The false economy of cuts to crisis care By Sean Duggan Just weeks after exposing pressures on acute beds in mental health services, Community Care and BBC News have today given the clearest warning yet about the extent and impact of spending cuts in community teams across England. Its survey, based on exhaustive searching of board reports from mental health trusts, indicates that services are experiencing significant real terms cuts and in many cases being forced to reduce capacity in community teams, including crisis resolution and home treatment. This is extremely worrying news. Crisis teams were a major and vital component of the National Service Framework for Mental Health, with a good evidence base for their effectiveness when implemented properly. Cutting back on the edges of such services can easily undermine them, reducing their ability to offer the support people need when they need it. And with police stations still too often used as ‘places of safety’ and growing pressure on A&E units, salami slicing mental health crisis care appears to be a serious false economy. The NHS is of course facing an unprecedented financial challenge and local government is having to make bigger sacrifices still. And the way mental health services are paid for, especially for children, still makes them much more vulnerable to short-term cuts than many other health services. Commissioners and providers of mental health care alike are then left with major dilemmas when told they must make cuts. Too often, the most vulnerable services are those that intervene early, that support recovery and that respond to the distinctive needs of the most marginalised in society. Cutting back on these services can be disastrous, storing up bigger problems as people’s needs escalate, placing yet more pressure on higher cost inpatient services. The government and NHS England alike have pledged to place mental health on a par with physical health and to work to close the gaps between them. Today’s survey is a timely and sobering reminder of how big a challenge that is. We need urgent action to ensure that spending on mental health care is protected and that money is directed towards services that promote wellbeing, support recovery and integrate physical and mental health care. We need to reinstate or replace the national survey of investment in mental health services and extend it to children’s services. And we need to support commissioners in the NHS and local authorities to reinvest in the most effective interventions and protect those that already offer good value for money.