The landscape of mental health crisis care in London has undergone a significant transformation, shifting from reactive, emergency-department-centric models to a more nuanced, community-led approach. This evolution is anchored in the London All-Age Mental Health Crisis Care Concordat, a strategic agreement designed to ensure that every Londoner experiencing a mental health crisis receives timely, equitable, and appropriate support. The framework is built on the principle of "experts by experience," integrating the perspectives of service users, carers, Black, Asian, and minority ethnic communities, and voluntary sector organizations. This collaborative development ensures that the resulting protocols are not merely administrative mandates but reflect the lived realities of those who navigate the system. The concordat represents a commitment among health organizations, London Councils, the Metropolitan Police, and the London Mayor’s Office to eliminate disparities and provide a seamless care pathway that respects individual needs and family involvement.
Historical Context and Strategic Investment
Over the past decade, London has seen historic investment in mental health infrastructure, resulting in the expansion of community-based services and the rollout of liaison mental health teams in every Emergency Department in the capital. This investment was driven by key strategic documents, including the NHS Five Year Forward View, the Better Health for London report, and the Mental Health Five Year Forward View. These documents highlighted the systemic challenges facing crisis care and provided the blueprint for improvement.
The progression began with the launch of the first crisis care concordat in 2014. Since then, London has witnessed significant growth in access to community mental health services. A critical development during the pandemic was the launch of open access crisis lines across all trusts, providing immediate remote support. Concurrently, the model of "crisis cafés" emerged as a vital community-based alternative to traditional hospital settings. These initiatives reflect a broader shift away from institutionalization toward decentralized, accessible care models. However, stakeholders acknowledged that despite this progress, further improvements were necessary to address access gaps, patient experience, and outcomes for London’s diverse population.
The Section 136 Pathway and Legal Framework
A central component of London’s crisis care infrastructure is the management of the Section 136 pathway under the Mental Health Act. This pathway involves the detention of individuals in public places by police forces for assessment. Historically, police custody was often utilized as a Health Based Place of Safety, but this practice has been discontinued in London, reflecting a move toward more therapeutic environments.
The London All-Age Mental Health Crisis Care Concordat and the associated Specification for Health Based Place of Safety sites establish a consistent, minimum standard of care. This guidance, first launched by Mayor Sadiq Khan in December 2016, targets all stakeholders involved in the Section 136 process, including London’s three police forces, the London Ambulance Service, approved mental health professionals, and acute care trusts.
The pathway covers the entire journey from initial detention to the completion of the Mental Health Act assessment and the arrangement of follow-up care. The guidance was updated and reissued in December 2017 to align with changes introduced by the Policing & Crime Act 2017. This legal update reinforced the requirement that places of safety must be health-based facilities rather than police cells. The current objective is to operationalize these specifications across London, ensuring that all Health Based Place of Safety sites provide a 24/7 service, supported by the broader crisis care system.
Community Alternatives and the Mental Health Crisis Assessment Service
To reduce the burden on Emergency Departments, London has developed community-based alternatives that offer a calm, therapeutic environment for individuals in crisis. A prime example is the Mental Health Crisis Assessment Service, established in March 2020 by Camden and Islington NHS Foundation Trust (now part of the North Central London Mental Health Partnership within NCL ICS). This service operates 24 hours a day, 7 days a week, providing an alternative to A&E that is tailored to individual needs.
The success of this model has led to its replication across other Integrated Care Boards (ICBs) in the capital. The concordat sets specific targets to increase access to these community services, aiming to see as many people as possible within four weeks of referral. There is also a focused effort to increase the number of people from minority ethnic groups accessing these services, ensuring that care is culturally competent and equitable. The agreement emphasizes that the voices of patients, their families, and carers must be central to care decisions, moving beyond a purely clinical assessment to a holistic support model.
London Ambulance Service: Joint Response and Remote Assessment
The London Ambulance Service (LAS) has redefined pre-hospital mental health care through specialized joint response units. Recognizing that A&E is not always the appropriate setting for a mental health crisis—and can often be stressful or traumatizing for patients—the LAS has deployed mental health joint response cars. These units pair a paramedic with a mental health nurse, enabling a rounded care approach that addresses both physical and mental health needs simultaneously.
This model allows for remote clinical assessment and referral into services closer to the patient’s home, thereby reducing unnecessary hospital admissions. The LAS mental health team, comprising more than 40 clinicians including nurses, social workers, and occupational therapists, provides expert care to approximately 9,000 patients per month. Given that more than two million Londoners experience poor mental health annually, this specialized intervention is critical. The team operates from the service’s emergency control room, providing remote assessment capabilities that streamline the pathway from crisis onset to appropriate care. This approach was highlighted in BBC News in February 2025, underscoring its significance in modernizing London’s crisis response.
Conclusion
The transformation of mental health crisis care in London represents a paradigm shift from reactive, emergency-focused interventions to proactive, community-integrated support systems. Through the All-Age Mental Health Crisis Care Concordat, the city has established a unified framework that prioritizes equity, timely access, and personalized care. By integrating police, ambulance, and health trust resources, London has created a cohesive pathway for Section 136 detentions and has expanded community-based alternatives like crisis cafés and assessment services. The joint response model further exemplifies this integration, demonstrating how multidisciplinary teams can provide compassionate, effective care outside of traditional hospital settings. As these systems continue to operationalize, the focus remains on continuous improvement, ensuring that the diverse needs of Londoners are met with dignity and expertise.