Acute and crisis care are essential elements of the mental health system. At their best, these services save lives and are there for people when they need urgent help. But too many people struggle to get help in a crisis, and experiences of coercive care and hospitalisation can create traumas of their own. Rising levels of need for emergency mental health care, coupled with short-staffing and dilapidated buildings, are placing systems under major pressure.
Briefing 64: Crisis and acute mental health care examines research from the NIHR Policy Research Unit in Mental Health about the most effective ways of supporting people in a mental health crisis. It sets out the evidence for community-based alternatives to hospital care (such as crisis houses, day units, home treatment teams and crisis cafes), which enable people to get support closer to home.
The briefing finds that there is a mismatch between evidence and practice in the provision of crisis care, with variable implementation of evidence-based approaches, and widespread adoption of models that don’t yet have a clear evidence base. And some existing mental health crisis services operate with exclusion criteria which mean that certain groups of people, including children, young adults, and those with co-occurring conditions, are unable to access support.
A system characterised by deeply entrenched power imbalances, institutionalisation, restrictive interventions and trauma cannot be transformed through superficial changes that don’t really address the problems at their roots. Services must work in partnership with people with lived experience to co-design crisis and acute care which properly serves their needs.
A major overhaul is needed to provide people with timely, compassionate and effective support, close to home. Crisis and acute mental health care calls on the NHS to be led by the evidence, invest in what works, and ensure provision is consistent across the country.
