"Non existent crisis support - sent round in circles"

Have been staying with a friend to give family a break as their mum is extremely unwell. The GP is non existent on the scene and despite being told the MH Trust is poor when people are in crisis it is where NHS 111 direct you to.

In fact everywhere directs you to same line. NHS 111 refused to refer so I or others have to as she is too unwell.

I live in a different city where there is a range of face to face crisis support places- none of which closed their doors during covid. I expected Islington to have similar provision. How wrong can you be.

The crisis line is run by the Trust. I rang several different times over several days and I dont know if it was because I was ' just a friend ( albeit also a health professional) that they took the attitude they did or because it is staffed with such inexperienced people. 

One person I spoke to wasn't even a fully qualified professional so shouldn't be allowed on this line in my opinion. My friend won't go near them and can't manage calls and her family feel they are not able to help.. 

So, this is what happened and it would be really helpful to know what I could have done differently or if these concerns should go to funders or the CQC instead? ( Although dont think funding would improve the quality).

- Over several evenings the wait time was over an hour. I had already left amswerphone messages that hadn't been returned. The phone would cut off after about an hour. This is not good enough and not clinically safe

- I spoke to 3 different workers. 2 couldn't find my friend on their system which actually shouldn't matter as anyone can approach and self refer so using this as a reason for not continuing the call is, frankly lazy. 

If you can't find someone's name then start a new referral. Given 2 different workers claimed this stopped them being able to help this would appear to be a Trust gatekeeping decision

- She should have been assessed urgently in my view. I was told instead of arranging an appointment to assess her ,day or night, I had to get her to A&E if at night or a hub in St Pancras during the day. A& E say they dont see MH pts so why direct there ? And it's a terrifying place for someone in crisis. I knew as a health care professional to ring ahead and check and 2 local A&Es both said they would turn away. 

So, the crisis team dont go out to people in distress at night in this borough? Why not? 

- Contradictory advice from one person said I could not take her to the emergency MH crisis care hub as she needed an appointment to see someone. They couldn't say if this was both day and night. They told me to call 999 as they would arrange to take her to the right place and -they would know.  Why dont crisis team workers know?

Not only is that going to unnecessarily increase risk and a factor crisis team workers must be aware of , it is also a huge waste of ambulance resources.

- The website says anyone can turn up at the hub in St Pancras Hospital day or night and no appointment is needed. It advises to ring ahead if possible but that same advice has been on there throughout the pandemic and appears related to covid travel restrictions. 

Again, that the Trust has left the same wording when travel restrictions and clinical restrictions have never been in place for medical crises seems to be about managing Trust resources not about safety. Again, this is gatekeeping or the wording would be different.

Why is such ambiguous wording there and why are crisis line staff stating someone has to make an appointment to be seen at the hub?

- Is the crisis line run by the crisis team because it felt like they were talking about 2 completely different services?

She needed urgent assessment for crisis support. Another friend had been told recently by a crisis house that the crisis team were gatekeeping referrals there . So crisis team refuse to go and see and  assess in own home, refuse to see at the hub the website says to go to as can't just turn up there and directs to A&E's that won't allow in.

In my view, you left someone at extremely high risk of suicide with NO support and that was with a friend ringing for them. 

You told me totally inappropriately that she - should ring the Samaritans - knowing she can't do so.

 She went missing a few days after I had to go home. With then huge police searches and where her physical health deteriorated so rapidly she had to be readmitted to hospital for urgent physical care. The Trust were contacted 're her discharge home and still no contact from the crisis team and so we go round in circles until something catastrophic happens. 

I know my way around the NHS but MH services are confusing, misleading and the communication is appalling.

How is anyone on their own meant to manage this?

Your crisis workers said they weren't even in the same place as the hub which surely can't help with communication. 

I have noticed the Trust only responds periodically and presumably only when a CQC inspection is due.

Maybe this time just put out a flowchart for those trying to get support themselves or for those of us trying to support because your crisis care system is broken.