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"Non existent crisis support - sent round in circles"

About: Camden and Islington NHS Foundation Trust

(as a friend),

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.

Responses

Response from Camden and Islington NHS Foundation Trust last month
Camden and Islington NHS Foundation Trust
Submitted on 23/06/2021 at 13:03
Published on Care Opinion on 24/06/2021 at 09:58


Dear GreenFingerFriend

Thank you for taking the time to inform us of your experience accessing support for your friend. We are very sorry that you had a negative experience and value the feedback for our learning to improve practices across our crisis services.

The Crisis Single Point of Access (CSPA) is our 24/7 urgent mental health crisis telephone line and is staffed with Crisis Resolution Team Clinicians. Clinicians can belong to a registered profession such as nursing, occupational therapy or social work but can also be graduates from a related area and/or have experience and skills working in the area of mental health. These clinical and assistant practitioners are a valued and skilled part of our of crisis team workforce however there should always be an available senior registered professional or manager to assist with any complexities or complaints on the call.

CSPA take referrals from a variety of sources including friends and family who are concerned about someone in mental health crisis. NHS 111 can also transfer calls to the local CSPA for people with mental health related issues.

We do try and seek consent from the person being referred and involve them as much as possible in the referral and in some cases do attempt a more assertive approach for assessment and home treatment if that is what is required. Details like name, date of birth and contact details are asked by the CSPA clinician to identify the appropriate electronic records for the person being referred. If they are not found on the local patient electronic notes then a search of the national database can be conducted to find the person. Not finding the appropriate records should not be a reason for not continuing the call and it would be helpful if you got in touch to provide us with more details of your referral. On acceptance of a CSPA referral CRT assessment can occur within 24 hours.

We do apologise for the long wait for your calls to be answered. There is a voicemail facility option that callers can choose to leave a message instead of waiting and a call back should happen within 1 hour. The call volume to CSPA has increased and we are looking into different workforce models to better manage the increased call volume, particularly at certain busier times of the day. If you are able to provide the dates and approximate time of your calls we can look into the reasons why call handling was particularly delayed. Reviewing the call data the average time to answer a call from Jan 2021 to April 2021 was between 1min to 2 min25seconds, however there is a proportion of calls that are unable to be answered within a short time frame and either leave a voicemail or unfortunately are abandoned.

Appointments for the Mental Health Crisis Assessment Service (MHCAS) are not expected and this service is open to self-referral 24/7 for emergency Mental Health assessment. The local A&E departments should not turn people away and have mental health navigator staff present to triage and may transfer persons presenting with mental health issues only if safe to do so to MHCAS for further assessment and care planning.

Finally we want to assure you and anyone reading this that friends can refer to the CRT via the CSPA on our freephone number 08009173333.

Thank you once again for posting your feedback on Care Opinion. It would be helpful for us to look into the details of your complaint and therefore encourage you to email us at feedback@candi.nhs.uk with details of the referral you were trying to make for your friend. All our calls are recorded for training and quality purposes so we can examine more closely what happened when you got in contact with our CSPA and what should have happened and provide you with a more detailed response. We can also share any more specific learning with staff and also with the relevant acute hospitals that are indicated in your complaint.

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