9 March 2026

Despite increasing activity from 1000 to 2400 last year, CNWL's Mental Health Crisis Assessment Service has maintained quarterly patient flow and achieved outstanding patient satisfaction. 97% of patients/carers describing their stay in MHCAS as Very good or Good on the Friends and Family Test.

Alison Butler, Director for QI and Dr Tami Kramer, Clinical Lead for QI joined Dr Mehtab Rahman, Consultant Psychiatrist, Toti Freysson, Service Manager and multidisciplinary colleagues at MHCAS to reflect on how they have incorporated QI methods to develop and deliver their innovative model of care for patients in mental health crisis.

The team demonstrated a number of tools and highly streamlined processes with potential for Adaptation, Adoption and Spread across services looking to improve, including:

A structured clinical handover system for safety using the MHCAS acronym to systematically cover all essential domains as follows:

M – Mental health diagnosis, Medication, Mental Health Act status
H – History of presentation to MHCAS
C – Community links, Current risks, Chronic illness
A – Assessment outcome, Aftercare arrangements
S – Substance use, Safety and Management plan, Safeguarding

Use of an interactive online whiteboard using Microsoft Forms which allows a real time summary of patient history, current and past presentations, patient needs, care plan and estimated date of discharge, which is reviewed and updated in real time and is accessible remotely.

Bespoke clinical tools to assess alcohol withdrawal and opiate management. To support consistent multidisciplinary decision-making with referring A&E teams to improve patient safety, clinical governance, and the quality of admission decisions. This initiative has reduced inappropriate admissions to MHCAS and has enhanced clinical capability and safer care pathways for patients. 

A structured QI framework. Ensuring patients are allocated to the most appropriate clinical lead (medical or nursing case management), improving clarity, accountability and efficiency. Nursing staff are empowered to lead risk management and discharge planning within a clear governance structure. Additionally, a support-worker feedback tool enables daily, real-time reporting on patient care needs.

A weekly 1 hour team meeting outside the unit to reflect on practice and drive service improvement called the MHCAS Thursday space.

Monthly reflective practice facilitated by an outside facilitator face to face.

Regular debriefs for any serious/significant incidents which arise in the MHCAS high acuity setting (up to 3 debrief sessions with a senior psychologist).

Alison Butler commented: 

“It was a pleasure to visit the MHCAS unit at St Charles and see first-hand the incredible innovation taking place. What stood out most was the genuine multidisciplinary teamwork — colleagues working seamlessly together with a shared commitment to improving patient care. The energy, creativity and collaboration within the team are truly impressive and reflect the very best of integrated working.

Dr Torsten Wrigley, resident doctor at MHCAS, won the Trainee Award at the recent Safety Conversation for his Poster “Smart handover: digitising clinical handover to improve patient safety”. The MHCAS Team have plans to share their innovations at forthcoming national and international conferences.  

The impact and innovation of the MHCAS have also been recognised nationally, with its work featured in major media outlets including The Times, ITV, and the BBC.