2.13 Review Gloucestershire Suicide Prevention Strategy and Action Plan to identify areas of alignment with or duplication of the Concordat and agree method for managing the relationship between the two May 2016 Jennifer Taylor Public Health The Suicide Prevention Strategy and Crisis Concordat through their respective action plans will be aligned to ensure duplication is minimised and that priorities are addressed through the most appropriate route 3. ACCESS TO SUPPORT BEFORE CRISIS POINT 3.1 Ensure simple access to Samaritans by systematic availability of Gloucestershire Samaritans Referral Form by Declaration signatories especially GPs, Emergency Department, Police, Ambulance Services and 2gether NHSFT From September 2014 Garth Barnes Samaritans Improved early access to listening service 3.2 Extend the work of Samaritan Volunteers within identified vulnerable areas and/or Self Harm helpline as area (to explore further) From September 2014 Garth Barnes Samaritans Alice Brixey Self-Harm Helpline Jennifer Taylor Gloucestershire County Council Additional support to the Suicide and self-harm strategy through early intervention.
Improve access to and experience of mental health services 3.3 Produce a report each quarter based on Wellbeing Plus client’s experience of what works well and what could be improved in a crisis. Content will be based upon ongoing monitoring July 2014 Ongoing 1/4ly reporting Revised date: March 2016 Cynthia Kerr Independence Trust Contribution to the client voice element of the review of the Mental Health Crisis Service in Gloucestershire. The report will be shared with the Stakeholder Group and the Crisis Project Group 4. URGENT AND EMERGENCY CARE ACCESS TO CARE Improve NHS emergency response to mental health crisis 4.1 Ensure as part of estate development, an appropriate space for mental health assessment room at Cheltenham General Hospital (CGH) is available 24/7 to ensure parity of esteem exists for mental health and physical assessments Ongoing – when opportunity arises for redevelopment of CGH Revised date: April 2017 E Gatling/A. Chandran/Space Utilisation Group Gloucestershire Hospitals NHSFT Parity of provision through appropriate space provision for mental health assessments Social services’ contribution to mental health crisis services Approved Mental Health Professional sufficiency and competency 4.2 Develop, formally agree and implement an Approved Mental Health Professional (AMHP) Joint Workforce Strategy October 2014 onwards Revised date: April 2016 Karl Gluck Gloucestershire County Council Sarah Bennion/ Jane Hutchinson 2gether NHSFT Sufficient number of trained and competent AMHPs AMHPs integrated with health colleagues in the mental health system AMHPs well managed and led Resources used efficiently and effectively
4.3 Ensure all Approved Mental Health Professional reports are of sufficient quality (audit) Jan-Mar 2015 Revised date: September 2016 Sarah Bennion 2gether NHSFT Karl Gluck Gloucestershire Clinical Commissioning Group All Approved Mental Health Professionals meet the legal competency requirements 4.4 A review of conveying/ transport arrangements for people assessed under or requiring conveyance under the Mental Health Act 1983/2007 in the South West of England in the context of the policy frameworks of the Crisis Care Concordat and ‘Parity of Esteem’ January 2015 Revised date: March 2017 Linda Buckley Clinical Commissioning Group David Pugh Independent Consultant Agreed and appropriate level of triage, prioritisation and response for people experiencing a period of mental health crisis/acute psychological distress and people with planned mental health conveyance needs. The provision of a safe, cost effective, efficient (a proportionate response e.g. single paramedic attendance, use of 111 to prevent call out, use of unmarked cars etc) and least restrictive conveyance service with clear agreed operational policies and protocols in place in relation to access, referral to the service and the use of restraint. Identified pathways and a clear understanding with 111 that minimises unnecessary call outs. An all age service that provides parity of esteem for people with mental health needs, physical needs and people who need a combination of both. All relevant organisations work together accepting their organisational responsibilities and responsibilities under the Mental Health Act to facilitate the conveyance of people within the community. Improved individual experience (users, carers and professionals).
