Government rejected proposals for four-hour waits for mental health emergencies

The government rejected proposals to guarantee that NHS mental health teams would respond to emergencies within four hours because it didn’t know how much it would cost to make sure services could meet the target.

The proposals are contained in a series of options papers for mental health access standards drawn up by the Department of Health and NHS England last summer. The documents, released to Community Care under the Freedom of Information Act, were produced as part of the government’s commitment to introduce the first waiting times standards for mental health from April 2015.

The options

The introduction of waiting time standards to mental health has been hailed as a landmark moment for the sector. Two targets were approved and will be introduced from this April. These will require 95 per cent of patients referred to talking therapies to be seen within 18 weeks, and 50 per cent of people experiencing a first episode of psychosis to start treatment within two weeks. The documents released under FOI give an insight into the other targets, including several related to acute care, that were considered but rejected. These were:

• A guarantee that crisis teams would respond to most urgent cases within four hours and less urgent cases within 24 or 48 hours depending on need;
• A guarantee that people detained in police custody under section 136 of the Mental Health Act would have assessments completed within four hours after their detention – a move that would require extra Approved mental health professional (AMHP) capacity out-of-hours;
• A national rollout of a ‘good practice’ crisis team model from Bristol that would ensure people could get a response 24 hours a day and 7 days a week;
• A requirement for every police force to have a mental health street triage scheme;
• The national rollout of a pilot scheme testing out talking therapies for people with severe mental illnesses such as schizophrenia and bipolar disorder.

‘Reflecting the aim of parity of esteem’

The documents acknowledge that the proposal for a four-hour crisis team response for urgent cases would mirror the waiting time standards that currently apply to physical health – where 95% of patients attending A&E should be seen within four hours – “reflecting the aim of parity of esteem” between mental health and physical health.

Crisis teams, which provide intensive home treatment as an alternative to hospital admissions, have been in place for more than a decade.The options paper concluded that more research was needed to gauge whether the NHS could deliver on a four hour target for most patients within existing resources or whether funding to boost staffing numbers would be required. It recommended revisiting the option following an audit of current provision, consultation with clinical experts and studying the findings of the CQC’s review of crisis care which is due out later this year.

In a presentation from February last year, four months prior to the option papers being drawn up, the NHS benchmarking network found that in 2012-13 an average of 78.4% of patients were seen by crisis teams within four hours, but some teams only responded to 37% of the cases within the window. Concerns have also been raised over the resourcing of the services. A report by Mental Health Strategies, a consultancy group that analyses issues for mental health trusts and NHS commissioning groups, warned that too many home treatment teams were funded at levels that were “simply insufficient” to meet demand.

Section 136 assessment proposals

The proposals for a guarantee that assessments of patients detained to police custody under section 136 would be completed within four hours of detention were also not taken forward. The options paper states that with Mental Health Act assessments taking around three hours, an AMHP would need to arrive within an hour of the person being detained. With most detentions to police custody taking place out-of-hours this would likely require a doubling of AMHP capacity at a cost of between £20m and £30m a year, the paper estimated. The paper recommends improved data collection on delays to assessments before considering this proposal.

Community Care understands that the current government sees its crisis care concordat policy as the best route of improving access to crisis services rather than revisiting the crisis team access standard proposals. A Department of Health report from last year said that the next priorities for access and waiting times in mental health beyond 2016 will focus on better treatment of eating disorders and the potential for rapid access to mental health services for women in pregnancy or in the post-natal period with a known mental health problem.

A Department of Health spokesperson said: “We want to make sure anyone with a mental health problem can expect the same standards of care available for physical health problems. We’re introducing the first ever access and waiting time standards in mental health care – this is a huge step forward towards equality with physical health care, but it is also a first step.

“We are also committed to improving care for people in crisis – there has already been a 24 percent reduction in the use of police cells as places of safety this year. But we want to go further and local areas are developing action plans to make sure anyone in crisis gets the right care, in the right place, at the right time.”