The Mental Health Crisis Pathway via 111 was introduced by the GHA on 26th July 2021. It allows patients and their relatives a single point of contact for a Mental Health Crisis, which can be safely triaged, managed and followed-up by clinical professionals. This 24/7 telephone backup provides reassurance to patients and families and increases the availability of specialist Mental Health staff to assess and support people in the community.
On rare occasions someone may wait longer for a psychology appointment when it is not a crisis or an emergency because they have requested a specific member of staff, however, they can should be offered an alternative. The GHA invites the Gibraltar Mental Welfare Society or the individual concerned to share details privately so that the matter can be properly investigated and addressed.
The Crisis Pathway is being closely monitored and detailed quarterly performance reports are being prepared. There is a 97% compliance with target response times and the reasons for any lapses are fully investigated and adjustments to the protocol are implemented accordingly. All evidence and feedback to date from clinicians, partner agencies and patients indicate that the 111 service works well and safely manages those in crisis, which is what it was established to do.
The Crisis Pathway is not designed or intended to be the appointment system for counselling or psychology and this is where those advocating seem to misunderstand the purpose of the 111 service; there is little evidence in respect of the efficacy of direct access to services provided by a psychologist in a crisis.
Indeed, early indications from the data collected to date indicates many of the patients presenting via the crisis pathway can be well supported in the community and the crisis prevented from further escalation. Much of this is through an early appointment with a Mental Health Nurse for advice support, early medication review or activation of enhanced support in the community. Changes in practice in the Community Mental Health Team have made it easier to activate enhanced supports to patients at risk of relapse at home.
Issues with coordination and communication within the Mental Health Service were recognised in the National Mental Health Strategy, and active work is being undertaken to address this. Dialogue and the inclusion of staff at all levels will be crucial to the successful and sustainable long-term change. There has been extensive communication with staff regarding the implementation of the strategy, including open sessions with staff that were well attended, the circulation of two newsletters and regular visits to clinical areas to discuss the planned programme of change. A further round of open meetings with staff is scheduled to discuss any concerns and the next round of work on the Mental Health transformation program.
The Director General of the GHA, Professor Patrick Geoghegan, said: ‘Discussion and the involvement of staff at all levels will be crucial to the long term sustainable change envisioned in the Mental Health Strategy, and I remain committed to working alongside staff to listen to and learn from their experiences. So far, all the feedback and empirical data indicates that the Mental Health Crisis Pathway is working well to safely manage people in crisis. I look forward to working closely with all stakeholders throughout the next stages of implementation of the strategy to ensure an effective and efficient Mental Health Service.’
Minister for Health Samantha Sacramento said: “The Government has made mental health a priority. The recent 111 crisis helpline is one of the outcomes of the Mental Health review that I commissioned last year. This access line is revolutionary for Gibraltar and provides immediate access for those who find themselves in a crisis situation arising from mental health. This has been an effective and welcome development by both practitioners and service users and patients. Recent attempts to minimise its success seem to arise from a failure to understand that this is an emergency service and as such this confuses the public. I would invite anyone who wishes to represent an individual who has had an issue accessing the emergency service to immediately contact the GHA’s senior management team so that this can be investigated promptly as this would lead to a quicker resolution for the patient.’