Abstract
Acute mental health demand in London is rising, as inpatient capacity reducing due to a trend towards less-restrictive care and home-based treatment, and closure of unfit Victorian premises. Patients who attend Emergency Departments (ED) can wait for unacceptably long for beds to be sourced, in stressful unsuitable environments.
Approach: Learning from peer organisations, we opened Ealing Crisis Centre in winter 2023-24, with the aim of testing an alternative model for crisis intervention. Service users with lived-experience were involved at inception to codesign the proposal.
A multidisciplinary team was recruited to offer biopsychosocial interventions in a therapeutic environment away from ED which would also allow time for extended assessment and improved clinical decision making.
Key objectives were:
•Improved patient experience low-restriction and stress environment
•Reduced waits in ED
•Clinical safety and positive patient outcomes
•Support system flow by diverting avoidable admissions into intermediate/alternative pathways
An available space was identified near an Emergency Department, in mental health premises. This was refurbished to a design co-produced with Experts by Experience.
Rather than ‘beds’ (like admitted patients) or ‘trolleys’ (like ED), a model of 5 reclining chairs was chosen, with the ECC designated as a pre-admission assessment space.
Capital investment was secured and revenue funded from underspends at financial year-end.
Results:
•ECC Pilot was operational 24/7 for 5 months and accounted for 1076 occupied ‘chair’ days.
•After ramp-up, average occupancy - 92%
•130 patients (all approaching admission) were supported•Of these only 18% went on be admitted – substantially fewer than would have been admitted directly from ED without this intermediate step.
•35% discharged to community crisis intervention (home-hospitalisation: 26%; or voluntary-sector crisis house: 9%).
•23% discharged routine mental health follow-up.
•16% discharged to primary or social care only.
56/130 (43%) patients responded to request for feedback – 95% of these said the service was “excellent”, with 100% reporting the interventions “effective”.
“I think this is the first psychiatric place I have been in that has helped me feel like people care”
The unit cost was approximately £500 per chair-day, which compares favourably to £605 per bed-night for an inpatient admission.
No improvement was observed compared to previous year and pre-pilot on % MH attendances >12h stay in ED.
Implications: We found ECC supported a reduced reliance on crisis and inpatient MH services as a result of meaningful engagement with patients, at a cost saving compared to inpatient care.
The care model was acceptable to patients as part of an integrated mental health crisis pathway.
Ongoing revenue funding was unavailable and the ECC pilot was discontinued in May 2024. The Trust committed to incorporate learning into a model on another site, where it will be colocated with other crisis facilities – improving safety and sustainability.
Learning from this and other pilots will infom a model of intermediate mental health care across two organisations and 8 municipal boroughs to deliver equitable access to core services for the population of North West London (2.2m residents).