A&E among least compassionate for mental health crisis care

Just a third (34%) of those who went to an A&E department said they were treated with warmth and compassion and only 35% said they received the help they needed in a timely way.

But nearly two thirds (65%) said the police gave them the help they needed, higher than the half (52%) who said this was true of their GP or community mental health team (28%).

The survey, which forms part of a report into mental health crisis care by the Care Quality Commission (CQC), found that A&E departments received the lowest score of any service.

Charities and volunteers were overwhelmingly seen as offering the most caring and effective help while ambulance staff, GPs and telephone helplines also scored well in some categories.

Community mental health teams were not given high ratings by those questioned, with two in five (43%) feeling that they did not consistently listen or take their concerns seriously.

Just 14% of respondents answered “yes” when asked the general question if they thought the care they received provided the right response and helped to resolve their mental health crisis, with 42% answering “no” and the same proportion saying “some but not all” of the time.

The CQC said the report reveals that public services need to “wake up” to gaps in mental health crisis care, with concerns that local authorities, NHS trusts and clinical commissioning groups are failing to work together to make sure that people in their local areas have access to crisis care around the clock.

It said there is a clear need for better 24-hour support for people having a crisis, particularly during the peak times of 11pm to 5am when people in crisis most often enter the system, as currently people often have to go to A&E departments or end up in police cells, rather than receiving specialist care straight away.

Around 5% of all A&E attendances are recorded as relating to mental health problems, and the CQC said it was clear that healthcare professionals can appear to lack compassion and warmth in how to care for and speak to people who are having a crisis, particularly those who have harmed themselves.

“One of the clearest findings from our call for evidence was that people are not satisfied with how A&E departments respond to people in crisis,” the report said.

“While we recognise the pressure that A&E departments are under, it does not excuse the fact that this figure remains unacceptably low.

“Feedback from people who came into contact with the police showed the service in a more positive light than many of the specialist mental health services. It is encouraging that a professional working outside of specialist services can get it right and this should act as a challenge to those working in the health service to do the same.”

The report said that although it is difficult to determine the exact number of people who have a mental health crisis, more than 68,800 people were admitted to a mental health ward for urgent care in England as inpatients in 2013/14.

Symptoms can include suicidal behaviour or intention, extreme anxiety and panic attacks, psychotic episodes such as delusions, hearing voices or a loss of sense of reality, and behaviour that is considered out of control or irrational to the extent that the person poses a risk to themselves or others.

Dr Paul Lelliott, the CQC’s deputy chief inspector of hospitals and mental health lead, said: “These findings must act as a wake up call to our public services.

“It is not acceptable for people with mental health problems to be treated differently to those with physical health problems.

“The majority of people who have a mental health crisis experience it out of normal office hours, and so the NHS and our other public services must make sure they are equipped to provide the specialist and urgent care that is needed around the clock.

“What’s more, we found that when people do receive help, hospital and mental healthcare staff are not always compassionate and caring. Worryingly, many people told us that when they were having a crisis, they often felt the police and ambulance crews were more caring and took their concerns more seriously than the medical and mental health professionals they encountered.”

Alistair Burt, Minister of State for Community and Social Care, said: “Improving mental health care is my priority. I am clear that there is so much more to achieve and we all need to work together to achieve it.

“The CQC will now inspect crisis care arrangements in every service and I have asked them to continue to help stamp out poor care and help us to make sure that people with physical and mental health conditions are treated with equal importance.”

The Department of Health asked the CQC to carry out the report as part of its wider pledge to improve mental health services and follows a £300 million increase in investment last year.

Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “Anybody experiencing a mental health crisis has a serious condition that needs to be treated urgently, and with skill – just as they would if they had a serious physical injury or illness.

“It is heartbreaking to hear that many patients do not experience this, and the consequences of a failed attempt to access help can be very serious.

“Mental health nurses in particular are experts in providing the care that is needed, and in intervening early so that the most serious symptoms can be avoided.

“The expertise is out there to avoid the need for crisis care, and to keep people out of distressing situations like A&E, but it needs proper investment in getting the right number of expertly trained staff in the community and in specialist services.”

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