What makes a good Crisis Plan?

Miles Rinaldi

Head of Recovery & Social inclusion

“On an important note, the team that supports me

believes fully that I have the right to decide the

treatment I need and this extends to crisis. This allows

me to work collaboratively with them and I trust them.”

CQC Community mental health survey 2013

Q: Does your NHS care plan cover what you should do if you have a crisis?

5

5.5

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6.5

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7.5

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BEH Camden &Islington

CNWL East LondonFT

North EastLondon FT

Oxleas SLAM South WestLondon

Surrey &Borders

WestLondon

Policy and guidance

• NICE (2011) Quality Standard for adult mental health

– People who may be at risk of crisis are offered a crisis plan (QS 9).

– People are actively involved in shared decision-making and

supported in self-management (QS 3).

– People in hospital for mental health care, including service users

formally detained under the Mental Health Act, are routinely

involved in shared decision-making (QS 10).

• Mental Health Act code of practice – chapter 17.

NICE (2011): A crisis plan should contain:

• Possible early warning signs of a crisis and coping strategies

• Support available to help prevent hospitalisation

• Where the person would like to be admitted in the event of

hospitalisation

• The practical needs of the person if they are admitted to hospital

(e.g. childcare, care of other dependants, including pets)

• Details of advance statements and advance decisions

• Whether and the degree to which families or carers are involved

• Information about 24-hour access to services

• Named contacts.

Crisis Plan

What the person wants to happen if they are in crisis and

need others to take care of them and keep them safe

Different from other plans:

• Care plan = a person’s assessed health and social care needs

that promotes recovery by focusing on improving outcomes that

mattered to the person

• Personal recovery plan = what the person will do for themselves

• Crisis plan = what they want others to do for them in a crisis

Trust audit (2012): Recovery focused care planning

What is a Joint Crisis Plan?

• The Joint Crisis Plan is an advance agreement between

service users and their care team regarding service user

preferences for treatment and practical arrangements in

the event of future mental health crises.

• A joint crisis plan aims to empower service users while

facilitating early detection and treatment of a relapse.

• A joint crisis plan has to be negotiated and agreed (for

it to be a joint crisis plan).

What is clear from the research evidence?

• Service users like having crisis plans.

– The completion process, content of the document and

quality of experience – much is known.

• In a time of crisis, crisis plans are all too often not

followed by mental health services.

– Little is known about access and honouring crisis plans

• The quality of crisis plans mirrors the quality of

the process whereby which they were developed.

What makes a good crisis plan?

• Delphi: services users, family, friends, carers and mental

health professionals.

• 78/94 statements reached positive consensus

An interesting finding....

• 10% of service users

• 25% of carers, families and friends

• 49% of mental health professionals

– Disagreed or strongly disagreed with the statement: ‘crisis

plans will not work because services will not honour them’.

Outcome of the coproduction exercise

• New collaborative crisis plan

• Good practice standards for the Trust

Developing collaborative crisis plans

Collaborative crisis plans have to be negotiated,

agreed and shared with others ... and the

negotiation is a critical part of the process.

Hence the need for a collaborative process.

Collaboratively developing crisis plans

Collaborative crisis plans uploaded on RiO

Comments

“We often only meet the unwell

individual and do not have any

“baseline”. If we have a

collaborative crisis plan where we

have information on what they like

to do and eat, their family and

friends etc., this helps us to

engage the person who is unwell.”

Deputy Ward Manager

“the nurses can quickly see what does

and doesn’t work for you… the plan

immediately cuts out the things that

aren’t helpful and makes it possible to

articulate things that you cannot

articulate when in crisis.”

Service User

Systems: Crisis plans

Community team and

GP

Crisis plans inform initial HTT / ward care plans

Updated crisis plans informed by

recent crisis

Home Treatment

Team

Inpatient Ward

Thank you

Miles.Rinaldi@swlstg-tr.nhs.uk