Appendix: Community-based crisis and acute care team type definitions

This code is to be used for teams that provide functions of urgent and acute mental health care in the community. This typically includes urgent mental health assessment, gatekeeping inpatient admissions, intensive home treatment as an alternative to admission, as well as facilitating early discharge from inpatient care.

This code is for use where a single point of access service is the team’s primary function. This code should be used if the team also includes a mental health enquiry and/or crisis response line.

This code is for use where a 24/7 crisis response line is the team’s primary function and should be used to record the total number of telephone referrals and contacts coming into these services.

Section 136 of the Mental Health Act, allows for someone believed by the police to have a mental disorder, and who may cause harm to themselves or another, to be detained in a public place and taken to a safe place where a mental health assessment can be carried out.

A place of safety could be a hospital, care home, or any other suitable place where the occupier is willing to receive the person while the assessment is completed. Police stations should be only be used in exceptional circumstances.

Health-based places of safety are most commonly part of a mental health unit on a mental health hospital or acute hospital site, or part of an accident and emergency department in an acute hospital.

Unless the place of safety is an A&E department, it will not usually be available to people who have not been detained by the police.

Crisis cafés offer mental health support to people, often in the evenings and weekends, when they may need help most. They aim to support people to reduce any immediate crisis and to safety plan; drawing on strengths, resilience, and coping mechanisms to manage their mental health and wellbeing. As well as offering support, professionals may also be able to refer and direct onwards to further services if required.

A sanctuary or safe haven provides a safe, homely place for individuals experiencing crisis to go as an alternative to attending A&E. Primarily a physical location of safety, offering practical and emotional support during the evening (although they don’t provide accommodation), they often include a 24-hour crisis support line too.

While the functions and naming of these services may vary slightly in different geographies, they are included as a single ‘team type’ for the purposes of recording activity in the MHSDS.

This is defined as an open access ‘walk-in’ NHS facility where people experiencing a mental health crisis can access support and assessment of their needs. They are sometimes viewed as an ‘A&E equivalent’ for mental health and are staffed primarily by NHS mental health nurses and other qualified professionals.

A psychiatric decision unit (PDU) is a dedicated mental health acute assessment unit, providing an additional facility for an enhanced assessment and offering short-term support to people in mental health crisis. People are typically referred to such units from A&E or another urgent mental health service, as a place of respite for those experiencing acute and complex mental health crisis, for whom inpatient admission is being considered.

They are predominantly assessment units, staffed by qualified NHS staff with overnight facilities (typically for up to 48/72 hours) for the assessment and development of treatment plans. The reduction in time pressure enables the service user to think through more clearly the nature of their crisis and the sort of help they need to recover, both over the short and long term, and gives clinicians time for more thorough, ongoing assessment, and sometimes for the crisis to resolve or reduce. This enables treatment plans to be tailored to the needs of the service users, making full use of community services, and potentially less likely to result in an inpatient episode.

Acute day services provide assessment and treatment to people experiencing a mental health crisis who would otherwise require admission to an inpatient service. People can also be referred to acute day services to shorten their time spent in an inpatient setting.

Crisis and recovery houses are community-based residential settings that give clinical and social support to people during a crisis. Some crisis houses may provide specialist care for a specific population, such as women, but most are accessible to the general population.

Care is usually provided in supported housing in partnership with voluntary or social care organisations. The function of the Crisis House is to serve as an alternative to admission into hospital. The service is aimed at supporting people who are experiencing a mental health crisis which would result in them requiring admission, but who could be supported positively and safely in the crisis house instead. The crisis house provides a safe alternative to home where people can recover from their crisis, be reminded of useful skills,

maintain their independence and access appropriate support.

The staffing of crisis houses can vary. Some are staffed mainly by voluntary sector and/or support and peer support workers, some mainly by clinical staff, or a mixture.