At the IIMHL Leadership Exchange in Washington DC, the second Crisis Now Global Summit on urgent and emergency mental health care was held. Janet Peters, New Zealand Liaison for IIMHL and Samantha Allen, CEO of Sussex Partnership NHS Trust reflect on some key lessons from the match.
The writers' collaboration on this report is an example of how IIMHL can bring leaders together – we sat next to each other at the summit and found we had common interests, so prepared this report together!
The aim was to draft the first iteration of an international best practice declaration so that crisis care, designed for the person in a mental health crisis, is available to anyone, anytime, anywhere.
The declaration will be shared across the participating countries in early 2020.
Watch this video about the second Crisis Now Global Summit:
David Covington and Brian Hepburn: The crisis is now
David Covington from RI International and Brian Hepburn from NASMHPD noted that the United States has a problem – in many communities, the crisis system has been handed over to law enforcement, sometimes with devastating outcomes.
Watch RI International's video on The Recovery Response Center and the Fusion Model:
The following video on the BHL Care Traffic Control model shows an end-to-end solution to bring the Crisis Now model into the community:
Misha Kessler: Lived experience
“Mental illness is one part of my tapestry,” said Misha Kessler.
Misha made a crucial distinction: mental illness is not the entirety of who he is – turning on its head the assumption that people are defined by their illness.
Mental illness is one part of my tapestry.
This word shift humanises and destigmatises, reminding people that those who experience mental illness aren’t other. They are one of us, and a mental health crisis can happen to anyone at any time.
Mental health crises affect nearly all of us – either because we experience them or because a loved one does. We, as a society, need to care about what happens to people in crisis.
Angela Kimball: Family
Angela Kimball brings expertise in grassroots advocacy campaigns and mental health policy to NAMI, as well as a drive to fight inequities and champion better care for people with mental health conditions and their families.
Angela is a family member who struggled to fund help for her son who was in crisis. This was very moving as she spoke so powerfully about lost opportunities for her son.
John Draper and Phil Moore: A national 3-digit crisis hotline
John Draper, PhD from the Suicide Prevention Resource Center and Dr Phil Moore from the NHS urged the participants to promote a proposed 3-digit suicide hotline, on the basis it is urgently needed in the United States.
Leaders in the behavioural health field also want to ensure that the line is fully funded and available to everyone.
Next steps and issues to be addressed:
- confirmed 3-digit designation
- support network infrastructure
- funding for states and local centres
- performance indicators/QA
- technology platform for system
- technical needs to implement 3-digit code across phone carriers and systems nationally
- marketing of the new number.
Becky Stoll, LCSW, Vice President of Crisis & Disaster Management at Centerstone, said adoption of the number will increase access, break down stigma and save lives.
“A dedicated three-digit number for those experiencing a mental health crisis would be a landmark step for the field of mental health; making it easier to support those in emotional pain and begin the journey toward healing,” said Becky.
John said he believes the 3-digit number could help millions of more people in crisis.
“It could transform the way people seek and receive all levels of crisis care in the US in much the same way that the establishment of 911 affected medical and law enforcement assistance in communities across the country,” said John.
Wendy Farmer and Tomotaka Uraguchi: Innovations in crisis technology
This presentation from Japan focused on voice recognition in an Uber-like system of technology. It demonstrated to us what could be possible with the use of artificial intelligence (AI) and how voice recognition could identify if a person’s mental health is deteriorating.
The presentation pushed us to the boundaries of our thinking in terms of the potential to revolutionise preventative care and early intervention in an era where technology is advancing in all other aspects of our lives.
Martin Connor: What if we could see the whole system?
Professor Martin Connor from Healthcare Logic in the United Kingdon demonstrated to us how to use data and clinical intelligence to provide an overview of how a system is functioning.
Moving away from the desire to have ‘real-time’ data, Martin demonstrated the importance of using information to inform operational decision making. This drew on his experience of setting up a "mission control" in a healthcare system on the Gold Coast, Australia.
Let’s assume we all agree on all the basics:
- safety first
- QI approach (focus on process, if you can’t measure it you can’t improve it)
- clinical engagement and support to teams is fundamental.
We need to sort out the operational data once and for all to enable us to focus on solutions to the model of care.
Dave Byers: Leading change: improving the Court and community’s response to mental health and co-occurring disorders
Trial courts have increasingly become the default system for addressing the needs of those with mental and behavioural health issues.
Sixty-four per cent of people in local jails suffer from mental illness. The rate of serious mental illness is four to six times higher in jail than in the general population, and the rate of substance use disorders is seven times higher among those in jail than in the general population.
Failure to respond to these issues invites a continuing public health crisis and the continued criminalisation of mental health that has devastating effects on individuals, families, and society.
As leaders of their courts and communities, judges are in a unique position to expand and improve the response to individuals with mental illness.
This manual is designed to assist judges and all court staff.
Also read this report: Decriminalisation of Mental Illness: Fixing a Broken System
Tom Betlach: What if we studied the business case?
Tom Betlach of Speire Healthcare Strategies, United States described a business case around Crisis System Principles:
- a coordinated system of entry
- call services
- mobile crisis teams
- stabilisation services
Dr Margie Balfour: What if access to care was the priority?
Dr Margie Balfour of Connections Health Solutions, Arizona spoke to the following:
System vs services
A crisis system is more than a collection of services.
Crisis services must all work together as a coordinated system to achieve common goals ... and be more than the sum of the parts.
The solution is not always more inpatient beds:
- stabilise crisis in the least-restrictive setting possible (which also tends to be the least-costly)
- governance and payment structure to incentivise these programmes and services
- data-driven and values-based decision-making and continuous quality improvement
- stakeholder collaboration across silos
- culture of: NO WRONG DOOR “Figure out how to say YES instead of looking for reasons to say no.
