10 March 2026

Central and North West London NHS Foundation Trust’s (CNWL) Mental Health Crisis Assessment Service (MHCAS) has sustained strong patient flow and exceptional patient experience, despite activity rising from 1,000 to 2,400 attendances last year. 97% of patients and carers rated their care as Very good or Good on the Friends and Family Test.

Alison Butler, Director of Improvement, and Dr Tami Kramer, Clinical Lead for QI, joined Dr Mehtab Rahman, Toti Freysson and the MHCAS multidisciplinary colleagues 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 several tools and highly streamlined processes with the potential of adaptation, adoption and spread across wider services looking to also improve. These included:

  • A structured clinical handover system, using the MHCAS acronym covering diagnosis, history, risks, aftercare and safety planning.
  • A real‑time digital whiteboard built using Microsoft Forms, enabling real-time summaries, remote access to up‑to‑date patient information and care plans.
  • Evidence‑based tools for alcohol withdrawal and opiate management, supporting decision making, improving patient safety, consistency and reducing inappropriate admissions.
  • A QI‑driven allocation framework ensuring patients are matched to the right clinical lead, empowering nursing staff and strengthening governance.
  • Daily support‑worker feedback mechanisms including a weekly 1 hour team meeting outside the unit, monthly reflective practice and regular debriefs for serious incidents, to highlight patient needs, risks and equity considerations.
  • Regular reflective spaces, including weekly team improvement sessions, monthly facilitated practice, and structured debriefs following significant incidents.

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.

MHCAS innovations are gaining national attention, with features in The Times, ITV and the BBC and MHCAS colleague, Dr Torsten Wrigley recently won the Trainee Award at the Safety Conversation event for his “Smart handover” digital innovation, and the team plans to share further learning at upcoming national and international conferences.