The Crisis Care Concordat National Summit had a full day programme celebrating progress and improving practice since the launch of the Concordat in February 2014. The focus was on what more we can all do to ensure that people of all ages who experience mental health crisis receive appropriate, timely and urgent care and support.
The Summit was full with 250 delegates and speakers. All delegates were Concordat activists – involved in their local Concordat groups and/or representatives from national signatory and supporter organisations. There was a good range of sectors and organisations represented, including from police, health, social care, commissioners, emergency medicine, voluntary sector etc as well as people with lived experience and carers.
Programme and summary
Paul Farmer, Chief Executive of Mind, chaired the day. He set out the aims for the day:
- Celebrate success
- Focus on learning
- Consider next steps
Paul spoke about the progress, locally and nationally, that has been made because of the Concordat. He also spoke about the Mental Health Taskforce and how mental health crisis care will be included in that when it is published.
Geraldine Strathdee, National Clinical Director for Mental Health, NHS England, and Naomi Good from the National Survivor User Network, had a conversation about what has changed in policy, practice and people’s experiences since they presented together at last year’s Concordat National Summit.
Rt Hon Alistair Burt MP, Minister of State for Community and Social Care, Department of Health, gave a video message to the conference, stating his thanks and commitment to the Concordat. Sarah McClinton, Director of Mental Health, Disability & Dementia, Department of Health, also spoke from the Government’s perspective.
Karen Bradley MP, Minister for Preventing Abuse and Exploitation, Home Office, made a speech focusing on the good work that is already happening and what more needs to be done.
Dr Susanne Gibson, Senior Researcher, from McPin, the specialist mental health research charity which is doing the evaluation of the Concordat programme, spoke about their research methodology and initial findings, including four main themes from their interviews:
- Partnership working
- Achievements and challenges
- Service user and carer experience
- The future of crisis care
Professor Louis Appleby, Chair, National Suicide Prevention Strategy Advisory Group, Department of Health and Professor of Psychiatry, University of Manchester, spoke about his research into suicide prevention. He emphasised the need to move away from only focusing on ‘outliers’ and to ensure there are proper suicide prevention actions in all areas.
Maqsood Ahmad, Strategic Clinical Networks Manager, Mental Health, Dementia and End of Life Care and Constable Adele Owen, Force Tactical Mental Health Lead, Greater Manchester Police presented the work of the Concordat across Greater Manchester, including pilot programmes to improve mental health crisis care.
Mark Trewin, Bradford Council and Emma Balfe, Mind in Bradford, presented the work of the Concordat in Bradford, including their whole system redesign and the measurable successes of the commissioned Sanctuary service provided by Mind in Bradford.
Mary Elliffe, Birmingham and Solihull Mental Health Foundation Trust, and two colleagues presented on the work happening in Birmingham and Solihull, including how it is linking with the Birmingham and Solihull Vanguard.
Professor Keith Willett, National Director for Acute Care, NHS England, gave the final presentation on the day, emphasising that mental health was integral to all the work happening to improve the systems and delivery of urgent and emergency care across England.
Seven seminar sessions ran concurrently:
1. Reducing crises through recovery focused practice
Ruth Allen, College of Social Work
Professor Tim Kendall, Sheffield NHS Foundation Trust
3. Are we ready for changes to sections 135 and 136?
Chris Witt, Home Office
Dr Phil Moore, NHS Clinical Commissioners Mental Health Network; Cllr Fiona Venner, Leeds Survivor Led Crisis Service; Jim Symington, Symington-Tinto Health and Social Care Consultancy
Dr Mohan Bhat, Director of Medical Education, North East London Foundation Trust; Dr Bini Thomas (Simulation Lead, NELFT); Dr Lindsay Banham (Fellow in Medical Education, NELFT); Helen Jameson (Chief Financial Officer and Director of Corporate Programmes, UCLP)
Sarah Brennan, Young Minds; Dr Liz Fellow-Smith, Royal College of Psychiatrists; Claire Bethel, Department of Health
Sophie Corlett, Mind; Cassandra Cameron, NHS Providers; Lynn Paterson, Leeds and York Partnership
Recording and broadcasting the Summit
There was a photographer and photographs from the main room and all of the seminar sessions. A highlight of the day was the illustrations from Creative Connection, who recorded visual minutes throughout the day and from all seminar sessions.
Twitter was used extensively in the run up to the day, during the event and afterward. The Twitter hashtag from the event #Concordat was trending for several hours, attracting many people to the Summit activity. The Department of Health also used audioBoom to capture short interviews with speakers, published immediately online.
Impact of the Summit
In addition to capturing views from seminars, on social media and on the visual minutes, there were two table-top activities where delegates were asked to discuss and give views on 3 points. Some comments are included underneath each:
1. What’s changed because of the Concordat? What are key outcomes? Examples of good practice. Local or national.
- Reduction in use of police cells
- PCC & Chief Constable meeting with NHS Trusts to discuss mental health services and policing
- People with experience of crisis care are able to share their experiences more directly with policy makers and service providers
- Measurable improvements in action plans
- Working on a female crisis care pathway – working with a housing provider, a social care intervention
- Fantastic relationship with police
- Strategic purpose for commissioning decisions
- CAMHS – CCG support pilot project for CYP with mental health and emotional behavior
- Police are training officers so that inappropriate restraint techniques are not used on mental health patients i.e. pain compliance
- Alternative place of safety to police cell and A&E are provided by the voluntary sector
- Improved timeliness of ambulance response to section 136; higher proportion of s136 patients conveyed by ambulance
- Simple changes have made a great different – it has supported innovation
- The CCC has overcome the inertia to change across the agencies and raised awareness of why change is needed
- Concordat has brought all agencies together – a real first ‘joined up thinking’ at last
2. What are the barriers to improving outcomes for people experiencing a mental health crisis?
- S136 suites are not a statutory obligation which may set progress back if there is a lack of parity of spend between mental health and physical health
- Too much focus on crisis rather than crisis prevention
- Shortage of competent, fully trained mental health staff i.e. psychiatric liaison nurses
- Physical health still has a way to go to embrace mental health
- Highlighted some major challenges that remain i.e. young people
- If partnerships not there it struggles
- Not sufficiently capturing the views/ideas of people with a lived experience in the solutions they feel is needed
- Ambulance response target isn’t always being reached
- Different motivations for different partners – yes should be day to day business but is sometimes a hard sell
- Local areas may not appreciate that they will save money – fear of making additional investment
3. What are the next steps for the Concordat? What changes would you like to see in a year’s time?
- We need to be more explicit about CYP and join up at department level
- Development of apps – self-help etc.
- Delivery of the actions
- Widen the membership of the Crisis Concordat group to build representation for the partnership
- We know what works – needs to be upscaled and implemented everywhere
- Need to have carers more clearly involved. Crisis has significant impact but not recognised – young carers etc.
- Use the voluntary sector more!
- Faster effective access from 999 call to definitive mental health care e.g. direct entry to mental health unit 24/7
- Roll out ‘models of care’ to be shared, ensuring sustainability
- Self-referral to crisis service
- Freedom and flexibility in how services are delivered
- In a year’s time I hope that there is still a Mind / DH team leading the programme
- Local authority suicide prevention action planning – roll-out and improvement
- Re-focus on core pathways for children in crisis – social work and medical model (joint budget / working)
- Roll-out / duplication of Bradford approach ‘whole system’ nationally
- Clear quality standards on crisis services and HBPoS
- Consistent access to beds, ambulance and mental health professionals
- Focused work on key areas – substance misuse / self-harm