Updates to Mental Health Crisis Care in London: New systems for Met Police and community care pathways.

The latest NHS Mental Health Crisis Care Agreement for London outlines a continuing focus on community-based crisis care, which is encouraging. Providers like Social Interest Group (SIG) are vital to community and emergency care. We offer out-of-hours and 24/7 care and support in community settings, reducing pressure on emergency departments and enabling people to stay in their homes or local areas during a crisis. Data shows that people recover better in the community than in the hospital, and our services deliver support in a way essential for well-being and maintaining relationships with support networks.

As this is a crisis care agreement, the Metropolitan Police are significant partners. Clarifying their role in crisis scenarios, particularly as the Met Commissioner recently stated that his officers would soon cease attending mental health callouts, is welcomed by SIG and our sector partners. We are meeting with senior officers in the Met and discussing the impact of the changes announced on our services across London to ensure that our teams, Residents, and Participants receive the proper support.

What has not been addressed within the new Crisis Care Agreement is that Local Authority Adult Social Care Services are still operating primarily 9 am-5 pm, Monday to Friday. The gap in support for those experiencing a mental health crisis leaves them vulnerable.

The current Adult Social Care structure leaves the Police, Service Providers like Social Interest Group, and NHS Emergency departments struggling to bridge the gap in service created by the absence of Local Authority Workers for many hours each week. We are disappointed that no reform to core working hours for Adult Social Care departments has been agreed upon.

We have also raised with Met officers our concern that whilst they have assured us that they will still attend crisis calls, officers are not fairly equipped to manage difficult situations as they do not receive training in understanding or de-escalating mental health crises. This needs to change, and we are passionate about partnering to train Police officers using our expertise in supporting those experiencing mental health.

Whilst these critical issues are not addressed in the latest agreement, the London All Age Crisis Care Concordat does empower us to know how we can expect the NHS, local councils, and the Police to support people through mental health crises. With changes beginning from the Autumn, these measures should be in place by Spring 2024:

• Initial Support and Assessment:  111 First calls will be redirected to a specialist mental health line for assessment and to be directed into the appropriate mental health pathway. This is in place of the current model in which an NHS assessment is carried out.

• Appropriate Response: ‘All six Mental Health Joint Response Cars (MHJRC) operate 7 days a week: The MHJRC cars are unique in that they are staffed by a paramedic trained to physically assess and a mental health professional who can carry out a biopsychosocial assessment, formulate a risk assessment, and deliver brief psychological interventions to reduce distress. This model is proven to reduce admissions to hospital.

• Emergency Situation: When police are involved due to someone experiencing a crisis, they have specialist phone support advising them on whether it is appropriate to detain that person and, if so, where a safe place in the community is available for them.

• In case of Hospital Admission: The CORE 24 standard should be followed to ensure that once a referral from an emergency department is made, patients should have a face-to-face assessment by mental health liaison service commence within 1 hour.