Monday, 24 February 2014

Crisis Care Concordat Part Two - urgent and emergency access to crisis care

The Concordat is broken up into four main areas (and so are these posts); the ability to access support before crisis point, access to urgent and emergency treatment when in a crisis, receiving the right quality of care during the crisis and recovery; staying well and working to prevent future crisis.
Mind (https://www.mind.org.uk/) worked with service users and carers to form statements  expressing the expectations around crisis situations.

The second area of expectations is around accessing the urgent or emergency treatment. The first part to strike a chord with me was that a mental health crisis should be treated with as much urgency and respect that a physical health emergency would be met by. It was respect that got me; if you go into a medical hospital for self-harm then no matter how dangerous it might be you're treat differently merely because you did it to yourself.
There was also a statement regarding restraint and that it should be safely, supportively and lawfully. It must be so hard for professionals to restrain, because the majority of the time it's a sudden knee-jerk reaction and can often be in self-defence so I'd imagine that it's very difficult to remember all of the restraint techniques they've been taught. Right there and then they just want to stop someone hurting themselves or others. To be fair, I've never personally experienced a bad restraint; the worst I've come off with has been swollen wrists (from the handcuffs being too tight) and finger-mark bruises. And I think the most un-safe was when I was handcuffed and had Velcro leg restraints on and then was put in a cage in a Police van and I fell all over the place because I couldn't keep my balance. I have, however, heard of instances when service users have resisted restraints or attacked staff quite severely whilst I've also heard of  service users being injured through badly managed restraints.
Further into the Concordat it details that the NHS Mandate for 2014-15 is derived from this Concordat and will mean that no one in a crisis is ever turned away. It also details that they should get support no matter how they first present and who they first go to for help. E.g. if I was to overdose and tell a policeman I should receive the same quality of care as I would had I called a specialist mental health team with the plans of overdosing. I think this is a very important point because in my hometown we'd have these 3 different A&Es that I could travel to and each one had a different attitude and reaction towards me.
The most suitable crisis care is defined as being as mostly community-based as possible, closes to home as possible, least restrictive and the most appropriate to the service users needs.
There is some consideration given to black and minority ethnic communities as well as children and young people.
There was a large chunk around training and the belief that those professionals who may come into contact with mental health, should have the appropriate training so that they can deal with the situation. Also, the need for more training between services was identified as some do not know what the roles of others are. It went on to detail how places of safety that police have the power to take you to should not include a police cell. This makes it essential that NHS places of safety are well equipped and meet the demands of the local area. I've been in a few places of safety and they've all been different. They were all a part of a large psychiatric Hospital but one was literally just a room to sit in with the police and then be assessed in under the Mental Health Act and another was set-up like an actual ward but purely for those brought in by police under their section 136 of the Mental Health Act. There is also another recommendation to aid the Police and that is that when they the first to respond to a mental health crisis there are agreed timescale responses from the health and care sector so that the individual receives care at the earliest opportunity.  I experienced this in a London Hospital once where I was found after overdosing, sectioned under the Police 136, taken to A&E and I had my Mental Health Act assessment before seeing a medical Doctor so that the police were relieved almost immediately.  In the worst cases I've had two officers with me for over 48 hours waiting for medical treatment to finish so that I could have a proper Mental Health Act assessment and I was discharged from it and fined for 'wasting Police time.'
There is also extra training recommended within the police force to aid officers in making their decision as to whether someone really does need to be detained by the Mental Health Act.
This part of the Concordat also contained advice for those in a mental health crisis who present at A&E which I found interesting as that was usually the first place I went to for help. The Concordat stimulates that those circumstances should be treat in par with physical illness admissions.
In part B12, the Concordat covers a situation where a service users needs to be transported between facilities and specifies that this isn't done via a police vehicle and especially not within a caged one. This is such a good instance to include as it's very upsetting and scary to be handcuffed and put into a cage in the back of a massive riot van while you're hallucinating.

To read the concordat yourself and make your own opinions, you'll find it here: https://www.gov.uk/.../36353_Mental_Health_Crisis_accessible.pdf