Moving Beyond ‘Pilot-itis’ in mental health crisis care

By Athina Lockyer, Head of Portfolio – Innovation and Enterprise

How to solve the challenges of mental health crisis care? How do we move beyond endless pilots? What constitutes sustainable transformation in a system of constant flux? How do we embed impactful change, and how do we measure it?

These were some of the questions discussed in a recent event held in partnership with communication technology specialists Wavenet and Content Guru that gathered senior NHS leaders to discuss the future of crisis care in the NHS.

Across contributions from policymakers, commissioners, providers, technology experts and public safety leaders, the message was clear – demand for mental health crisis support continues to rise, but the solutions already exist. The challenge lies in implementing them consistently, collaboratively and at scale.

Here, we share our reflections from the day.

A need for clear evidence about what works

Dr Helen Gilburt from The King’s Fund helped to set the scene by describing a system under significant pressure. She alluded to the constantly changing policy environment, increasing financial constraints, structural reforms and additional scrutiny.

While investment has grown over recent years for services, there remain important questions about how effectively that investment is translated into improving outcomes for people and staff.

Helen highlighted the need for a clearer evidence base around what works, particularly in crisis care, and warned against large-scale transformation programmes that are not accompanied by a cyclical loop of learning and adaptation.

Above all, she stressed the importance of building services that people trust and can access when they need them, supported by confident staff, shared language and strong relationships across organisations.

A proven alternative to hospital care

A powerful example of putting this into practice was shared by Dr Jihad Malasi, of Kent and Medway ICB. Recognising that many people in mental health crisis do not need emergency departments or inpatient admission, he explained how Kent and Medway has invested in Safe Havens and Crisis Recovery Houses with buildings physically located on or close to Acute Trusts, delivered in partnership with the voluntary, community and social enterprise (VCSE) sector.

These services provide peer support, mentoring and short-term crisis accommodation, creating alternatives to hospital care and allowing people a stepped approach to engaging or disengaging with crisis services. Whilst the results have been encouraging, with reductions in emergency department attendance, ambulance conveyances and police detentions, Jihad cautioned that success has depended less on commissioning buildings and more on building trust between NHS organisations, clinicians and VCSE partners. As he put it, “you can commission bricks and mortar, but you can’t commission trust.”

Technology to augment clinical decision-making

Technology as an enabler for transformation was another major theme. Tom Haxby, from Content Guru, highlighted how mental health crisis services are experiencing growing demand, particularly through crisis lines, while workforce growth has not experienced the same investment to allow teams to keep pace with demand.

He demonstrated how cloud-based platforms, AI-enabled triage tools and real-time data can help services route people to the right support more effectively, reduce administrative burden and improve patient experience. Importantly, he argued that technology should augment, not replace, clinical decision-making. The most successful implementations focus on understanding demand, engaging staff and service users early, and ensuring technology supports more personalised care.

Collaboration is an overlooked aspect of transformation

Dr Reggie Sangha, of Content Guru, led a panel discussion and all agreed that a focus on reinforcing the need for genuine collaboration across systems is a critical but undervalued aspect of transformation. Participants discussed the importance of equitable funding, workforce wellbeing, easier access to crisis services and stronger partnerships with VCSE organisations. There was widespread agreement that prevention must become a greater priority, with one speaker noting that the sector needs to “stop pulling people out of the river and go upstream to see where they’re falling in.”

What does a successful integrated mental healthcare model look like?

Presentations from Sussex Partnership NHS Foundation Trust and South East Coast Ambulance Service (SECAmb) laid the groundwork for what integrated working can achieve.

Sussex’s model combines rapid response teams, crisis text services, walk-in support and close working with emergency services across the pathway, helping to reduce Section 136 detentions, avoid thousands of emergency department attendances and improve patient flow for both providers.

Meanwhile, policing representatives from Kent and Medway highlighted both the opportunities and challenges associated with the Right Care, Right Person approach, stressing the need for strong implementation, shared accountability and sufficient community provision.

Success depends on embedding what works

The event concluded with a sense of cautious optimism. While mental health services face considerable pressures, there was a shared belief that progress depends less on creating new pilots and more on embedding proven approaches, strengthening partnerships and relentlessly focusing on what works for people in crisis with their feedback incorporated into innovation.

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