Mental health reform targets vital by October 2017 – Crisp Commission

Much-anticipated findings from the Crisp Commission have recommended a string of fundamental reforms across England’s mental health system by October 2017 – including introducing a four-hour wait target for adult psychiatric wards and phasing out the national practice of sending patients long distances for treatment.

The commission, created in January 2015 and chaired by former NHS chief executive and permanent secretary at the Department of Health, Lord Nigel Crisp, found that access to acute care for severely ill adult mental health patients is inadequate and, in some cases, even potentially dangerous.

“There are major problems both in admissions to psychiatric wards and in providing alternative care and treatment in the community. These two sets of problems are intimately connected and need to be tackled together,” the final report said.

Lord Crisp said the report’s major headline was the need to end the difference in standards between mental and physical illnesses: “People with severe mental illnesses need to find care just as quickly as people suffering from physical illnesses – and they shouldn’t have to travel long distances to do so.”

The commission’s first recommendation was to roll out a pledge in the NHS Constitution by 2017 for a four-hour waiting time ceiling across wards and acceptance for home-based treatment following assessment.

But it also criticised the practice of forcing acutely ill patients to travel long distances to receive treatment due to severe bed shortages, demanding that is phased out nationally by October next year. In 2015, the HSCIC revealed that more than 2,000 mental health patients had to travel outside their local region for beds, which often accounted for a journey of over 50km.

The Crisp Commission’s interim report, published last year, also found that delayed discharges, unsuitable living conditions and inappropriate services were also the real culprits behind these excessive bed shortages.

As a result, it recommended today that there must be better access to a mix of types of housing and greater flexibility in its use to provide for short-term use in crises, as well as reduce delayed discharges from inpatient services and offer long-term accommodation.

Prof Sir Simon Wessely, president of the Royal College of Psychiatrists, the body responsible for creating the commission last year, said: “The answers lie not in just providing more beds, although there are definitely places where that might help in the short term, but assessing the entire system. 

“In particular we stand alongside Lord Crisp in asking that there is a new pledge for a maximum four hour wait for admission or home treatment by 2017, and that the unacceptable practice of sending seriously sick patients around the country is ended by the same date.  If we were talking strokes, heart attacks or cancer, we wouldn’t even have to ask.”

Also by October 2017, commissioners, providers and strategic clinical networks in each area must undertake a capacity assessment and improvement programme to ensure they have the right amount of beds and resources across their crisis resolution and home treatment teams.

Major mental health charity Mind – whose chief executive, Paul Farmer, sits on the commission’s panel and heads the country’s delayed mental health taskforce – supported the report’s goal to put an end to the “mental health postcode lottery”.

Farmer said: “It is unacceptable that people who are feeling suicidal or who may have self-harmed and are in desperate need of care find themselves trekking hundreds of miles across the country to get help. It is essential that when someone has a mental health problem and they are in crisis that they can reach out and always get the support they need as swiftly as possible.

“Mental health has historically been underfunded and the scandal around out of areas placements is a symptom of a mental health service in dire need of significant investment.  A mental health crisis is an emergency just like a physical health emergency and we should not be prepared to tolerate a second rate service for either.”

Other important recommendations across 12 key points in today’s report included creating a single set of clear and measurable quality standards for acute psychiatric wards; enhancing the role patients and carers play in service design, monitoring and governance; piloting a race equality standard to improve the experience of care for black and minority ethnic communities; improving data collection and use; promoting leadership development and an open culture across mental health organisations; and increasing financial transparency.

Mismatched government rhetoric

Stephen Dalton, chief of the Mental Health Network – the health service’s own organisation for service providers – argued part of the problem was that the government’s rhetoric about prioritising mental health does not match the reality of “shrinking funding” and “hard-working staff struggling to cope with growing public need”.

“The report rightly says this is not just about beds but is about understanding why people are admitted and why it can be difficult to discharge some people. The real answer is to ensure people can get care when and where they need it most,” he added.

“In recent years investment in mental health services has been falling. It is now urgent that this trend is halted and that we see NHS England get investment directly to the frontline of provision.”

Shadow mental health minister Luciana Berger MP, who spoke to NHE about mental health services and commissioning in November, agreed with the last point, blaming Tory ministers for “presiding over a system described as potentially dangerous”.

“The commission rightly highlights staffing shortages, unacceptably long waits for care and the unacceptable practice of sending very ill patients hundreds of miles just to get a bed – something which has significantly increased on this government’s watch,” she continued.

Care and mental health minister Alistair Burt said he asked NHS England last year to “reduce unnecessary out of area treatments, and eliminate their inappropriate use”.

But he acknowledged that “there should be standards for what people can expect from mental health treatment, and when”.

“NHS England and others will be working on this over the coming months,” Burt said. “It’s vital that people get the mental health care they ne         ed as quickly and as close to home as possible.”

Prime minister David Cameron has also pledged increased mental health funding of up to £1bn from different sources, with NHS England due to publish a report on improvements next week. According to the Crisp Commission, spending on mental health amounted to just £6.6bn in 2011-12.

NHS England’s mental health taskforce final report, once pencilled for a November deadline, is also expected shortly.


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