‘We’ve just begun’
Having worked on the Concordat since it was published last February, I am heartened by how much change we are seeing already, all over England. However, in a way, the hard work has only just begun – we now need to see words put into action.
Local areas are off to a great start though, with all the Declarations signed and the action plans in place. Having gone through all the local plans, I’ve identified 9 principles which I think, together, make for a strong Concordat approach.
1. Involve people with lived experience and carers in developing plans
This should go without saying. The strongest plans are those where it’s clear people with lived experience of mental health crisis are at the centre of the Concordat in their local areas. Some areas have even worked with people who use services and their carers to develop their own ‘I’ Statements. Check out plans from the West Midlands for examples of this.
2. Include all ages
Age should not be a barrier to accessing appropriate and urgent crisis care, whether you are 15 or 50. In practice, a number of local areas needed support to enhance their plans to include children and young people, as well as adults. Many local areas are working really hard to make the changes necessary to improve services for children and young people.
3. Work across agencies
Street triage, joint training, multi-agency information sharing are only some of the innovative things happening across England that are making people and the system work better.
4. Include third sector organisations
As service providers, many local voluntary and community sector groups can give good support to people. In fact, the Care Quality Commission’s thematic review of crisis care services found that ‘volunteers and charities received the most positive responses from those who come into contact with them’.
Groups like local Minds often act as advocates for people with lived experience, ensuring that the voices of people with lived experience are heard and their needs are at the heart of local action. They can also help to hold partners to account by seeing if they really are doing what they have said they will do to improve outcomes for people experiencing mental health crisis in their area.
5. 24/7 services
The very first ‘I’ Statement in the Concordat says:
When I need urgent help to avert a crisis I, and people close to me, know who to contact at any time, 24 hours a day, seven days a week. People take me seriously and trust my judgement when I say I am close to crisis, and I get fast access to people who help me get better.
Anything less than 24/7 access to services isn’t good enough crisis care.
6. Strong local governance arrangements
One of the most frequent questions I get asked is: who’s going to make sure things actually happen at the local level? Anchoring crisis care work in new Concordat-specific governance structures is a must and linking those with existing strategic groups is even better. Some local areas are also ensuring that their Health and Wellbeing Boards and local multi-agency System Resilience Groups have oversight of local activity.
7. Make national ambitions local ambitions
One of the crucial ones, in my view, is reducing the use of police custody in a mental health crisis to ‘exceptional’ circumstances only and a ‘never event’ for under-18s.
Some areas have stated they are implementing the Department of Health’s new guidance on reducing the use of restrictive practices, which states that planned or intentional face-down (prone) restraint must not be used.
8. Develop a strong evidence base
Accurate data and information on who is using services, when they are using them, and how they are accessing them, are crucial to commissioning the right services, so they can be responsive to the needs of diverse populations and to specific needs based, for example, on gender.
9. Plans reflect all aspects of the Concordat
Finally, it is not enough for there to be a 24/7 telephone crisis line and a responsive crisis resolution / home treatment team if the services are not up to scratch once someone has accessed them. The best plans are comprehensive and consider recovery and helping people stay well following a crisis as much as they focus on prevention.