A Framework for the Development of Crisis Services: Identifying the Functions of Emergency Psychiatric Care

Pages9-17
Date01 March 1996
DOIhttps://doi.org/10.1108/13619322199600003
Published date01 March 1996
AuthorHelen Smith
Subject MatterHealth & social care
The Mental Health Review 1:1 © Pavilion Publishing (Brighton) 1996 9
A Framework for the Development
of Crisis Services: Identifying the
Functions of Emergency Psychiatric Care
Helen Smith
CMHSD
People in crisis have many needs; these are
likely to include: ‘accommodation and food;
24-hour observation; prolonged assessment;
medication; respite from family; respite for family;
problem solving/advice; counselling; company;
rest and safety; stress relief; help with self-care;
detoxification; relief from responsibility.1Despite
this wide range of needs, users often experience a
‘Procrustean Bed’* whereby all their needs in crisis
have to be met by a single service, that is, in-patient
care. There are two major problems with this limited
response: many of the needs of people in crisis can
safely be met through services other than admission
to hospital. This is not to deny the importance of
hospital admission as part of a range of responses,
but to highlight the fact that, for many people,
alternatives will be highly desirable and effective.
Secondly, people have many ‘types’ of crisis and a
comprehensive service needs a range of responses
if peoples’ diverse needs are to be fully met.
Within the category of ‘crisis response’, the
needs of people differ enormously. The long-term
user with a diagnosis of schizophrenia will have
very different needs to the depressed mother who
urgently needs a break from the demands of her
family, to the adolescent admitted to A&E after
taking an overdose and to the black homeless
person admitted on Section 136. The need for acute
psychiatric care is
not
a uni-dimensional
experience and services need to provide different
care settings and treatment approaches which can
respond to all the needs which a group of users
bring. The notion of a
range
of services is thus
at the heart of an effective local service.
Finally, before looking in more detail at a frame-
work for crisis services, the principles which guide
their development need to be established. Most
services now have general principles which state
that users should be treated as far as possible in
community settings. This reflects the fact that the
vast majority of service users are, of course, living
in the community. The role of acute services is to
support and complement the community services
and allow individuals to be treated in the least
restrictive/most facilitative environment possible.
However, it is still fairly uncommon to find services
which actually
do
have the community as their focus
— too often the in-patient unit remains the focus of
clinical care and the major consumer of mental
health resources. One of the implications of this is
that the vital role of other agencies, particularly
social services, may go unrecognised in what is seen
as mostly a health service preserve. This article is
based on the premise that the full involvement of
social services, primary care, the voluntary sector and
users and carers is central to a successful service.
It is worth considering this last point in more
detail. Peter Campbell, in this issue (see page 19),
discusses what users want from crisis services and
mentions user-led initiatives in this field. It is crucial
in all areas of service planning that users are fully
consulted and involved in service development.
* Procrustes had a bed which all his visitors had to fit — too small and he stretched them, too large and he cut off their feet!
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