A clear contract monitoring process 4.5 Identify and quantify the housing needs of people with mental ill health and those at risk of being homeless To be confirmed Outcome Managers Gloucestershire County Council To be confirmed 4.6 Explore opportunities to link into the Building Better Lives Work stream for Housing April 2016 Outcome Managers Gloucestershire County Council Steve Strong To be confirmed Improved quality of response when people are detailed under Section 135 and 136 of the Mental Health Act 1983 4.7 Audit of experience of subjects of S136 of the Maxwell Suite December 2015 Revised date: September 2016 Genevieve Riley 2gether NHSFT David Pugh Independent Consultant Detainee experience of Maxwell Suite established (note: research of Laidlaw, Pugh et al focussed exclusively on detainee experience of police stations) Opportunity to improve experience of S136 detainees Improved information and advice available to front line staff to enable better response to individuals 4.8 Development of an equitable and integrated peri-natal specialist mental health service to ensure that women and families who need it receive an integrated plan and response in pregnancy and the postnatal period September 2016 Helen Ford Clinical Commissioning Group Integrated assessment and plan for women and families with mental health needs Women are aware of trigger points in order to receive rapid access to specialist knowledge to support early intervention to prevent crisis escalating Improved early detection of maternal mental illness Enhances parent/infant interactions strengthening the relationship between parent and child and parenting capacity Positive impact on child development and future mental wellbeing of both children and parents
6. RECOVERY AND STAYING WELL/PREVENTING FUTURE CRISES Joint Planning for prevention of crises 6.1 Develop a service that will support carers of people with Mental health issues where there is a very significant impact on carers emotionally and/or physically due to repeated mental health crises. This is subject to a Big Lottery, Reaching Communities partnership bid currently being prepared. £300K over 3 years Consult with MH Carers Dec 15 – May 16 Bid Submission: June 2016 Decision stage 1: August/ September 2016 Tim Poole/ Jacky Martel Carers Gloucestershire Carer has easy access to listen ear and support Practical help to access other support both before, during and after a crisis. Training in how to manage challenging situations and early recognition of signs of impending crisis Education programmes about specific conditions and crisis responses. Connecting carers to increase peer support. 6.2 Promote and extend the use of Crisis Plans, Advance Statements Decisions and Advance Decisions to refuse treatment for mental health patients including people with dementia By end October 2014 Revised date: September 2016 Les Trewin 2gether NHSFT Gloucestershire Hospitals NHSFT All known service users will have a future crisis plan that lessens the likelihood of a repeat crisis and ensures the wishes of the service user are taken into consideration Evidence that these plans are routinely part of the CPA process Clinical audit programme evidence that the plans exist are accessible 24/7 and that they are acted upon
commissioning expectations and specifications and exploring options for with other emergency services Revised date: April 2016 Clinical Commissioning Group Les Trewin 2gether NHSFT A minimum of an initial response to all crises as defined by the person experiencing the crisis/carer and referring agency Clear and concise pathways of care without ‘hand offs’ Standard response times, referral processes and quality standards to mental health crises delivered in response to Gloucestershire commissioning specification for 2015/16 Skilled, competent and confident workforce 2.1 Explore funding possibilities to develop Positive Caring mental health specific courses to include different mental health conditions/strategies for coping with crisis provider information and input to Carer Support Groups about dealing with crisis October 2014 Tim Poole Carers Gloucestershire Carers better able to: Recognise and deal with the onset of a crisis through having a greater understanding of the conditions affecting the person they care for. Respond to changes in the person’s condition, knowing what is normal to expect and when to alert others. Flag up changes leading to crisis earlier Ask questions that might otherwise not be able to ask 2.1b Provide 1:1 peer mentoring support to carers to enable locally based non-judgemental support October 2014 Tim Poole Carers Gloucestershire Carers better able to: Recognise and deal with the onset of a crisis through having a greater understanding of the conditions affecting the person they care for. Respond to changes in the person’s condition, knowing what is normal to expect and when to alert others. Flag up changes leading to crisis earlier Ask questions that might otherwise not be able to ask
