To: Melanie Walker - CEO of Devon Partnership NHS Trust
Ensure everyone presenting at a Devon A&E in a MH crisis is seen
I am writing to you today, to ask you to change policy so that everyone who presents at one of Devon’s accident & emergency departments in a mental health crisis during the pandemic, gets seen by a member of the liaison psychiatry team.
Why is this important?
I understand the logic in wanting someone to avoid A&E unless they have co-morbid psychical injury, however people often feel scared, like they have nowhere else to go. If someone reaches somewhere safe like A&E it is absolutely vital that they are seen.
It seems morally wrong that this service is now shielded, asking people to phone the First Response call centre even once they have arrived at A&E, to reduce the amount of people being seen. To someone in severe distress, this could be the last straw and make them feel as if they don’t deserve help and that they shouldn’t have reached out.
Those in a mental health crisis are highly vulnerable individuals who could be at serious risk of harm, many will not be able to talk on the phone.
I have unfortunately had first-hand experience of this new system.
Appendix 1.4.1 of this NHS England document from 2016, “Achieving Better Access to 24/7 Urgent and Emergency Mental Health Care”, states
The evidence-based treatment pathway introduced in this guide requires that people who need urgent and emergency mental health care receive an evidence-based package of care informed by NICE guidance within four hours of presenting in an ED or referral from a ward.
• An urgent and emergency liaison mental health service should respond to the person within one hour of receiving a referral. An emergency response consists of a review to decide on the type of assessment needed and arranging appropriate resources for the assessment (see Section 4.2.2)
c The NCCMH, a partnership between the Royal College of Psychiatrists and University College London, was one of the national collaborating centres first established by NICE in 2001 to develop clinical guidelines. d Forthcoming on the NICE website.
• Within four hours of arriving in an ED or being referred from a ward it is recommended that the person should:
• have received a full biopsychosocial assessment, and
• have an urgent and emergency mental health care plan in place, and • at a minimum, be en route to their next location if geographically different, or
• have been accepted and scheduled for follow-up care by a responding service,
• have been discharged because the crisis has resolved
• have started a Mental Health Act assessment.
It’s worth noting that official NHS England advice on nhs.uk, (https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/) remains the same:
Call 999 or go to A&E now if:
• someone's life is at risk – for example, they have seriously injured themselves or taken an overdose
•you do not feel you can keep yourself or someone else safe
A mental health emergency should be taken as seriously as a physical one. You will not be wasting anyone's time.
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