Project Details
Description
Background
In 2014 the UK government published its mental health crisis care concordat, and stated that it expected that ‘every community have plans to ensure no one in crisis will be turned away’ (Department of Health and Concordat Signatories, 2014). A recent study that compared mental health presentations in five acute mental health assessment centres in London, before and at the peak of the COVID-19 pandemic, found that following assessment 28.8% of people were discharged without follow-up before the lockdown, and after lockdown 28.0% of people were discharged without follow up (Mukadam et al., 2021). The issue of exclusion from services at the point of a mental health crisis is nationwide. People who experience a mental health crisis often attend emergency departments (EDs) and research into patients who attend EDs across England for mental health reasons found that 31.4% were discharged without follow-up (Baracaia et al., 2020). Furthermore, the Care Quality Commission found that only 14% of the adults they surveyed replied ‘yes’ when asked if they felt the care they received provided the right response and helped them to resolve a mental health crisis (Care Quality Commission, 2015). An inquiry by Mind (2011) into acute and crisis mental health care found that many people reported access to services at the time of a mental health crisis as highly problematic, with people describing that they had been ‘batted away’ and ‘deflected’, and one respondent explaining that ‘it feels like I literally have to have one foot off the bridge before I can access services’.
Exclusion from mental health services on the very basis of psychiatric diagnoses is undoubtedly a paradox, and this appears to intensify for people with a dual diagnosis, or comorbidities. It seems that the more psychiatric diagnoses a person has, the more likely they are to be excluded from services. For example, a study on comorbidity of substance misuse and mental illness in community mental health and substance misuse services found that a third of patients who misuse substances and have mental health problems do not receive any mental health intervention at all (Weaver et al., 2003) and this group is more likely than others to fall between services when experiencing a mental health crisis (Hughes et al., 2007).
The work proposed here will be informed by and will be an important augmentation to the NIHR Three Schools funded work and will in turn inform the development of grant application to the NIHR RfSC.
Aims and objectives
For this scoping study we aim to find out about:
• Who does not get care when they are having a mental health crisis and if they used social care services when they were excluded
• Whether they sought out social care services
• Any social care services that they do have contact with
To do this we will:
• Interview people who did not get the health care they needed when they experienced a mental health crisis about their engagement with social care services, to explore their experiences, barriers to support and their views on services or strategies for social care that could address exclusion during a mental health crisis.
People who have experienced exclusion from health services during mental health crises, carers and people who work in social care services will be involved in this scoping study. They will:
• Help put together the questions for the interviews
• Help us to understand the information we collect
We will share what we learn from this scoping study with people who work in social care services and with policymakers. By doing this, we hope to work on ideas for more research that will inform the development of training to improve the provision of services.
In 2014 the UK government published its mental health crisis care concordat, and stated that it expected that ‘every community have plans to ensure no one in crisis will be turned away’ (Department of Health and Concordat Signatories, 2014). A recent study that compared mental health presentations in five acute mental health assessment centres in London, before and at the peak of the COVID-19 pandemic, found that following assessment 28.8% of people were discharged without follow-up before the lockdown, and after lockdown 28.0% of people were discharged without follow up (Mukadam et al., 2021). The issue of exclusion from services at the point of a mental health crisis is nationwide. People who experience a mental health crisis often attend emergency departments (EDs) and research into patients who attend EDs across England for mental health reasons found that 31.4% were discharged without follow-up (Baracaia et al., 2020). Furthermore, the Care Quality Commission found that only 14% of the adults they surveyed replied ‘yes’ when asked if they felt the care they received provided the right response and helped them to resolve a mental health crisis (Care Quality Commission, 2015). An inquiry by Mind (2011) into acute and crisis mental health care found that many people reported access to services at the time of a mental health crisis as highly problematic, with people describing that they had been ‘batted away’ and ‘deflected’, and one respondent explaining that ‘it feels like I literally have to have one foot off the bridge before I can access services’.
Exclusion from mental health services on the very basis of psychiatric diagnoses is undoubtedly a paradox, and this appears to intensify for people with a dual diagnosis, or comorbidities. It seems that the more psychiatric diagnoses a person has, the more likely they are to be excluded from services. For example, a study on comorbidity of substance misuse and mental illness in community mental health and substance misuse services found that a third of patients who misuse substances and have mental health problems do not receive any mental health intervention at all (Weaver et al., 2003) and this group is more likely than others to fall between services when experiencing a mental health crisis (Hughes et al., 2007).
The work proposed here will be informed by and will be an important augmentation to the NIHR Three Schools funded work and will in turn inform the development of grant application to the NIHR RfSC.
Aims and objectives
For this scoping study we aim to find out about:
• Who does not get care when they are having a mental health crisis and if they used social care services when they were excluded
• Whether they sought out social care services
• Any social care services that they do have contact with
To do this we will:
• Interview people who did not get the health care they needed when they experienced a mental health crisis about their engagement with social care services, to explore their experiences, barriers to support and their views on services or strategies for social care that could address exclusion during a mental health crisis.
People who have experienced exclusion from health services during mental health crises, carers and people who work in social care services will be involved in this scoping study. They will:
• Help put together the questions for the interviews
• Help us to understand the information we collect
We will share what we learn from this scoping study with people who work in social care services and with policymakers. By doing this, we hope to work on ideas for more research that will inform the development of training to improve the provision of services.
Status | Finished |
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Effective start/end date | 1/04/23 → 30/06/23 |
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