Crisis support: how NHS 111 ‘press 2’ and pilots in Emergency Departments are making a difference
With a growing number of people in mental health crisis in Emergency Departments, teams across south west London are making changes to offer better support.
This includes the new NHS 111 ‘press 2’ service which has been running for almost a year, as well as a rapid assessment pilot in Kingston Emergency Department – which is part of a range of measures across the four south west London hospitals.
A year of NHS 111 ‘press 2’ for mental health
Ryan Brookes is the Clinical Service Lead for NHS 111 Mental Health. He helped launch the new service locally in 2014 and manages a team at their call centre: “People who call 111 with mental health challenges speak to trained practitioners - our main goal is to support people’s needs and offer a safe alternative to visiting A&E.”
With around 2,000 calls each month, many of them from people experiencing mental health crisis - such as suicidal thoughts or recent overdoses - timely support is crucial.
Ryan explains the support the service offers: “Often callers are directed to crisis assessment teams instead of A&E - these teams often see people within hours. We’ve also referred thousands to services such as talking therapies, crisis cafés, and charities, and user feedback has been overwhelmingly positive.”
Step into the 111 call centre in and you’ll notice the typical open-plan office layout, staff at computers wearing headsets. But the nature of these calls couldn’t be more important.
“We have mental health concerns ranging from low mood and panic attacks right up to severe mental health issues like schizophrenia and suicide,” says call handler and nurse Queenie. “Sometimes callers don’t always know how at risk they might be - but we’re trained to ask specific questions, to really get to the heart of what’s going on.”
All the mental health nurses working in the service have at least two years of training and a year of experience in mental health settings, with ongoing support in their roles. Queenie explains: “We’re essentially a team that supports each other, drawing on each other’s expertise. We also have regular training, so that we’re constantly building our skills and knowledge.”
Queenie’s motivation comes from a personal experience of losing a family friend to mental health challenges. “She called for help, but none of us really understood what she needed,” Queenie recalls. “That motivated me to get into mental health, to understand where people are coming from, and help them in a way I wish we had done before. If we truly understand where they’re coming from, we can give them the right treatment and help them live a fulfilling life.”
While the ‘press 2’ service is effective at getting people in crisis the support they need, the service is keen to increase awareness as they have capacity. In 2025, a text-message service will be introduced as a new way for people to get in touch and increase capacity further – designed for those who prefer not to speak over the phone.
Pilot services in Emergency Departments to support people in mental health crisis and frontline staff
Ashley Joyce, who leads the Kingston Liaison Psychiatry at South West London and St George's Mental Health Trust explains the number of people in crisis arriving at emergency departments is increasing. “We’re receiving around 15 to 25 referrals a day from emergency departments, and we’re experiencing longer wait times for psychiatric beds when people require hospital admission. That’s not just in our trust, that’s across London. It feels like managing a ward-size number of patients in A&E.”
When people arrive in emergency departments, collaboration between hospitals team and mental health services is key to ensuring they receive rapid and appropriate care.
To address the challenges, Kingston Hospital is part of a rapid assessment pilot which is supporting patients arriving in emergency departments get to the most appropriate service as quickly as possibly. Ashley explains: “We have a support worker based in Kingston hospital who can quickly screen patients displaying signs of mental distress, to see if they need an immediate assessment. It’s saved our team time, because we can prioritise the most acutely unwell patients who need complex clinical care. If it proves successful, we’re hoping to roll it out to more hospitals in south west London.”
Ashley explains the reasons why people suffering a crisis might arrive at A&E:
"Sometimes people experience mental health relapse; sometimes they haven’t had any previous mental health support in the community. We also see older adults with cognitive decline arriving from care homes that can’t manage them, and we see an increase in people coming in with substance misuse or other social stresses.”
He adds: “The physical environment in A&E can be highly distressing. While Kingston has a mental health assessment unit, it was designed for no more than three patients so people are now ending up in corridors. For them, the uncertainty of not knowing what’s next can be incredibly difficult - which is why speeding up assessment is so important.”
Across each Emergency Department in South West London, Liaison Psychiatry teams like Ashley’s provide an important link to local mental health services. From the end of February, St George's Team is due to begin trialling a similar triage system to enhance support available. And across South West London, ‘Enhanced Response Practitioners’ at South West London and St George’s work with patients under the care of community mental health teams providing a further alternative for anyone experiencing a mental health crisis.
