‘Too many’ in crisis receive poor care, warns watchdog
People facing mental health crises often think they are being judged and disrespected by emergency care staff, according to evidence compiled by the Care Quality Commission
People facing mental health crises often think they are being judged and disrespected by emergency care staff, according to evidence compiled by the Care Quality Commission (CQC).
The finding is part of the CQC’s review of the quality, safety and effectiveness of care following the signing last year of the Crisis Care Concordat.
The CQC report, Right Here, Right Now, suggests that the quality of care experienced by people in crisis in England varies depending on where they live and when they seek help. Many people in crisis have problems accessing appropriate help when they need it.
Attitude of staff
When assessed on the attitude of staff, those working for charities and volunteers have received the most positive ratings, while emergency care providers fare worst.
Despite many examples of good care, ‘far too many’ people in crisis have poor experiences due to service responses failing to meet their needs, and lacking basic respect, warmth and compassion.
‘This is unsafe, unfair and completely unacceptable,’ concludes the report, which is based on evidence from service users, analysis of national data and local area inspections.
CQC deputy chief inspector of hospitals and lead for mental health Paul Lelliott says the findings must act as a ‘wake-up call’ to public services. ‘It is not acceptable for people with mental health problems to be treated differently from those with physical health problems.’
The CQC put out a call for evidence in spring 2014 and had more than 1,750 responses in six weeks. Most respondents said they were dissatisfied with how emergency departments (EDs) deal with them. Slightly more than one third (36%) of people who had attended EDs during crises said they had felt respected, 37% said they had been listened to and their concerns had been taken seriously, and 34% said they had been treated with warmth and compassion. Of the 300-plus people who submitted evidence on their experiences of emergency care, only 33% said they had not felt judged.
'Self-harm is the most likely mental health-related condition that emergency care staff encounter, yet people who had attend as a result of injuries consistent with self-harm reported that they had had ‘almost universally’ negative experiences. One said: ‘A&E was horrible. I felt like I was being judged for inflicting injuries on myself and that certain staff actively didn’t want to treat me.’
The report notes that those presenting with self-harm at EDs may do so because primary care services cannot refer them to appropriate services or because of pressures on specialist mental health services that prevent them from providing community support.
According to the report, two thirds of people in crisis attending EDs several times had had previous contact with specialist mental health services, which suggests that people in crisis struggle to access specialist services. Some reported that, when they had sought help out of hours, they had been directed to EDs.
Dr Lelliott says: ‘Our report demonstrates a weakness in mainstream mental health provision in regard to 24-hour crisis care. In some cases, the only recourse for people trying to access crisis services is a phone line telling them to go to their local emergency departments.’
His comments are echoed by RCN general secretary Peter Carter: ‘Anyone 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 heart breaking to hear that many patients do not experience such treatment. The consequences of a failed attempt to access help can be serious.
‘The UK has made great advances in its understanding of mental health conditions but, until we invest in the care that helps at the right time, we will see more people who are seriously unwell presenting in overstretched emergency departments.’
British Medical Association board of science chair Sheila Hollins points out that mental health services have been subjected to ‘significant funding cuts’ just as demand has increased.
‘There is a need for better 24-hour crisis care for patients with mental health issues as the current availability and access is poor,’ she says. ‘When emergency departments face unprecedented pressure, it is unacceptable that patients have to rely on overstretched emergency services for help due to a lack of mental health provision.’