Four in ten mental health crisis teams understaffed

Crisis teams at four in ten mental health trusts are understaffed, with team sizes falling “well short” of government benchmarks for effective care, an investigation by mental health campaigners has revealed.

In a wide-ranging report on the state of mental health crisis care, mental health charity Mind warned that crisis teams are “under-resourced, understaffed and overstretched”.

The charity obtained data from 44 mental health trusts under the Freedom of Information (FOI) Act. It analysed the FOI data alongside a survey of almost 1,000 service users and preliminary research findings from mental health academics at University College London.

The results expose a huge variability in the support available to people in mental distress, with delays in people being assessed by professionals and under-pressure services rejecting clients who self-refer at the point of crisis.

Issues raised by the investigation include:

• 40% of trusts had staff numbers below the recommended level of 14 staff to 20 to 30 service users detailed in Department of Health guidance.
• One in ten crisis teams still fails to operate 24-hour, seven-day-a-week services, despite recommendations by the National Institute for Health and Clinical Excellence (Nice).
• Just 12 mental health trusts had more than one alternative option to hospital and home treatment for people in crisis. Five trusts had no alternatives.
• Just over a quarter (28%) of mental health trusts reported having access to one or more crisis houses. A previous investigation in 2007 found the level to be 38%.
• On average crisis teams visit service users every three days.
• Only one in five trusts accept self-referrals from service users that aren’t already known to them.
• Two-thirds of respondents who used crisis services said they were not assessed within the four hour window recommended by Nice. A similar level (65%) said they were not offered a choice of treatment. 
• Less than a third of service users (29%) felt staff treated them with “respect and dignity”.

Faye Wilson, chair of the British Association of Social Workers’ mental health forum, said that crisis teams are a “valuable resource” that are being overstretched by being asked to fill in the gaps for other services without additional support.

“They are not being supported with staffing and resource levels. They are being asked to do more and more,” said Wilson.

“Some are being told to help out with inpatient work, I know in my work as an AMHP that when I have section 136s under the Mental Health Act there is a role there too. I think the lack of resources means a lot of staff in these teams are being handed an impossible remit.”

Martin Webber, reader in social work at the University of York and a registered social worker, said he was “not at all surprised” at the findings.

“It supports the experience of service users and mental health social workers who find that crisis services operate as a quasi-tertiary service rather than an extension of primary care,” said Webber. 

“However, I can see little changing unless there is new investment, which is unlikely in the current financial climate. Meanwhile, it is left to the police and emergency duty teams to meet the needs of vulnerable people in need of crisis care.”

Paul Farmer, chief executive of Mind, said: “We are deeply concerned that some crisis care services appear to be struggling to support people with mental health problems when they need help the most.”

“Good services can make a huge difference to whether someone recovers from the crisis, yet Mind often hears from people who have been turned away because they “aren’t suicidal enough” or who have been made to wait around for hours just to be seen by someone who can help them. An emergency is an emergency,” Farmer added.

Paddy Cooney, interim director of the NHS Confederation’s mental health network, said: “Health and care professionals should always treat every service user with the respect and dignity they deserve. Anything less is completely unacceptable.”

“It’s no secret that the NHS is under intense financial pressure at the moment, but for the future health of the country, it is crucial we don’t see a disproportionate impact on mental health funding or services,” added Cooney.