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The COVID-19 pandemic brought unprecedented and unforeseen circumstances into our lives. But just as social distancing rules helped to flatten the curve on the virus transmission there is another curve we must diligently watch and aim to flatten for the future – that of mental ill-health. It is vital that mental health crisis care is available and accessible for the long term.

The pandemic hit Australia just after January this year when the eyes of the world watched as homes burned to the ground, businesses were lost and wildlife struggled to survive the terrible fires that engulfed the country. On the other side of the world in the UK houses were awash with floodwaters and livelihoods were lost. These very visible events clearly show the impact that climate change is having on the lives of people across the globe. Added to this is the global pandemic driven by a virus we don’t understand that has potential to resurface in communities and nations over and over.

What is not clear, is the longer-term impact that these tragedies have on the lives of individuals, families and whole communities. When the visible signs are gone it is all too easy to forget the impact on people – both their physical and their mental health needs. Good crisis care must be available for everyone ……. everywhere ……. every time.

This however raises the question of what is optimal care for those experiencing a mental health crisis? It was this question that a gathering of mental health and suicide prevention leaders from 10 countries grappled with while attending the International Initiative for Mental Health Leadership (IIMHL) 2019 Leadership Exchange and Crisis Now Summit meetings held in Washington DC.

The response is the publication of the Washington DC International Declaration on Mental Health Crisis Care in which there was unanimous agreement that influencing health systems in a way that provides parity with a medical emergency was a key requirement.

Structural reform for mental health crisis care requires a comprehensive and integrated crisis network as the first line of defence in order to prevent tragedies of public and patient safety, extraordinary and unacceptable loss of lives and a waste of resources. The Declaration calls for healthcare leaders, governments and community organisations to adopt a systemic approach with the core elements being:

1. High tech crisis call centres

2. 24/7 non-law enforcement mobile crisis team

3. Crisis emergency receiving and short -term stabilisation centres; and

4. Essential principles and practices governing care pathways.

These quality crisis systems are further enhanced by harnessing data and technology, drawing on the expertise of those with lived experience, delivering services where the person is and providing evidence-based suicide prevention.

Mental healthcare must be moved out of the shadows, into mainstream care and focused on the whole person. Parity should be the norm for individuals experiencing a crisis, which means access to timely and effective care based on the person’s needs. The response must be equivalent to that of a person with a physical health emergency.

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