"Out of Hours provision for people with a mental health crisis in the Cambridge area"

About: Addenbrooke's Hospital Addenbrooke's Hospital / Accident and emergency Cambridgeshire and Peterborough NHS Foundation Trust / Adult mental health NHS Cambridgeshire and Peterborough CCG

(as a relative),

I am seriously concerned about the current provision of out of hours mental health support for adults with a mental health crisis in the Cambridge area. I am the partner of an adult who has Asperger Syndrome, as well as comorbid mental health difficulties.

What could have been better?

In my opinion, there is a clear service gap out of hours (night-time, weekends and bank holidays) for those who need urgent support. My partner has attended Accident & Emergency (A&E) at Addenbrooke's on four occasions in the last couple of months due to an acute worsening of his mental health problems. My partner does not know his GP well and, although he is highly intelligent, has difficulty asking for help and articulating what is wrong. This is because of his Asperger Syndrome, and is a significant barrier to accessing relevant support services.

On the first occasion we had to wait for over four hours to see an A&E doctor, and were then told that we would have to wait at least another five hours before the duty psychiatrist would see my partner. My partner was admitted to the Emergency Assessment Unit (EAU) whilst we were waiting. My partner did not want to be admitted to hospital, however we were told by nursing and medical staff that we had no choice as we had been waiting in A&E for so long by this point, and my partner was about to 'breach' the government waiting time targets. A&E/EAU is an inappropriate setting for somebody with acute mental health problems who has no physical health need, and needs to see a member of the mental health team urgently. My partner eventually walked out as he had become increasingly frustrated at the lacklustre co-ordination of service and the very long wait. I share his concerns.

We were told by the Crisis Resolution and Home Treatment Team (CRHTT) over the telephone, and various A&E staff that there is only one duty psychiatrist working out of hours (night-time, weekends and bank holidays) who has to cover the Fulbourn, Ida Darwin and Addenbrooke's Hospitals. We were also told that the CRHTT will not see anyone without having been assessed by the A&E doctor first, even if their case is very urgent. This not only exposes a gap in service provision, but is also potentially dangerous. A member of my partner's family sadly took their own life two years ago after a strikingly similar experience with the CRHTT and Addenbrooke's A&E.

On subsequent occasions, we have had similar experiences and did not actually see a psychiatrist until the fourth visit due to the excessive waiting times which cause my partner anxiety and extreme frustration. On the fourth visit my partner was admitted to the EAU (even after stating that he did not want to be admitted) and we had to wait for over seven hours in total.

The outcome of the meeting with the psychiatrist was an urgent referral to a local Community Mental Health Team (CMHT). We were told that we would be receiving a telephone call from an assessment team to find out more about my partner and his difficulties, as well as a letter with an appointment to see someone at the CMHT. It is now over two weeks later and we have not received any telephone call or letter. This is not what I would expect for an 'urgent' referral to the local CMHT.

My partner struggles with ambiguity and needs concrete clear information. We were clearly told by the duty psychiatrist what support was to be arranged, and this has not materialised. My partner will take things as literate, and it has been a big source of anxiety that this has not been arranged.

We contacted Urgent Care Cambridgeshire who said that there was nothing on our GPs records about any referral. We also contacted the local CRHTT by telephone at Fulbourn Hospital, who were unable to help or tell us about the progress of the referral. We were told by the CRHTT staff member that all we could do was visit our GP on Monday and 'push for an urgent referral to the CRHTT or CMHT'. This is completely unacceptable. Service users and carers should not need to have to continually chase up an 'urgent' referral to a mental health service.

What was good?

Staff (over the telephone) at the CRHTT tried their best to listen to my partner and me, even though their hands were tied and they could do nothing. Some A&E staff (not all) were sympathetic to our situation, even though they were powerless to speed through an urgent referral to the CRHTT.

My partner is (understandably) very frustrated. I am actually a mental health worker myself and was shocked at the disorganisation, lack of consistency and communication, and unacceptable standards of support that was available. We have just moved back into the Cambridge area after a few years living elsewhere. Moving home is incredibly stressful for anyone, but particularly for people like my partner who have Asperger Syndrome and really struggle with change. This, coupled with starting a new university and some other stressful life events, has led to a relapse in my partners’ mental health problems. I would expect better care and support for him, especially since the implementation of the Autism Act and the recent findings of the CQC about the multitude of problems that occurred at various services within CPFT.

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Response from Lee Bennett, Head of Patient Liaison, Cambridge University Hospitals NHS Foundation Trust

Thank you for posting your comments. We were sorry to learn of your concerns. From an Addenbrooke's perspective we can only comment on the care provided in the Emergency Department. I am sure colleagues at both CPFT and NHS Cambridgeshire will respond to the wider issue of mental health care provision in Cambridge which is beyond our remit.

I have shared your comments with the senior clinical team in the Emergency Department and will add further comments from them as soon as I receive them. If you want to contact the Addenbrooke's PALS team in the meantime to discuss your concerns in more detail then we would be pleased to look into this for you. PALS can be contacted via email at pals@addenbrookes.nhs.uk or 01223 216756.

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Response from Maureen Walton, Patient Experience Manager, NHS Cambridgeshire and Peterborough CCG

Thank you for bringing this matter to our attention. We are sorry to learn that both you and your partner have had such a poor experience of the service.

We would be happy to assist you further and to clarify some of the concerns you have raised. We would therefore be grateful if you could contact a member of our Patient Experience Team by email at CAPCCG.PET@nhs.net or by telephone on (0800) 279 2535.

Kind regards

Patient Experience Team

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Response from Annie Ng, Head of Patient Experience, Cambridgeshire And Peterborough NHS Foundation Trust

Thank you for bringing this to our attention. We were sorry to hear about your experience of using our Trust services. We would be grateful to have an opportunity to speak with you directly about this. Would you be able to contact our PALS team directly on 0800 3760755 or via email palsandcomplaints@cpft.nhs.uk. Marie Mckearney is the PALS manager and she would be happy to discuss this further with you.

Kind Regards

Patient Experience Team

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Response from Lee Bennett, Head of Patient Liaison, Cambridge University Hospitals NHS Foundation Trust

I have now had a response from one of the Lead Consultants in the Emergency Department and I hope the following information is helpful:

The patient’s experience that their partner relates is distressing and fits with what we see for some of our patients at weekends and evenings currently.

For these reasons we have worked hard to resource an extended Psychiatry Liaison service. We are about to appoint a new consultant specifically for liaison in the Emergency Department (ED) and will be advertising for 5 new band 7 (senior) nurses so that we can provide a proper Liaison service until midnight during the week and 8-6 at weekends.

The team we hope to recruit will also be tasked with increasing the training for ED and CDU (clinical decisions unit) staff in mental health, working in ED in parallel with the ED team rather than waiting for medical issues to be sorted out then seeing the patient, they will also have more time to liaise with community mental health teams.

This feedback is very useful to us as we are bidding currently for more funding to improve the training aspect of the new service.

The patient’s partner mentioned CRHTT, it is worth saying that overnight the CRHTT nurse will assess patients with the duty doctor, but this is quite a new initiative. At other times they are covering all of Cambridge City so cannot always prioritise ED patients if there are other sick patients at home.

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