"Crisis team access"

About: Lord St Resource Centre / Crisis Resolution & Home Treatment Team - St Helens

(as a friend),

I really do not understand access to the crisis team. I have a friend who has been in contact with mental health services for some time and has periods of crisis. We all know that crises don't just occur between 9 and 5. Yet whenever a crisis happens after 9 at night and this person asks to speak to someone, the answer is always 'you're not on the list so we can't contact them'. This happens even when there's a general knowledge that this person's having a few hard weeks. This isn't a one off event.

I can understand that they want to encourage people to get through crises themselves. And that one person's definition of a crisis isn't another's. But there must be a few people who members of staff have legitimate concerns about at any one time. Couldn't they have an additional list of people who aren't within the crisis team at that moment, but who might need quick access, or might not. Like a traffic light system - amber could go either way. Why does it seem like they don't want people to access their crisis service?

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Response from

Thank you for your feedback. I hope to be able to clarify points and take on board the issues you have raised.

The Crisis Resolution/Home Treatment Team (CR/HT Team) in St Helens operates from 9am-9pm throughout the week. After 9pm-9am the Team operate an ‘on call’ service, staffed by two practitioners, working from home and on call for home treatment and emergency assessments. This ‘on call’ work is in addition to full time working. The service provided meets the service specification laid down in the Department of Health Mental Health policy implementation guide and is the level of service commissioned by our local Primary Care Trust.

People open to the CR/HT Team are able to get 24 hour care if needed.

For new referrals, during weekdays, 9am-5pm, the CR/HT Team can be accessed via our Access and Advice Team if the person is not open to 5 Boroughs services or via the Care Coordinator if the person is already open to our services. However, as you have pointed out, not every crisis happens during normal working hours and in such an event, referral to the CR/HT Team is via GP, GP out of hours or the A&E Department at Whiston Hospital.

Due to reduced staffing levels with the ‘on call’ service, 9pm-9am, there is a need to prioritise work and this is done through close communication between services.

When a person attends out of hours at the GP surgery or A&E, he or she will be seen by a doctor for an initial screening assessment of his/her mental health needs. From this, if it is assessed as appropriate, he/she will be referred by the doctor to the CR/HT Team for further assessment/treatment.

To assist this process, every patient open to 5 Boroughs services receiving an enhanced level of care has an allocated Care Coordinator and a care plan. The care plan identifies the individual’s mental health needs and states interventions required to meet those needs. Within the care plan there should also be a crisis/contingency plan which details signs that the individual is becoming unwell and what needs to be done to help that person. The CR/HT workers and Care Coordinators are frequently in touch to identify those patients who are becoming unwell and have a potential crisis which may require support outside of normal working hours. Therefore, the Care Coordinator is the key professional to ensure that patients are able to get additional help when and where they may need it.

In the scenario you describe I recommend that patients and their Care Coordinators review care plans and specifically crisis/contingency plans frequently to ensure understanding of triggers to crisis and clear strategies are put in place to assist the individual to manage potential crisis points.

Should you wish, I will review the care provided on your behalf and liaise directly with you. My details are: Sandra Embling, Service Manager, Knowsley House, Peasley Cross, St Helens, WA9 3DE and my contact telephone number is: 01744 646736.

I would also like to thank you for your suggestion of having an additional alert system. I intend to explore your ideas further with the Teams involved with a view to improving assess and our response out of hours.

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