References and research

The conversations we have had with young people who have presented to hospital in a mental health crisis and the hospital staff who support them have shaped this training tool.  This anecdotal evidence is also reinforced by multiple publications that have considered the relationship between outcomes, experience and attendance. We have included highlights from various publications below, which support statements made throughout the training.


  • The Care Quality Commission (CQC) recognises the impact of poor care when people attend hospital for their mental health on people’s safety and ability to cope. They highlight the importance of care and compassion, staff training, and safety plans in supporting people and the effects they could have on repeat attendance. (CQC, 2015)


  • Mind’s independent inquiry into acute and crisis mental healthcare highlighted the importance of the quality of human interactions – such as respect, being taken seriously, a warm, caring, compassionate response, and understanding. These interactions could be lifesaving when a person is having a mental health crisis as they could leave a person feeling safer and more able to cope. (Mind, 2010)


  • “People who self-harm, especially when young, are a vulnerable but largely hidden population, who do not often come into contact with services and for whom a presentation to accident and emergency (A&E) represents a key opportunity for engagement and possible suicide prevention. This opportunity is frequently missed.” (Owens et al, British Journal of Psychiatry, 2015) This research also suggests that positive encounters in A&E can reduce shame and stigma, which can encourage future help seeking behaviour and contribute to a longer term reduction in distress.


  • The Royal College of Emergency Medicine Guidelines for Frequent Attenders recognizes the importance of good care, good engagement, and challenging stigma as key elements of approaches to reduce reattendance. (RCEM, 2017)


  • Spending on early intervention services for children and young people dropped by 49% (£3.7 billion to £1.9 billion) between 2010/11 and 2017/18. (The Children’s Society, 2019). Children and young people (0-18 only) make up approximately 20% of the population but receive only 6.7% of money spend by local NHS areas on specialist mental health versus adult spend (Children’s Commissioner for England, 2018)


  • In 2015/2016 services were funded so around one in four children with a diagnosable mental health disorder had access to specialist treatment. NHS England’s plan by 2020/2021 is for this funding to increase so that one in three children with a diagnosable mental health disorder can access treatment. (NHS Long Term Plan, 2019)


  • NHS England and local Clinical Commissioning Groups (CCGs) all together spent £1 billion on children and young people’s services in 2017-18 (around 1% of their total budget). (National Audit Office, 2018)




  • It is important that healthcare workers (not just specialists) have whole person conversations about needs and risks as a key part of engaging the patient and building the therapeutic relationship (NICE, 2004)


  • Assessing needs (as well as risks) from the person’s perspective, as well as a more rounded psychosocial assessment, and improved care can reduce the likelihood of someone self-harming again and may reduce reattendance (NICE 2004, Kapur et el, British Medical Journal, 2002).