Energising mental health crisis support and co-production in Yorkshire

In Sheffield, our Psychiatric Decision Unit is a 24/7 nurse-led facility that offers short term mental health crisis support. Our facility is designed to be a calm, trauma-informed setting that offers timely access to mental health professionals, often making it more suitable than A&E for individuals experiencing a mental health crisis. 

Despite operating in an environment of rising demand, our service data was showing us that the Decision Unit was not being used to capacity.

With support from the Q Exchange funding programme, we undertook an improvement project to find out more about why this was happening and what action we could take. We wanted to improve uptake amongst our service users and reduce demand on other areas of the health and care system.

Initially our aim was to increase the uptake of referrals to the Decision Unit by around 30% by improving awareness and offering training in improvement to our organisation and partners in the surrounding health and care system.

Early on in this project, we discovered that it wasn’t quite that straightforward.

Our Expert by Experience group, made up of service users themselves, pointed out that this approach was not going to address our real problem. We did not have enough understanding or data about why referrals to the Decision Unit were being declined.

Working closely with our Experts by Experience, we carried out our work using a Plan Do Study Act model (PDSA) across two phases. We published a leaflet asking for feedback about the Decision Unit. We distributed this through our voluntary sector network so that we could gather insight from both within and beyond our community of service users. 

From this survey we learned that people wanted clear, practical information that would give them a sense of where they would be going and what it would be like when they arrived. They also wanted images of the physical space on our website, along with clear information in plain language.

Others suggested simple changes to make the Decision Unit feel more welcoming and inclusive, particularly to those from vulnerable groups, including lesbian, gay, bisexual and transgender individuals who represent a high proportion of our service users. We have made the bathrooms gender neutral and refreshed the space in a vibrant, welcoming colour theme. 

We are now finalising a video walkthrough narrated by a service user which will be uploaded to our website, as a way of making the Decision Unit even more welcoming and accessible. This is part of the second stage of our PDSA workplan. 

One of the Experts by Experience working on this project has offered practical insights about the kind of information that people need to have when being treated at the Decision Unit. For example, people need to know if there are showers, and whether they needed to bring a towel or toiletries. We will be including this kind of detail in the video, so that it reflects what our service users want.

Engaging with our service users in this early phase of the project helped us to build one of our most important stakeholder relationships. We know from our engagement work with the Expert by Experience group that mental health service users have a highly effective peer network. They share information about their care experience, so it was crucial for us to establish credibility with this community.

Working closely with service users is helping us to understand exactly what is needed to co-create a more welcoming, inclusive space for them to be in, and is helping us to continue to improve the quality of our service. This service-user led approach has been successful and is shown in our occupancy data with an increase of 26%, close to our initial target of 30%.

Following the work to increase referrals to the Decision Unit, we started another improvement workstream in collaboration with partners in the South Yorkshire Police, A&E, and the Yorkshire Ambulance Service.

Our project, From Streets to Safety: Sheffield’s Transformation of 136 Services, aims to improve the Section 136 pathway, where an individual can be detained under the Mental Health Act (1983), by including the Decision Unit as a less restrictive option for people during mental health incidents.

We have undertaken a detailed review of data from multiple partner agencies around Section 136 to gain a deeper understanding of these incidents. An initial pilot phase completed at the end of November 2025 and we are evaluating the results. We are exploring whether our Decision Unit can be a suitable pathway for individuals experiencing a mental health crisis, as an alternative to the use of Section 136 or admission to A&E.

We have recently been told that this project was shortlisted for the 2025 Seni Lewis Award. This award aims to shine a light on exceptional work that brings together mental health services and the police to ensure care is delivered with dignity, respect and safety.

What this improvement project has taught me and our team is that building relationships is key to improving services. This work cannot be rushed. Improvement requires a strategic, long-term mindset and the ability to build strong, trusting relationships with your colleagues. 

That is what has helped us to create high levels of trust with our stakeholder network and improved the service referral rate. Those who work closely with me know that I love a good quote, and this is one of my favourites:

The most rewarding part of this project has been seeing the collective commitment of our partners to ensuring individuals experiencing acute mental health distress can be referred to a calm, trauma-informed environment, co-designed with service users, and that offers them the best possible care.