How Do I Get Support In A Crisis- Both Sides Of The Story! Julie Wiles Access Manager North of Tees

How many people are affected by mental illness? 1 in 6 British adults are experiencing one diagnosable mental health problem at any one time. One quarter of routine GP consultations are for people with a mental health problem. The most common mental health problems are anxiety and depression, but at any one time it is estimated that one in 100 people will have a psychotic illness. In , 84,702 people were admitted to inpatient wards in England with a psychosis, anxiety or depressive disorder.

Costs to the Economy Mental illness costs the economy approximately £47 billion each year including £15 billion in lost employment and £10 billion in benefits. In , the NHS spent £8.4 billion on mental health services which was £1.5 billion more than Coronary Heart Disease and twice as much as Cancer. ( National Audit Office - Helping People Through Mental Health Crisis – The Role of CRHT Services 2007)

Mental Health Services Affective Disorders In Patient Services Psychosis Patient Carer Support Services Liaison Services Crisis Teams Voluntary Services Employment Support Services IAPT Prison Services Primary Care Mental Health Services Eating Disorders Rehabilitation and Continuing Care

Definition of Crisis A crisis is defined as:- “The breakdown of an individuals normal coping mechanisms. Crises may be developmental, situational or as a result of severe trauma.” (The Sainsbury Centre for Mental Health 2001)

The Functions of Crisis Teams Act as a ‘gatekeeper’ to mental health services, rapidly assessing individuals with acute mental health problems and referring them to the most appropriate service. Provide face to face contact for all clients at risk of admission to hospital. For individuals with acute, severe mental health problems for whom home treatment would be appropriate, provide immediate multi-disciplinary, community based treatment 24-hours a day, 7 days a week. Ensure that individuals experiencing acute, severe mental health difficulties are treated in the least restrictive environment as close to home as clinically possible. Remain involved with the client until the crisis has resolved and the service user is linked into on-going care. If hospitalisation is necessary, be actively involved in discharge planning and provide intensive care at home to enable early discharge. Reduce service users’ vulnerability to crisis and maximise their resilience.

The following principles of care are important: A 24-hours a day, 7 day a week service. Rapid response following referral. (DoH guidelines specify 1 hour) Intensive intervention and support in the early stages of the crisis. (Up to one visit per shift) Active involvement of the service user, family and carers. Assertive approach to engagement. Time-limited intervention that has sufficient flexibility to respond to differing service user needs. Learning from the crisis.

NAO Crisis Resolution & Home Treatment The Service User & Carer Experience Service users and carers appreciate a holistic approach to CRHT and value personal engagement as highly as clinical expertise. Personal engagement – listening skills, interpersonal skills, Professional Interventions – techniques used to address anxiety and depression, psychosis, medical advice, administering medication, relapse prevention. Practical help- practicalities of day to day living, assistance with domestic tasks and responsibilities. Information Giving- information on help available and contacts for emergency situations. Level of involvement- collaboration with providers, involvement in care plans, inclusion in decision making and the extent to which service users and carers feel informed about diagnosis and treatment.

Comments -The Good “I’d like to thank all your staff who put me on the way to getting well through my crisis. I can’t praise them enough, without their help I would have been very ill. Once again, thank you all.” “Thank you very much to all the team for helping me, I’m very, very grateful.” “I don’t know how we’d have coped if it weren’t for the support and advice and care from the team. Thank you all so very much.” “I have got a good crisis team. If it wasn’t for them turning up at my flat because I was ill, I never knew I had left the door open. Thanks to them they changed the locks, gave my son a key and organised the looking after of my cat whilst I was ill”

Comments- The Not So Good “You seem to talk to different people all the time” “Last time I was under the acute service they didn’t come when they said they would and they didn’t ring when they said they would.” “They didn’t understand my son’s illness, but he used to tell me everything. Eventually they came to the understanding that we are partners in this- working together” “They would come in and they would ask “How are you?” Then they would give her the pills and then they would be out with no real contact” (NAO Service User Focus Group 2007)

What We’re Doing About Them Review of crisis services undertaken. Stockton team to commence working waking nights. Dedicated medical input from October Improving access to the team and mental health services. Listening to and responding to any concerns experienced and identified from service users and carers. Reviewing the skill mix within the team and training needs required. Improving communication and existing links with the acute care pathway, crisis beds, voluntary sector, GP’s and secondary care mental health services.

The Future- New Horizons – Toward a Shared Vision for Mental Health (DH 2009) Ensure consistency and continuity in service provision for CRHT, Crisis beds, CPA, Recovery Social Inclusion, Personalisation Reducing Stigma and Discrimination Physical Health Needs

GUIDING VALUES – NEW HORIZONS

Thank you Stockton Crisis Resolution and Home Treatment Team