Welcome to the ZSA Facts for Action series
This page provides key information to explain what crisis response services are and will help build your understanding of the role this service has in suicide prevention.
Experiencing a mental health crisis has different meanings for different people. For some it can be a personal reaction to challenging and distressing life events, whilst for others it can be a relapse of symptoms of a severe and enduring mental health illness. But for all, experiencing a mental health crisis represents a key window of opportunity to take life changing and life saving action to relieve distress, reduce risk of harm and set a person on the path to receive the support they need and deserve.
The 2020 annual community mental health survey reported that 28% of people indicated that they would not know who to contact, out of office hours in the NHS, if they had a crisis. Of those who reported having experienced a crisis, almost a fifth did not get the help they needed or were unable to contact the identified person or service.
We have recently published a special report on mental health crisis response and services which provides an overview of the issue of crisis, and the many ways in which services and systems are working to prevent it or provide effective care for those at risk. From this work we aspire to inspire and encourage collective improvement goals, and align work across sectors, to better advance crisis care for everyone.
See our publications page for this report.
ZSA Suicide Prevention Resource Map - Related Indicators
Here you will find a number of indicators within the Suicide Prevention Resource Map that are either directly (e.g. patient experience, liaison psychiatry, crisis resolution home treatment teams, section 136 assessments) or indirectly related to crisis response (e.g. CCG spend on mental health, contact with mental health services, prevalence of serious mental illness).
People in general medical settings often have mental health needs and therefore these settings require prompt access to high quality liaison psychiatry services 24 hours a day, 7 days a week. Services that meet these requirements are known as “Core 24”. NHS England / Improvement set a goal that at least 50% of general hospitals will have liaison psychiatry services that meet the Core 24 standards for adults and older adults by 2020/21.
- Core 24 liaison psychiatry provision (CCG data)
- Core 24 liaison psychiatry provision (Local Authority data)
- Core 24 liaison psychiatry provision (STP data)
Crisis resolution and home treatment teams (CRHT)
Crisis Resolution and Home Treatment (CRHT) teams respond to psychiatric emergencies and crises at a persons home and work with patients to avoid unnecessary mental health hospital admissions.
- Number of referrals to Crisis Resolution and Home Treatment (CRHT) teams per 100,000 registered population (16-64)
- Number of referrals to Crisis Resolution and Home Treatment (CRHT) teams per 100,000 weighted population (16-64)
- Average response time from referral to assessment for crisis resolution services
- Number of contacts with Crisis Resolution and Home Treatment (CRHT) teams per 100,000 registered population (16-64)
- Number of contacts with Crisis Resolution and Home Treatment (CRHT) teams per 100,000 weighted population (16-64)
- Average number of contacts per accepted Crisis Resolution and Home Treatment (CRHT) team referral
Section 136 assessments
Section 136 is part of the Mental Health Act. Section 136 gives the police the power to remove a person from a public place, when they appear to be suffering from a mental disorder, to a place of safety (most often within a mental health unit or at an Accident and Emergency Department but police stations can also be used as a place of safety as a last resort).
- Number of Section 136 assessments per 100,000 registered population (16-64)
- Number of Section 136 assessments per 100,000 weighted population (16-64)
- Total CCG spend on mental health (all ages) per 100,000 registered population (£)
- CCG spend on mental health (all ages) as a percentage of CCG base allocations
- Number of people in contact with mental health services aged 18+ per 100,000 registered population
- Number of people in contact with mental health services aged 18+ per 100,000 weighted population
- Severe Mental Illness (SMI) Prevalence
Case study examples of best and innovative practice
Stigma Statistics - STAR platform
Stigma Statistics’ Suicide Tracking Analysis and Reporting (STAR) platform enables the sharing of information relating to suspected suicides in real time. The tool allows data to be collected for any sudden death where suicide is suspected whether it be from the police or coroner and shares data with and notifies identified key stakeholders who can then input data they hold about the person.
Crisis helpline: NHS 111 Press 2
As part of the Urgent and Emergency Care Vanguard programme in Cambridgeshire and Peterborough, a pilot scheme commenced in September 2019 to extend the NHS 111 service to enable people who are experiencing a mental health crisis to dial the NHS urgent medical advice number and chose option 2 which will put them through to a member of Cambridgeshire and Peterborough NHS Foundation Trust’s First Response Service.