2.2 Following a review, commission a new model of Crisis and Home Treatment Service ensuring services and pathways are designed across the age transitions from under age 12 through to adulthood (14+ for early intervention clients for initial stage) April 2015 Eddie O’Neil Clinical Commissioning Group Simon Bilous Gloucestershire County Council New CRHTT service specification agreed and incorporated in 2gether NHSFT contract to commence delivery from April 2015 Agreed performance indicators and reporting for new service Well planned and managed transition Clarity over criteria/thresholds and ways to overcome them Outcomes-led/ needs-led approach Age removed as a barrier to accessing appropriate support 2.4 As part of the commissioning of the revised contract for the CRHTT ensure 2gether mental health expertise and advice is available 24/7 for partner colleagues dealing with safeguarding situations for all ages and whether the case is ‘known’ or ‘not known’ March 2015 Revised date: June 2015 Karl Gluck Clinical Commissioning Group Safeguarding assessments are informed by the best possible background mental health information and expertise Improved safeguarding decisions 2.5 Develop a Communication Plan targeted at: partner agency staff the public for the future revised mental health crisis pathway utilising the resources of partner agency Communications June 2015 Revised date: February 2016 Cathie Hole 2gether NHSFT and partner agencies Communications Leads Partner agency staff understand the core elements of the revised mental health crisis pathway GPs are clear about the eligibility criteria, access & their role within the pathway Members of the public understand how to recognise a mental health crisis in their community & how to engage a positive service response There is a common understanding of mental health crisis care at every local community at Parish/Town Council level
also have an identified mental health need Data to inform service planning in relation to 2.7 above 2.9 Review the Psychiatric Liaison Service to consider all age approach to include hours required within the Mental Health Liaison team to best meet patient need Scoping by September 2014 (via Psychiatric Liaison Group) Revised date: September 2015 Eddie O’Neil CCG Simon Bilous Gloucestershire County Council Maggie Arnold/ Delia Gloucestershire Hospitals NHSFT Age no longer a barrier to accessing appropriate support Crises responded to within standardised timescales and quality standards and with better outcomes Fewer admissions – to GRH, Tier 4 inpatient care, Maxwell Suite 2.11 Review commissioning implications of DH Review of Sec 135 and 136 (Dec 2014) and new MHA Code of Practice (Jan 2015) for Gloucestershire MH Crisis Care Declaration and Action Plan June 2015 Karl Gluck Clinical Commissioning Group David Pugh Independent Consultant Links made to any relevant local developments Future DH requirements anticipated and built in local developments 2.14 Subject to identification of additional need, establish preliminary resource implications for an extension of the availability of the Liaison Health Visitor post in order to ensure that all CYP aged 0 to 18 who attend ED and MIUs are reviewed. March 2015 Revised date: May 2015 Michael Richardson Gloucestershire Care Services Vivienne Mortimer Gloucestershire Hospitals NHSFT Effective liaison to universal public health nursing services particularly school nursing for the purposes of the concordat will aim to effect the following mental health outcomes: Increase in CYP and families knowledge where to access emotional health and well-being advice
Develop guidance and access to specialist training 2.25 Link 2Gether NHSFT with the Central Southern Commissioning Support Unit to participate in the roll out of the Shared Care Records project April 2015 Karen Taylor CCG Cathie Hole 2gether NHSFT Better information sharing across partner organisations Fewer A&E attendances Fewer emergency admissions Improved medication management 2.26 Produce a local mental health information sharing/triage system for the Police/NHS in order that the service/ dealing with a crisis knows what is needed to manage the crisis/risks to the distressed person or to others April 2015 Steve Bean Gloucestershire Constabulary Eddie O’Neil Clinical Commissioning Group Information sharing enable people known to services to get the treatment they need quickly and where applicable, services are aware of their crisis plan and any advance statements no matter at what point they re-enter the mental health system Improved quality of assessments 2.28 Explore opportunities to use the centralised Custody Suite at Quedgeley to improve the service to mentally ill people in crisis on the explicit the Maxwell Suite remains the Place of Safety of choice for the overwhelming majority of S136 detainees November 2014 Steve Bean Gloucestershire Constabulary Improved and more sensitive less stigmatising service to mentally ill people in contact with the Criminal Justice Service Healthcare available to assist with initial assessment and triage of anyone presenting with healthcare issues. 2.29 Critical review/analysis of partner agencies mental health crisis related policies, procedures and protocols February 2015 Jim Symington Symington-Tinto Health and Social Care Consultancy David Pugh Independent Consultant Reflects best practice as evidences by analysis of national documentation including NICE guidance Evidence of a personalised approach Involvement of carers/friends and ‘protected characteristic groups’ Consistent with service specifications
2.30 Amend current contract specification to include standardised response times, from Psychiatrists to referrals for inpatients with mental health crisis By April 2015 Maggie Arnold Gloucestershire Hospitals NHSFT Eddie O’Neil CCG 2Gether NHSFT Scoping exercise completed SLA response times to requests for Consultant review agreed 2.31 Explore opportunities for partnership working around the planning and targeting of Community Fire Safety initiatives January 2015 Sally Waldron Gloucestershire Fire & Rescue Service Targeted prevention work will focus on risk factors using an evidence-led approach 2.34 Establish the scope of Gloucestershire Young Carers and 2gether NHSFT in identifying and meeting the needs of young carers in mental health crisis situations June 2015 Mandy Bell Gloucestershire Young Carers Les Trewin 2gether NHSFT To meet the information needs of young carers if a parent is not physically or emotionally available to them e.g. mental health crisis 3.3 Review information provision and pathway for patients who attend following self-harm, who are not admitted September 2014 Delia Gloucestershire Hospitals NHSFT 2gether NHSFT Pathway reconsidered Patients are identified, and managed to prevent crisis and attendance at Emergency Department GP informed of outcome 3.4 Establish a Gloucestershire link with the British Transport Police to involve them in prevention projects to tackle mental health and suicidal behaviour challenges December 2014 David Pugh Independent Consultant Prevention of people seeking to harm themselves on the railway
