Mental health teams in crisis

Joy Hibbins, who runs a Suicide Crisis Centre primarily set up to support people who do not access other services, reveals that, lately, a lot of of callers who use the traditional mental health system have been contacting her organisation instead of the mental health crisis teams…which take too long to get back to people – if at all.

Up until now, I’ve tried to avoid direct criticism of the operational aspects of our mental health crisis services. I’ve spoken more generally about how I feel changes and reform are needed. But I think the issues are now so serious that the current situation has to be highlighted.

I run a Suicide Crisis Centre. We’re totally independent, funded by public donations and small grants. Increasingly, we have become a replacement crisis service for people who are under community mental health services. Last month 77% of our clients were under secondary psychiatric services which is for people with more severe and enduring mental health conditions such as schizophrenia, bipolar disorder and personality disorder.  

If you’re under that service, you have access to the Crisis Resolution and Home Treatment Team. If you are at risk of suicide, they are the team you contact. What’s happening is that people under the service are contacting us instead when they are in crisis. Increasingly, it’s because the crisis team isn’t getting back to them quickly enough – or at all.

A client under secondary psychiatric services who contacted us yesterday told us that she had left a voicemail message for the crisis team to call her last week and they never returned her call. She was left unsupported. She is the second client to inform us of this kind of occurrence in the last week.

When a BBC news crew filmed our work last year, they saw us trying to contact the crisis team for a client we went out to visit.  The cameraman captured on film the moment where the 24-hour crisis team was “closed”. That was just before 10pm. We were assured that they would phone us later. They didn’t. We stayed with Sarah until 5am and they didn’t call during that time:

We cannot simply dismiss that as a one-off. It is still happening. Indeed the chaotic situation which happened yesterday afternoon shows very clearly how staff shortages put lives at risk.

A young woman who we have supported in the past contacted us. She was at risk of suicide. Her presentation yesterday concerned me and I felt she needed psychiatric assessment. She is under secondary mental health services and had tried to contact her regular team but no one was available, she said.

I contacted the mental health service which supports her – the Recovery Team. There should always be a member of the triage staff available within that team to talk to patients. Yesterday they had no one on triage, their receptionist told me. I called the crisis team. Despite my telling the crisis team member who answered that there was no one available in Recovery to talk to or assess our client, he insisted that she must be supported by them until 5pm. After 5pm the crisis team would be available to her, he said. I explained the situation again. Despite this, he insisted this must be the plan, and that I must call Recovery again. He actually put the phone down on me at this point.

The crisis team should be a 24-hour service, as I have previously said. If our service had not been there, she would have been totally unsupported and at risk, at a time when she needed psychiatric assessment.

At this point I took the decision to email the Chair of the board of trustees at the NHS mental health trust about the situation. After that, our client was contacted by a nurse from the mental health service.

An hour later, I was contacted by a young woman in her twenties who is also under secondary mental health services. She is well-known to the crisis team. She was stating an intention to harm herself but would not give me her location. For the next five hours I communicated with the local police force as we tried to locate her and ensure her safety. I don’t know if she tried to contact the crisis team at any stage but they certainly weren’t involved last night.   The client is safe and well today.

As a result of all this, I worked a seventeen-hour day yesterday. I wasn’t forced to do it. It was my choice. We care about our clients and I couldn’t have just gone home knowing one of them was at risk. But I am left feeling that if we had a properly-staffed mental health service, I wouldn’t have needed to do all that yesterday.

We are far too regularly an unofficial replacement for the crisis team, because they are either unable to meet demand or they are understaffed.  I know that some mental health staff work beyond their allocated shift, too, because they are concerned about a patient. I’ve been a patient myself and have experienced that. I have bipolar disorder. On one occasion, a mental health liaison nurse at the general hospital was supposed to finish her shift at 10pm but couldn’t find an available psychiatrist in the county to assess me. At 11.10pm she was still on duty. She didn’t want to leave before the situation was resolved. Our Centre was set up predominantly to help people at risk of suicide who were not accessing any other service and people who had disengaged from other services. It was set up to reach people who are unlikely to ask for help from anyone else. As we are supporting so many people who should be able to access the crisis team but can’t, we are concerned that there are times when the people who are not under services are unable to access us because we are so inundated with clients.

We need the crisis team to do the work of the crisis team, not depend on our service to support the patients they can’t. The thing is, they know that we will. We will never walk away from a person who needs us.   

The Suicide Crisis Centre can be contacted at: