In 1995 The Consultation and Advocacy Promotion Service carried out research into a definition of crisis and explored how a crisis could be addressed. The authors produced a report ‘Research into Mental Health Crisis Services for Lothian’ (1995). This involved an in depth consultation with service users, the majority of whom at that time were not involved in the formal user movement. From this consultation it became clear users defined a crisis as ‘an individual experience not necessarily requiring admission to hospital but necessitating an immediate response -not an appointment’. From this key finding a model for service delivery emerged, for a non-medical Crisis Centre, an outreach team and a telephone help line available twenty-four hours a day.
A number of years later as part of the Joint Mental Health Plan for Edinburgh, the Strategic Development Group (Mental Health) established a Crisis Services Task Group. This group was tasked to produce the strategic plan for the development of mental health services in Edinburgh and to inform this process commissioned a piece of work titled ‘A Needs Assessment and Options Appraisal’ from the Scottish Development Centre for Mental Health. This research included evidence of a review of the Psychiatric Emergency Team (PET) based at the Royal Edinburgh Hospital, reports from City of Edinburgh Council Mental Health Officer Service. Further it included feedback from users, revisiting the 1995 CAPS research and undertaking a review of carers experiences, as well as a small scale survey of out of hours General Practitioner Services and the views of local service providers and individual professionals. Researchers organised and carried out study visits to Islington Crisis Resolution Service, Mind Crisis Line and Hull Crisis Service as well as looking at national research and the recommendations from the Framework for Mental Health Services (1997) and the Accounts Commission paper ‘A Shared Approach’ (1999).
Recommendations from the report were for mental health crisis services to provide individual non-medicalised support at an accessible base in the centre of Edinburgh. To provide a staffed help line for service users and carers and to take calls over twenty four hours, seven days a week to assist people find a way forward and enable actions to be agreed that would lead to resolution of the crisis. Further recommendations highlighted the need for the service to work closely and collaboratively with out of hour’s services in Edinburgh e.g. Emergency Social Work Services, Out of Hours Teams as well as the Psychiatric Emergency Team.
With these recommendations and a commitment to the further development of the crisis service a steering group was formalised with membership including Edinburgh Users Forum, supported by Consultation and Advocacy Promotion Services, Edinburgh Carers Council and the funding bodies the City of Edinburgh Council and NHS Lothian. This group then through a competitive tendering process commissioned Penumbra to provide the service. The group became formalised as the Edinburgh Crisis Centre Partnership Group and a formal agreement between the partnership members was negotiated. The Crisis Centre also attracted funding from the Scottish Executive to pay for a 3 year evaluation of the Crisis Centre with the aim of informing other NHS Boards and Local Authorities throughout Scotland of the key learning points.
The Partnership Group through shared decision making govern the Crisis Centre and has overall ownership of operational policies and procedures reviewing them annually. Members from this group and their wider membership are also involved in the recruitment of Crisis Centre staff.
Equality in access to the Centre’s services as well as in the recruitment process has been a priority throughout the Centre’s development. Overcoming physical barriers to accessing the Crisis Centre building forced the Centre to open on an interim basis and we were unable to provide overnight accommodation for the first two years of operation. The Partnership Group worked hard towards addressing this situation and with the help of a wide range of friends we fully opened in 2009 and have, since then, been able to offer overnight stays.
