Crisis tends not to happen suddenly. There are warnings; there is a build up. If the warnings and the build-up are spotted, then hopefully preventive action can be taken. You won't be told (effectively or actually) to go away until you're really ill or imminently suicidal. If you know what helps and what doesn’t, this will be trusted as valuable expertise and will shape the care you receive if and when crisis comes. In fact you'll have a crisis plan that you’ve negotiated with your care team and signed off yourself that sets out what you want to happen and where you want to go when you’re in crisis. It won't happen in every set of circumstances. But it could happen in many more situations than it does now.
This may sound obvious, but Mind's crisis care inquiry found that too often people are turned away and struggle to get help. Their crisis calls may go unanswered or they are told they are not ill enough to qualify for help. But the fact that they are there at all means they could be well down the road towards crisis already. Too few people have a crisis plan, and those who do are often not involved in deciding it, or say it is stuck in a filing cabinet and rarely referred to. The Care Quality Commission prioritises care planning as something that needs to improve for detained patients.
In a better future vision of health care, your definition of your own crisis will count, and the plan you have co-written will determine the care you get. The benefits of peer support from other people with experience of mental health problems will be obvious and the people providing it will be valued as equals by other health care workers. Alternative models of service that are massively valued by the people who use them – including Leeds Survivor Led Crisis Service and Maytree – will spread rather than being rare and isolated examples. It’s an overused term, but with the right changes, the postcode lottery of good access to crisis care beyond hospitals will end. And when you go into hospital or other services you’ll be treated with courtesy as a welcome guest. Boredom, insecurity and abuse on wards will be a thing of the past. Cultures of restraint will be replaced by respect and dignity.
How do we get to that vision? This is partly about health service cultures, but wider society sets the tone. Attitude change – underpinned by law – is fundamental. We need to see mental health as being about 'us' not 'us and them' – to end the stigma and discrimination. There is still a long way to go, as the three-quarters of people with a mental health problem who lost friendships as a result know too well, and those who lose their jobs – or never get one – because of it know even better.
But there is hope too. For instance, last year, MPs in Parliament and Assembly Members in the Welsh Assembly spoke about their own experience of mental health problems. They didn’t know when they took that step that their colleagues and the media would respond warmly. The fact that their stories were so well received shows that as a society we are slowly moving in the right direction.
Parliament is important but it isn’t in people’s daily lives the way that employers are. When it comes to helping people understand mental health and how to look after it, employers have a big part to play. Creating a mentally healthy and open workplace where employees feel supported enough to discuss a problem – that’s another marker of progress that is good for business as well.
Which brings me back to the staff–patient dynamic in health care. The NHS is a huge employer and its staff are rightly expected to care for people using clinical skills, respect and kindness – often in very high-demand situations, which in mental health settings include the risk of self-harm or suicide. If we expect people to be kind and empathic in their work, that is how they should be treated by their employer too. If we want staff to work in partnership with patients, respecting their wishes and knowledge of their own needs, they should feel safe enough to discuss their own mental health. And if a small organisation like Leeds Survivor Led Crisis Service can provide staff with supervision, reflective practice groups, experiential training and individual wellbeing budgets we should expect the NHS to support its frontline staff just as well.
The NHS should have been at the forefront of the Time to Change campaign – as an employer not just as the main provider of services. They are getting there – but as with the rest of the country, the journey is too slow, and too long, and the time for change is now.
Alastair Campbell is a writer and strategist best known for his role as former British Prime Minister Tony Blair's spokesman, press secretary and director of communications and strategy.
This blog is also featured on the Health Service Journal website