During a shift in an NHS mental health crisis team, I am visiting a woman who is feeling suicidal. She welcomes me in advance to her apartment and asks me if I want a cup of tea. I have a lot of visits to make and I want to get started, so I politely decline.
She looks a little disappointed and asks if I’m sure. I feel it’s important to her, and I really like a cup of tea), so I accept her offer. At that moment, the dynamic of our interaction changes in a subtle but vital way.
A power imbalance remains. I’m still a mental health professional walking into her home, but now I’m also a guest. She is guarded at first, saying she has had poor experiences with the crisis team before. Soon, it opens up as the conversation progresses. We explore what’s going on together and she agrees to a follow-up meeting the next day.
I work these NHS shifts every fortnight, alongside my role at Mind, where we try to influence mental health policy and practice. we have seen greatly increased rates of mental health problems and a service model that is unsustainable in the face of increased demand. The human impact of this alone should make this a major priority for the next prime minister. The huge social and economic consequences will make it impossible to ignore.
New Cross-Government Mental Health Strategy it will need to address the systemic drivers of poor mental health, but it will also need to rethink how support is accessed and delivered. As my crisis team meeting shows, the quality of people’s initial interaction with services is critical to outcomes: a kind word and openness to conversation can make or break whether someone engages with support.
Reaching out for mental health help can be daunting, even more so for people with previous negative experiences of services. If acted upon quickly and effectively, it is a key opportunity to prevent someone’s mental health from deteriorating further and to understand what support they need to get back on track.
In the crisis team, I will normally see someone within 24 hours of the referral and often spend about an hour with them for an initial assessment. But for those not in crisis, the path to meaningful support is much less clear and timely. This is despite the fact that we know that earlier engagement often prevents more costly acute interventions.
Most people struggling with their mental health, if they feel ready and able to seek support, will book an appointment with their GP. Many GPs do a great job of talking to people about their mental health, but a ten-minute appointment can only really scratch the surface. The support options available are often limited to medication and speech therapy, for which people are likely to face a long wait.
Mental health problems are usually inextricably intertwined with people’s social and economic circumstances: their work, their finances, their relationships. Any trauma, adversity they may have encountered in the past or their upbringing can also affect it. A good first support conversation would allow time to explore these factors and build a richer shared understanding of why someone is struggling.
These conversations would serve a therapeutic benefit—making someone feel heard and valued—which might be enough in some cases. It would also do a much better job of identifying the range of support one needs, some of which may be clinical, some addressing social and economic needs.
That’s why Mind is calling for a ‘Same-day Open Access’ model of mental health support in England. as proposed in Wales. This will mean people have more control over accessing the support they need, rather than having to bounce between high-care services. The first step would be to shift more resources towards people who have access to a great support chat with a skilled professional on the day they need it.
These conversations should be available through a variety of access points so that as many people as possible feel comfortable asking for support. Currently, people from racialized and marginalized communities who struggle with their mental health tend to have worse outcomes. Partly because of a lack of culturally responsive support, they are more likely to come into contact with services only during a crisis.
Mental health services they seem to have been politically deprioritized in recent years, despite a focus on long-term unemployment and claims for mental health-related benefits, particularly among young people. But the quality and accessibility of the initial engagement – to build a relationship of trust and understand the complexity of the challenges people face – is also critical for better results in this space.
Within local government and community services, there is a growing recognition of the importance of ‘relationship services‘. But the thinking of Whitehall and Westminster is still largely stuck in a new mentality of Public Management: a doctrine of public service reform focused on market-style incentives and the importation of private sector practices into government.
This leaves him ill-equipped to recognize or design for something as simple as whether a professional has the time and the relationship to sit down with someone for a cup of tea.
If, as seems likely, Andy Burnham becomes the next prime minister, he will bring a deep understanding of these opportunities and challenges from developing Live Well Access in Greater Manchester. This could provide the basis for a transition to the open-access same-day mental health support model and an opportunity for many more people to get the help they need much sooner.