S12 Solutions: digital tool to support the mental health act
S12 Solutions is a digital tool (phone application and web platform) that was designed to support Mental Health Professionals to undertake Mental Health Act (MHA) assessments.
Crisis decision support tool at Birmingham and Solihull Mental Health NHS Foundation Trust
The Mental Health Crisis Decision Support Tool was introduced into the Birmingham and Solihull Mental Health NHS Foundation Trust to predict the likelihood of mental health crisis.
Outcome measurement within liaison psychiatry services at Central and North West London NHS Foundation Trust
In 2016/17, Central and North West London NHS Foundation Trust commenced work to embed outcome measurement in routine practice through the Psychological Medicine Clinical Network. Adopting the Framework for Routine Outcome Measurement in Liaison Psychiatry transformed the reports the participants sent to commissioners and managers and enabled the services to analyse what they were doing, whether they were helping and include patients’ own words to describe their experience.
Mapping crisis care pathways at Northumberland, Tyne and Wear NHS Foundation Trust
Northumberland, Tyne and Wear NHS Foundation Trust have collaborated with Northumbria police forces on mapping and redesigning crisis care pathways leading to Northumbria being one of the areas in the country with the lowest numbers of people detained under Section 136 of the Mental Health Act.
Pan-London Compact - an implementation group audit of emergency departments
The CQC assessment of mental health services in acute trust references the work of 27 London acute emergency departments to audit people presenting at emergency departments in August 2019 with a mental health related problem
Mental health care in the London Ambulance Service
NHS England / Improvement have published a summary of work within London whereby people experiencing a mental health crisis will be sent a specialist blue light mental health car staffed by a mental health nurse and a paramedic instead of a traditional ambulance. By responding together, the specialist ambulance crew has an aspiration to reduce mental health hospital admissions from 58,000 to 30,000 per year once rolled out across London.
The Welsh Crisis Care Concordat
The Mental Health Crisis Concordat was published by the Welsh Government in 2015 and is a shared statement of commitment in responding to mental health crisis with services such as the police, NHS, the Welsh Ambulance Service and Local Authorities.
The Concordat sets out how partners can work together to deliver a quality response when people with acute mental health crisis, need help, have contact with the Police and who are likely to be detained under Section 135 or Section 136 of the Mental Health Act 1983.
Psychiatric Decisions Unit at Birmingham and Solihull Mental Health NHS Foundation Trust
The PDU was developed to provide an alternative pathway for patients accessing emergency departments and other services, such as the police and ambulance services. The PDU is an ambulant assessment area which provides a calming environment for the assessment and development of treatment plans for more complex service users who are in crisis and are accessing emergency services.
Birmingham Mental Health Alliance for Excellence, Resilience Innovation & Training (MERIT)
The Mental Health Alliance for Excellence, Resilience, Innovation and Training (MERIT) provider collaborative was established in 2016 as a vanguard site in response to the Five Year Forward View for Mental Health and was initially comprised of Solihull Mental Health NHS Foundation Trust, Black Country Partnership NHS Trust, Coventry and Warwickshire Partnership NHS Trust and Dudley and Walsall Mental Health Partnership NHS Trust. Their focus is on proactive early intervention care rather than reactive crisis management, which is achieved by promoting a recovery culture and providing crisis care and reduction of risk, which is used everyday in acute services.
Psynergy in Blackpool, Flyde and Wyre
In December 2018, a pilot was introduced in Blackpool, Fylde and Wyre to respond to people experiencing mental health crisis as a partnership between Lancashire Care NHS Foundation Trust, North West Ambulance Service (NWAS) and Lancashire Constabulary. This involves a senior mental health nurse, a paramedic and a police officer coming together as a crew in a NWAS vehicle to jointly attend to people experiencing a mental health crisis
Australia’s Gold Coast – implementation of the zero suicide framework and suicide prevention pathway
Mental Health and Specialist Services in Australia’s Gold Coast undertook work in 2015 to implement a systems approach to suicide prevention using the Zero Suicide Framework (ZSF). This resulted in reductions in the rates of repeated suicide attempts and the number of deaths by suicide