Caroline Dollery and Phil Moore: Working well together and co-production
National Collaborating Centre for Mental Health. Working Well Together: Evidence and Tools to Enable Co-production in Mental Health Commissioning. London: National Collaborating Centre for Mental Health; 2019
Co-production is an ongoing partnership between people who design, deliver and commission services, people who use the services and people who need them.
Ron Bruno and Leah Dunbar: The role of law enforcement
These speakers spoke of the need for law enforcement to change and mentioned the “bible” of best practice:
The goals of a local CIT programme are:
- To improve safety during law enforcement encounters with people experiencing a mental health crisis, for everyone involved.
- To increase connections to effective and timely mental health services for people in a mental health crisis.
- To use law enforcement strategically during crisis situations—such as when there is an imminent threat to safety or a criminal concern—and increase the role of mental health professionals, peer support specialists, and other community supports.
- To reduce the trauma that people experience during a mental health crisis and thus contribute to their long-term recovery.
This 244-page best practice guide was published in 2019.
Crisis across countries I
This was a panel discussion that included participants from China (Jie Zhang), Japan (Yukihisa Namiki and Tomo Uraguchi) and Malaysia (Siti Hazrah).
The topics were wide-ranging and it included insights on the support provided to students in China and the use of wearable technology to track.
Crisis across countries II
New Zealand: Janet Peters
Janet, the New Zealand Liaison for IIMHL talked about best practice and mentioned Tupu Ake as an example of successful peer-led crisis respite.
Janet also discussed the new primary care funding which should assist people to get help earlier thus avoiding crises.
The Netherlands: Dr Elnathan Prinsen
Elnathan works as a psychiatrist in an IHT/crisis service team in Deventer and is the healthcare manager of the emergency mental healthcare division at Dimence. They offer a new model of crisis care which is intensive support in the home “the right care in the right place”.
That means avoiding expensive care, moving the point of care delivery closer to people’s homes and replacing care delivery with other forms such as e-health, at an affordable social cost:
- working with the way people function in their environments as the starting point
- paying attention to health, behaviour and prevention and detecting illnesses early
- providing accessible support and care for everybody
- providing suitable and effective care that fits in with learning experiences and the context
- having good outcomes in terms of the perceived quality of life.
Read “The right care in the right place” Taskforce report.
Canada: Leah Dunbar
Leah Dunbar manages a mental health collaboration between six Toronto hospitals, Toronto Central Local Health Integration Network, and Toronto Police Service (TPS).
Leah conducted a study to see how effective the Mobile Crisis Intervention Team expansion was. In 2014, the programme expanded to include all police divisions. These teams are police-hospital partnerships of police officers and nurses who respond to mental health crises together.
The study produced very positive results, showing that 100 per cent of clients felt that their needs were being met by the MCIT during crisis periods.
A new app/online resource is available to service members to connect the public to community resources, including mental health services.
The Community Asset Portal (CAP) is a web application that shows an up-to-date map of social services such as shelters, community resource navigators, and mental health and youth support services.
The app detects the location of users and allows them to see the resources using a colour-coded map or by moving through a list of categories, such as Health or Food & Housing services. It also shows people how to get to the location by car, foot and public transit, as well as gives contact information.
Process for drafting the international guidelines
There were five groups:
- The why Universal values, rights and principles
- The who Leadership, culture and commitment to parity
- The what Specific practices and interventions
- The how Implementation and continuous improvement
- The whom Community and public health
David Covington said, “when we came back from breaking into five delegation workgroups, each team presented their blue-sky pitch, an idea that would launch crisis upward in a tangible, attainable, and translatable way."
The teams discussed sustainable funding mechanisms, standardised definitions, and data-driven quality improvement.
The commonalities between them were striking: the groups stated mental health is a cornerstone of overall health and crisis care must be centred around the people who need it, available to anyone, anywhere, and at any time. Crisis care must meet people where they are, and not the other way around.
It’s what’s practised in the Netherlands with their crisis resolution and intensive home treatment (IHT) programme, where multidisciplinary teams go to the homes of people experiencing urgent psychiatric issues.
Treatment can be scaled up or down to match patients’ needs. Elnathan Prinsen, PhD said the reason for going directly to patients is that it makes treatment more accessible, and prevents further disrupting the day-to-day lives and social roles of people in crisis.
“The person may be a father, a spouse. We must focus on treating people in their environment, allowing them to maintain all social roles.”
The care Dr Dollery mentioned is not only about compassion toward those who have experienced crisis and face mental or behavioural health challenges – it also includes self-compassion for those of us who struggle with it on a day-to-day basis.
Kessler shared with me previously that being caring for himself has been instrumental in his recovery – allowing him to accept that he will face lows, and while he does all he can to address them, they will sometimes happen.
Shelby Rowe, a mental health professional who was interviewed for #CrisisTalk in June, shared a similar sentiment of self-caring and revealed that permitting herself to acknowledge her feelings and release anger at herself gave her a sense of freedom from fearing failure.
What people with lived experience share is that recovery is a journey, not a finish line. It’s also not about curating a fictional recovery perfection that appears unattainable to those in crisis.
The summit was a cultural melting pot of knowledge and experience. It provided an opportunity to examine the core issues relating to urgent and emergency mental health care. While the tapestry of care and some approaches differed across the globe, participants were galvanised by the need to have a more joined-up, accessible and integrated urgent and emergency mental health care system.
It is evident the consistent response in a crisis is lacking in even the most developed countries – this is what unites all of us in developing a global declaration for urgent and emergency mental health care.
A draft document will be prepared by Sue Murray from Australia and sent for review.
The next Crisis Now summit will take place in Liverpool, United Kingdom in May 2020.