergency (A&E) departments and specialist mental health services compared to other services. We asked people whether they felt listened to and taken seriously, whether they were treated with warmth and compassion and if they felt judged. Fewer than four in 10 respondents gave a positive response about their experience in A&E for any of these statements. Those coming into contact with specialist mental health services were only slightly more positive.

In comparison GP, ambulances and the police were all perceived as being more successful in providing caring and empathetic responses to people in crisis. It may be less of a surprise that volunteers and charities received the most positive responses from those who come into contact with them but the gap between the voluntary and statutory sectors is substantial.

Irrespective of location or which services people came into contact with, 56% (449 people) told us that the care they received helped to resolve their crisis or was partially helpful, but 42% (339 people) said it did not help. A health and care system where over four in 10 respondents feel their crisis was not resolved raises serious questions about the fairness and safety of service responses.

This variation is unfair. The principle of parity of esteem between mental and physical healthcare is built into the NHS Mandate. Providers must recognise that the risks from emotional harm are just as real, and potentially life-threatening, as those from a physical injury. Feedback from our call for evidence highlights poor staff attitudes to injuries caused by self-harm. These attitudes cannot be tolerated and show that work is still needed to embed parity of esteem across organisations.

This report makes an important contribution to the conversation around crisis care at a national and local level. It gives a strong evidence-base for recommendations to local Concordat groups, and identifies a series of areas where we encourage commissioners, providers and services to make improvements.