Concerns about accessing mental health support in Gloucestershire, particularly for patients in crisis, feature prominently in public feedback received by local health and social care champion, Healthwatch Gloucestershire.
Nationally, patients experiencing a mental health crisis are increasingly visiting A&E hospital departments to seek the care and support they need*, and NHS England wants mental health care to be at the same standard as physical health services in acute hospitals by 2020/21.
Healthwatch Gloucestershire wanted to find out more about people’s experiences of emergency mental health care to help drive improvements in services. They asked Evolving Communities to carry out a research project, which was developed in collaboration with Gloucestershire Health and Care NHS Foundation Trust (GHC) and Gloucestershire Hospitals NHS Foundation Trust (GHFT).
They gathered feedback from patients, family members and carers who have accessed mental health support at the A&E departments of Gloucestershire Royal Hospital and Cheltenham General Hospital, as well as those who work with people who have mental health issues.
Between January and March 2020, twenty-one people shared their views through an online survey, face-to-face and telephone interviews – in many cases talking about multiple visits to A&E covering a wide range of encounters. Several key themes that emerged.
- There is a reluctance to seek mental health support at A&E; those who do often feel desperate.
- Every contact matters, and previous experience in A&E can influence levels of anxiety and the likelihood of people seeking further support.
- People feel safer accessing care if they feel heard, understood, and not judged by A&E staff.
- People reported being left for long periods, in busy environments, in isolation without being checked on, and without any indication of timescales for care. This was especially difficult for those in a fragile mental state and sometimes resulted in patients discharging themselves before treatment.
- Some people had only received support for their physical health issues without consideration of their underlying mental health issues, even when these were on record.
- A&E assessments are most useful when used as a framework to get to know the person rather than as a tick box exercise.
- A mental health ‘episode’ is rarely over when patients leave A&E, so care plans and swift follow-up appointments with relevant support services are hugely appreciated; including friends, family and other supporters in follow-up is beneficial.
Healthwatch Gloucestershire and Evolving Communities have made the following recommendations to help local NHS mental health services, and other organisations involved in crisis mental health care in Gloucestershire, respond effectively to the issues raised in the report.
- Emergency department staff should continue to receive regular mental health awareness training.
- A person-centred approach should be adopted when assessing patients.
- Service users’ views should be included in any improvement and development plans, including the current evaluation of hospital waiting rooms.
- A&E mental health services should be evaluated regularly, including staff feedback to make sure improvements are manageable.
- Although the GHC Mental Health Liaison Team is not currently commissioned to provide follow up support for patients, during the Covid-19 pandemic they have been conducting 48-hour follow up calls. An evaluation of this service would be helpful to understand the impact of this support for patients.
Dr Sara Nelson, Head of Research & Insight at Evolving Communities, said:
“Last year, Healthwatch Gloucestershire investigated local people’s views about mental health services in Gloucestershire. It became clear that people were having difficulties accessing mental health support when in crisis; they were unsure where to go for support and felt they were being left to fend for themselves. This new research provides valuable insight into the emergency care and support needs of those with mental health issues. We heard stories of staff showing compassion and kindness and using their initiative to provide a caring service across the board, but there were also some common areas of concern. This report will be used by those who provide mental health services in the county to inform their plans for improvement.”
Nathan Gregory, Deputy Director for Urgent Care and Speciality Services, Gloucestershire Health and Care NHS Foundation Trust (GHC), said:
“This report is important to ensure that people receive parity of esteem for both their mental and physical health care needs and GHC supports the recommendations made. The ongoing delivery of mental health awareness training with accident and emergency department staff is vital to ensuring the completion of person-centred assessments which include peoples mental and physical health care needs.”
Read the full report (updated November 2020): Experiences of urgent mental health care in accident and emergency: A Gloucestershire perspective.
*NHS Digital, Hospital Accident and Emergency Activity, 2017-18