The concept of a ‘crisis card’ originated in the voluntary sector as an advocacy tool for use in mental health emergencies. This type of self-help initiative, and variations which include advance planning for mental health crises, are becoming more common, and have received Government and media attention (Brindle, 1993). The Health Committee's Fifth Report to the House of Commons (1993) on ‘Community Supervision Orders' included evidence given by Survivors Speak Out on the use of crisis cards or treatment contracts as an optional alternative to community supervision orders. Survivors Speak Out described how a user, “when in a rational state of mind, can set out in writing (on a crisis card) how they would like to be treated in circumstances when they are not the best judge of their own interests”. The Government's response was to encourage the informal use of crisis cards and the development of best practice and guidance on their use bearing in mind the central role of the user (Department of Health, 1993). They also recommended that ways of amending the law to provide for crisis cards to be legally effective should be examined. The Report of the Inquiry into the Care and Treatment of Christopher Clunis recommended that the Royal College of Psychiatrists should design a card for mentally ill people. This appeared to be a response to the identified need for improved provision of information, communication and liaison across geographical boundaries where necessary (Ritchie et al, 1994).
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