Crisis Houses

Maria Caulfield Excerpts

Wednesday 22nd May 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Fovargue. I thank the hon. Member for Enfield, Southgate (Bambos Charalambous) for bringing forward the issue. I offer my deepest condolences to his constituents on the loss of their daughter Jess.

Improving mental health crisis services has been a key priority for the Government for the past few years. We very much recognise that we need to support people better in their communities, rather than wait for someone to go into crisis when the only option is admission into a mental health in-patient unit. If we can get to people earlier, the outcomes are better, particularly for certain groups, depending on age, gender and ethnicity. We know that recovery is possible if the right treatment and early intervention can be given. That is why we have invested heavily in crisis services over the past few years. We see the difference that that can make, with people not ending up in detention in police cells, A&E or other inappropriate settings.

Before I touch on crisis houses specifically, I want to mention the range of crisis support available. We have provided more than £150 million of capital investment in urgent and emergency care infrastructure, £7 million of which has gone into new specialist mental health ambulances, which have mental health teams on board, rather than a traditional ambulance crew. Also, £143 million has gone into a range of alternatives—crisis houses are one of them, but we also have crisis cafés, step-down services and other crisis centres—which provide healthcare for people at a difficult time. More than 160 projects have been allocated funding and 137 of them are completed. We now have our crisis 24/7 helplines, so that around the country, in every area, a call will go through to the local crisis team. They are now linked through the NHS 111 service to provide a consistent route, so if a person is not aware of their crisis helpline number, dialling 111 will get them to that crisis line and their local mental health crisis team.

Crisis houses are a key part of that provision, and the early evidence shows that even crisis cafés can be associated with an 8% lower admission rate to hospital. Telephone services are associated with about a 12% lower admission rate. Overall, there is a 15% lower rate for detention under the Mental Health Act, which is all to the benefit of patients going into crisis. Crisis houses specifically are part of that crisis support team, and they provide accommodation for those who need such help and support, perhaps as a step towards more intensive crisis support, although sometimes that is just enough that someone is able to return home.

The hon. Gentleman is right that there is a mix in the provision of crisis houses. Some provide specialist care and regulated activity, including for those going through drug and alcohol addiction, some of whom might need their medication assessed and changed. Those crisis houses that do not provide such activities are not regulated by the CQC—he is absolutely right about that—and, to date, there have been no plans to expand the list of CQC-regulated activities to capture crisis centres that do not provide the more intense support. I hear his concerns, however, and as part of our work on the suicide prevention strategy, through which we are trying to reduce the number of suicides in England, we know that those suffering with pre-existing mental health illnesses are a high-risk group. I hear his concerns about Jess and the fact that she was in a place of safety that did not safeguard her needs, in particular as a vulnerable woman needing that help.

Crisis houses play an important role. They help mental health support teams, allowing them to deal with the most serious cases. They can also become a familiar setting for those patients who may use them regularly if they are going into crisis; they will know that that is a place where they can get help and support. Through our work on the suicide prevention strategy, in all the accommodation that people come into—crisis houses, police cells, prison cells, A&E or mental health in-patient settings—a key piece of work is on trying to eradicate ligature points, so that if someone is thinking of such a method of suicide, we have made it as difficult as possible for them to do that.

I am also concerned by the hon. Gentleman’s point about staff training. These staff members are looking after very vulnerable patients and they need training to know to whom they can signpost more quickly, whether that is the crisis team or other support avenues. Crisis houses are about more than just accommodation. Although they are not a regulated activity, they are more than just a roof over someone’s head. They are about assessing someone and getting them more intensive support if needed or getting them back home if possible.

Although I cannot commit today to including crisis houses as a regulated activity, I want them to meet the same standards as other places in which people going into crisis are often accommodated. Our motto for the suicide prevention strategy is “Suicide is everyone’s business”, so if crisis houses are not going to be a regulated activity and therefore not the business of the CQC, there must be more safeguards in place to ensure that they are as safe as possible, particularly for those at risk of suicide and for the staff, who have a difficult enough job at the best of times without having to deal with the fallout of a young person taking their own life under their care.

What I can commit to today is discussing the issue of crisis houses with Professor Louis Appleby, the Government’s adviser on suicide prevention, with whom I am working on the suicide prevention strategy and the suicide prevention oversight group. I am not sure whether regulation falling under the CQC is the answer, but I agree with the hon. Gentleman that there are clearly some gaps in training and development for staff. They must be able to better assess risk. There is also the issue of ligature points in crisis houses and gaps in their assessment as a place of safety for those staying in them.

I commit to following up on Jess’s case. We are going to get those suicide rates down. It is no one’s fault, but if there is extra work we can do to make crisis houses not just places of crisis, but places of safety, we should leave no stone unturned in doing that. I am very grateful to the hon. Gentleman for raising his constituent’s case as an example of what can happen. Crisis houses are not a regulated activity at the moment, but I am sure that there is more we can do to improve the safeguards that are in place. Following the debate I will speak to Professor Louis Appleby to see what more we can do for crisis houses to ensure that when a person going into crisis reaches out to get the help they need, they are as safe as they can be.

Question put and agreed to.