The London Mental Health Compact

Background and aims

The London Mental Health Compact is a shared statement of commitment to ensure that people in a mental health crisis had timely access to places of safety and mental health inpatient treatment, including services such as:

• London Mental Health and Acute Trusts
• London Ambulance Service (LAS)
• Approved Mental Health Professional (AMHP) services
• Clinical Commissioning Groups (CCGs)
• NHS England and Improvement
• Local authorities
• Police services in London.

The compact aims to improve access to mental health inpatient services in London by specifying minimum service standards and key stages along the patient pathway, with clear lines of responsibility and escalation processes. It also details the reporting requirements needed to ensure up-to-date information on bed capacity and service pressures.

People that present in mental health crisis should have timely access to effective intervention, such as health-based places of safety (HBPoS), mental health assessments, and conveyance and admissions into inpatient care. A ‘place of safety’ is used when an individual of any age has been detained under section 135 or section 136 of the mental health act 1983.

However, inconsistent decision-making and a lack of transparency around capacity management can result in delays to access care and treatment, as the lack of management leads to high pressures on the capacity of treatment facilities. These delays can result in the service user becoming more distressed leading to further deterioration of their mental state and can increase their clinical risk. Delays in accessing appropriate care also increases the pressure on other local services.

Solution

The compact applies to access to health-based places of safety and mental health inpatient care in London. It covers services for people of all ages who present in mental health crisis.

The following principles apply to the acceptance of an individual into a HBPoS:

• Individuals detained under section 136 of the MHA should be conveyed to the closest HBPoS.
• Once a place of safety has been identified and agreed to have capacity, police and ambulance staff should not have to wait more than 15 minutes.
• Acute and mental health trusts should also have an escalation process in place to expedite issues once an individual is waiting to be accepted.
• Matters should be escalated to surge services if an individual has been waiting more than 4 hours for a HBPoS from the time an initial request for access was received by the acute or mental health trust.
• Commissioners and acute and mental health trusts should monitor and
  discuss utilisation of HBPoS at regular intervals.

The following principles apply to admissions to mental health inpatient services:

• Individuals in crisis should have a physical and mental health assessment and a care plan in place within 4 hours of arriving at a HBPoS, emergency department, or from the point of referral to the local crisis team or liaison and diversion service.
• If the outcome of a mental health assessment is that an individual needs admission, that person should be admitted to hospital as soon as possible (a maximum of 12 hours) following the decision to admit.
• If the outcome of a mental health assessment (either informal or MHA assessment) is a clinical decision that the individual needs inpatient admission, this should be formally recorded as the time at which there is a decision to admit (DTA).
• Individuals should be admitted into care in a location that best serves their interests, and that is as close to their chosen location as possible, which can promote their recovery and support on discharge.
• Admission should not be refused or delayed due to uncertainty or ambiguity as to which Clinical Commissioning Group (CCG) is responsible for funding the care.

Outcomes

Through integrated care, people in mental health crisis have timely access to a HBPoS and mental health inpatient care and treatment when they need it.

This has improved the understanding of the level and nature of hospital attendances by patients experiencing mental health crisis, ultimately providing a safer, more efficient, and improved experience for patients.

Additional information

You can find out about the London compact by accessing the 2022 NHS England London Compact report.