Minutes from urgent care services focus group at Mind, 11/12/12

Present: 15 mental health service users and carers, Cavita Bachan (SPFT), Juliet Oxbury, Sara Callaman (Mind), Emma Seymour (CVSF), Sharon Munnings (BHT)

What does ‘crisis’ mean?

The group were asked to define what crisis meant to them in a few words – these are the responses:

  • Fear
  • Panic
  • Not able to go on living
  • Being unable to speak, even to a duty worker
  • High levels of stress
  • Pain
  • Needing more support, especially out of hours
  • Can’t cope/at the limit of my ability to cope – ‘drowning’
  • Self harming as a way of ‘coping’
  • Suicidal
  • Great pain
  • Panic and not knowing who to turn to
  • Unsafe
  • Desperation
  • Unable to express and communicate needs leading to impulsive behaviour
  • Risk of serious self harm or overdose
  • End of resources – need immediate help
  • Really strong feelings you can’t control – feeling overwhelmed by them
  • Don’t know what to do or where to go
  • Very altered reality
  • Danger to self
  • At a tipping point – support network needed and urgent consultation
  • Very, very depressed
  • Self-loathing, hate, disgust
  • Spiralling downwards
  • Horrendous anxiety
  • Exhausted and needing help

What do you think the NHS should do to ensure everyone has good information about how to access mental health urgent care in B &H?

Feedback from focus group participants:

  • Provide posters in GPs waiting areas, and also in libraries, community centres, toilet doors in public places, pubs etc
  • Leaflets explaining the new services should be made available at all access points – GPs, hospital, Wellbeing Service – and also at community mental health centres and via workers and care co-ordinators. Leaflets could also be sent from GPs and Recovery teams to individuals.
  • Details of the new services need to be well-publicised online with all the appropriate health websites: GP websites, BICS Health & Wellbeing Service website, SPT, and other local websites –e.g. Mindlive website, Right Here website and The Big White Wall etc.
  • Details could be sent out via Twitter and Facebook pages
  • The out of hours phone number for access to the service needs to be included in all GP answering phone messages for out of hours services.
  • Samaritans and the Royal Alexandra Children’s Hospital also need to be informed about the service
  • Publicising at relevant workers groups – e.g. the Drug and Alcohol Working Group
  • There is sometimes a problem with even staff in the mental health system not knowing how their own referral processes work. It will be important to ensure that GPs and mental health workers have clear understanding of how the new system works

What problems do you think the new urgent care services will solve, and what are the possible gaps?

Feedback and issues raised from focus group participants:

  • It makes something available out of hours which isn’t currently available, and a new space for mental health patients at A & E is really positive
  • However (some feel) it would be better if it could be located away from A&E altogether
  • We like the idea of not having to wait in main A&E, but having a separate waiting area. This will be better for staff as well, as they won’t have to waste time duplicating assessments (e.g. with the crisis team) and referring on. And it will mean service users will feel safer and less stigmatised.
  • The new services close the gap for times when people can’t access GP or care co-ordinator
  • Who defines ‘crisis’? One possible problem is a gap between service users and staffs’ definitions of a crisis
  • Ideally we would like a crisis house. We need a safe place, centrally located, near night bus routes, where people can go to just be safe while in crisis.
  • What happens if you are assessed and told you need admission? At the moment the hospital will not give beds to mental health patients waiting to be admitted to mental health services, even if there are beds available. Are we going to have to wait for many hours in the mental health waiting area? Not having somewhere for people to sleep overnight is a gap. Could there be recliners, like in the discharge lounge?
  • There is also a danger that patients who are admitted for physical health problems, but who also have mental health problems, may be passed off to the mental health team without proper treatment for their physical health needs. The A&E mental health team will have to be very firm about this, to ensure people get proper treatment for both physical and mental health needs.
  • If there are only 2 or 3 slots the service could be very easily overwhelmed by demand.
  • The single support worker in A&E might be overwhelmed with demand if s/he has to sit with several patients and answer the phone.
  • What will staff do if people just come to the mental health waiting area in A&E because they just want to feel safe for a while? Will they be sent away of they don’t want treatment but just need a safe place?
  • Other A&E staff are going to have to be well-trained about the new service if it is going to be well-integrated
  • What is going to happen with people who have, or might have been, drinking? At the moment mental health service users of A&E are often breathalysed in the main waiting room, even if they haven’t been drinking. Will this be done before admission to the mental health waiting area? And what if they have been drinking?
  • This new service isn’t going to make a lot of difference unless there is more prevention and treatment available while still in crisis. We need the opportunity to access support before a crisis without it going on our medical records: if there’s no support until we are in a full-blown crisis then all that will happen is that lives will continue to get worse.
  • There is a worry that this service is going to be inundated because the everyday service isn’t good enough, with no treatment for underlying problems. If this new service does help people, it will soon collapse under the weight of demand.
  • Training for support staff and GPs in facilitating and directing people to the new service is important
  • Will carers’ knowledge and experience be taken seriously by staff in the new services?