A new report launched today by Northern Ireland Mental Health Champion, Professor Siobhan O'Neill, The Economic Case for a Mental Health Regional Crisis Intervention Service in Northern Ireland, reveals that community-led mental health crisis interventions could save the health system more than £9 million annually by reducing Emergency Department attendances.
The report finds that the immediate costs of mental health crises to the health care system, ambulance, social work, PSNI and families in Northern Ireland is conservatively estimated to be more than £45 million annually.
By using evidence from Scotland, the report demonstrates that more than two-thirds of people in crisis can be successfully supported by community organisations, freeing up specialist services for those with the most acute needs.
One of the main models of crisis intervention examined in the report is Scotland’s Distress Brief Intervention (DBI), which provides 14 days of compassionate support for people in distress in the community, who do not need statutory mental health services. The cost of DBI per person is £392 (including 14 days of support). The average cost of an ED contact currently in NI is £544 per person. The report shows that implementing a similar model in NI, for eligible people who would otherwise attend hospital EDs, could lead to immediate savings of over £9 million per annum1.
Further analysis indicates that if the mental health benefits of the intervention are sustained beyond one month, the resulting savings would increase across the healthcare system, including in primary care.
The report also illustrates that initiatives that are in place in parts of NI, such as triage for those with a mental health–related crisis, and support for frequent callers of emergency services, can reduce costs for both ‘blue light’ and health services. The cost effectiveness of brief psychological therapy delivered by non specialists was also highlighted in the report, along with emerging evidence on the economic benefits of crisis cafés and outpatient units staffed by mental health workers, which provide safe spaces for people in distress.
The report demonstrates the importance of Cross Departmental collaboration and the broader benefits beyond Health services, with particular economic benefits to policing and the Justice system.
At the report launch, Professor O'Neill called for urgent investment in community-based crisis services, which can provide earlier support, reduce hospital attendances, improve outcomes for people experiencing mental health emergencies, and deliver significant savings across the healthcare system.
Professor O’Neill said that the services should be part of the Regional Mental Health Crisis Service, which was launched in August 2021, but has not yet received the funding necessary for delivery on the ground.
The Mental Health Champion, Professor Siobhan O’Neill said:
Recent figures from the self-harm registry chart a 74% increase in Emergency Department presentations for suicidal ideation, and we have also seen a rise in suicide rates since 2017.
The Emergency Department is not always an appropriate place for crisis support and can contribute to escalation in suicidal distress and hopelessness. Many people who experience a crisis do not need to be supported by a specialist mental health service nor should they need to spend hours waiting in EDs. I believe that connected, compassionate support for at least 14 days, delivered by the Community and Voluntary sector, would better meet the needs of many people experiencing suicidal distress. The findings are particularly important given the forthcoming introduction of Right Care Right Person which will see changes in how PSNI respond to mental health crises.
Our Executive need to act urgently to implement Community and Voluntary sector crisis services in every part of Northern Ireland, recognising that they are a central component of suicide prevention and will result in savings across Departments.
David McDaid, commissioned by the Mental Health Champion to write the report said:
Providing timely and appropriate care to people when they are experiencing a mental health crisis not only can improve outcomes, but it can also play a role in reducing pressures on blue light services and hospital emergency departments. Scotland’s Distress Brief Intervention (DBI) has been shown to work in Scotland and has been scaled up nationally.
I am confident that, working firstly in partnership with front line services including the PSNI, Northern Ireland Ambulance Service and GPs, to help identify people who would benefit from DBI, combinations of Community and Voluntary sector services within a Regional Mental Health Crisis Service, are then likely to be cost effective, and importantly, improve outcomes for people in distress.
A focus on people in distress who do not need specialist mental health support is likely to have a positive return on investment, saving resources through providing more tailored and appropriate non-clinical support. Whilst a DBI model is one possibility, there would also be benefits from training people within community organisations to deliver brief psychological support, alongside better forms of triage when people contact the emergency services. Frequent callers to emergency services are another group that could benefit from support from community organisations.
You can read the full report here: The Economic Case for a Mental Health Regional Crisis Intervention Service in Northern Ireland
1The detailed modelling in the report (see Table 3) shows that if 100% of the target population (39,990 contacts) were reached, the immediate costs averted to the health system would be £7.72 million, with additional savings to PSNI (£5.22 million) and families (£2.74 million), totalling over £15 million. The £9 million figure is therefore a rounded, conservative estimate based on savings to the health system, PSNI and to families if 75% of the targeted ED contacts are diverted.