Background: The Welsh Mental Health Crisis Care Concordat (MHCCC) was published in December 2015. The focus of the concordat is on improving the quality and availability of services, with an emphasis on people in acute mental health crisis. Its main objective is to prevent the criminalisation of people who present with mental health problems. A National Task and Finish Group (NTFG) Board has guided the development of the MHCCC and the local implementation plans in Wales. These plans will now be implemented over the coming months.
What the evaluation is about
We explored the experiences of people involved in developing the Mental Health Crisis Care Concordat implementation plans across Wales in this early and brief evaluation. The aim was to identify opportunities and gaps that have emerged and to provide learning to inform the rollout of the MHCCC.
What we did: We looked at all the local implementation plans and talked to 21 representatives from statutory services and third sector organisations about: their role in the planning, development and implementation of the concordat; their understanding about how the concordat will operate and the expected benefits/challenges arising from the concordat.
Summary of findings:
- Stakeholders report the NTFG as a great success as it provided a forum for discussion and knowledge exchange.
- Opportunities to move away from silo thinking and working to provide a service that matters to people was seen as important.
- Local delivery plans include innovative ideas and areas of good practice
- Details need to be agreed on how the plans will be delivered.
- Challenges include agreeing priorities, working within financial constraints and maintaining momentum.
- Crisis care pathways need to be supported by clear decision-making arrangements and real time clinical advice where appropriate.
- Care should be based on recovery principles and professionals should treat people with compassion and dignity.
- Providing services for people who are intoxicated and/or moderately violent and the development and provision of a range of Alternative Places of Safety (APoS) were perceived as challenging and may benefit from further work at national level and additional resources.
- Decisions need to be made about what data to collect, how it is collected and how it is shared.
- Data collected needs to include experiences of people using the services and professionals providing it.
- Including people who use services and carers is very beneficial and can ensure that services provided meet people’s needs
This brief and early evaluation of the implementation of the Mental Health Crisis Care Concordat and the experiences of people involved in the National Task and Finish Group highlights some successes and illustrates examples of good practice and innovation. There is cause for optimism and excitement looking ahead to the actual implementation of the MHCCC. However, the work is only just beginning and this brief evaluation has identified a number of areas that will be important in the future of crisis care.
Our findings and the literature around comprehensive person-centred mental health service provision, suggest that conceptualising mental health crisis responses as occurring in a system of services rather than independent sectors is critical. Developing and implementing care pathways collaboratively is crucial. Ensuring that all key partners are familiar with these pathways is equally important. Taking forward joint working principles and learning from the development phase will be key to making the implementation of the MHCCC a success. Providing opportunities to share learning and experiences are essential and examples are joint training and co-location (for example in the control room). Distinct visions of care and service provision that guide specific practice need to be made transparent. A system approach underscored by principles of joint working will facilitate working through challenging issues such as conveyancing or providing services to people who are intoxicated and/or moderately violent or. Areas need to make sure that they develop mechanisms to sustain collaboration and work towards embedding change in their organisations. Situating the MHCCC in the wider policy and practice context such as the unscheduled care framework would support this.
Recommendations
- Continue developing and strengthening joint working foundations whilst moving from a task-focused to a systems thinking approach: This will facilitate dealing with complex issues, including commissioning and running Alternative Places of Safety and working with people who are intoxicated and/or moderately violent.
- Consider overall data needs to be able to document change and compare service provision across Wales: in addition, meaningful qualitative data should be collected and ways established so it can be fed back into the system to enable learning.
- Continue enabling meaningful involvement for people who use services and their carers at all stages of the implementation: This would support the shift from a medical, problem-focused model of service delivery to a recovery-based one.
Wider questions
It became clear during the interviews and the analysis of the data that there are some wider issues linked to the implementation of the MHCCC, which need to be considered. The following two issues seemed to be the most pertinent:
- What is the role of the police in mental health crisis? Some commentators in the literature suggest that this is linked to the wider question of the future of policing in the 21st century. Additionally, there are debates about the police taking more of a public health role.
- What are the definitions of mental illness, distress and crisis and our expectations of appropriate responses from services and communities? There are a number of interpretations and expectations that people and professionals hold implicitly. These need to be articulated and made transparent.