3.5 Develop interface with CRHTT and explore with users of the Teams if they see the need for an Independent Mental Health Advocacy in this context October 2014 Leonie Seabourne, CCP Independent Mental Health Advocacy Service Karl Gluck Gloucestershire County Council Clarity of relevance of statutory advocacy to users of CRHTT Subject to above, service users empowered through access to appropriate advocacy in crisis 4.2 Local implementation of the Association of Ambulance Chief Executive national S136 guideline for transportation of people under Section 136 detention From April 2014 David Partlow South Western Ambulance Service NHSFT All Section 136 requests for ambulance transportation would be categorised as a Green 2 (30 minutes emergency response). 4.3 Create multi-agency ‘Standards for mental health Assessment’ leaflet/information leaflet Dec 2014 Revised date: April 2016 Karl Gluck Gloucestershire County Council David Pugh Independent Consultant A set of multi-agency standards around MH assessment Shared understanding between key stakeholders Users/carers/public know what they can expect from key agencies in a MH assessment A timely and efficient assessment process 4.4 Creation of a set of evidence based actions that will improve Mental Health safeguarding responses in a mental health crisis Nov 2014 Alison Feher Safeguarding Lead 2gether NHSFT All staff are aware of their safeguarding responsibilities Effective responses to all safeguarding situations for people whose circumstances make them vulnerable Effective sharing of information
MH crisis responses aligned to Gloucestershire Safeguarding strategy and systems 4.5 Develop a safeguarding protocol for On-call managers within the 2gether NHSFT June 2015 Alison Feher 2gether NHSFT On-call managers always consider safeguarding implications of any mental health crisis situations The needs of vulnerable individuals are always considered in a MH crisis situations 4.6 Develop a MH Crisis Specific Information Sharing Agreement/Protocol February 2015 Revised date: September 2015 David Pugh Independent Consultant Interagency Monitoring Group Information is appropriately shared in mental health crisis situations including safeguarding 4.7 Audit of Safeguarding referrals where the primary issue was wider mental health problems including carers April 2015 Revised date: June 2015 Safeguarding Board Audit Committee via Sarah Jasper Improved understanding of mental health safeguarding situations 4.8 2gether CRHTT staff and managers are fully aware of their safeguarding responsibilities in all crisis situations September 2015 Alison Feher 2gether NHSFT The needs of vulnerable adults and children/young people in mental health crisis situations are always taken into account 4.9 Presentation to Adult Safeguarding Boards November 2014 Jim Symington/ David Pugh Both Boards aware of work of mental health Crisis Task & Finish Group Any relevant synergies established 4.11 Review current model for ‘specialing’ to ensure it best meet the patient’s needs at all ages By September 2014 Sue Milloy/ Jon Burford Gloucestershire Hospitals NHSFT 2Gether NHSFT Closer observation of patient, best meets their clinical needs. Resource allocation is better managed
4.13 Ensure all AMHPs maintain competence through an agreed Continuing Professional Development programme (annual report) April – onwards Annual report May 2015 Jane Hutchison/ Sarah Bennion 2gether NHSFT All Approved Mental Health Professionals meet the legal competency requirements 4.15 Review interface between daytime Approved Mental Health Professional and EDT (to include planned OOH Mental Health Act assessments) End of October 2014 Karl Gluck/ Louise West Gloucestershire County Council Ensure that Mental Health Act assessments are undertake in a timely fashion in accordance with the legislation/Code of Practice There is a smooth and efficient interface between day time AMHP and EDT There are no unreasonable delays arising from this interface 4.16 Review system for requesting a Mental Health Act assessment by an AMHP End of October 2014 Revised date: June 2015 Karl Gluck Gloucestershire County Council Les Trewin 2gether NHSFT David Pugh Independent Consultant Clear guidance for Health and Social Care staff on how and when to request a Mental Health Act assessment All relevant parties are aware of Help Desk number and differential between Urgent Mental Health Assessment and Mental Health Act Assessment 4.17 Review role of AMHP within Crisis Resolution and Home Treatment Teams January 2015 Revised date: March 2015 Karl Gluck Gloucestershire County Council Sarah Bennion 2gether NHSFT David Pugh Independent Consultant Options appraisal for commissioners on best practice The skill mix of re-commissioned Crisis Service is informed by this analysis 4.19 Review multi-agency Police assistance for Approved January 2015 David Pugh Revised multi-agency policy that meets the requirements of the revised MHA Code of Practice
Mental Health Professionals policy Revised date: June 2015 Independent Consultant 4.20 Establish availability of emergency specialist foster care arrangements for children and young people when in significant mental and emotional distress and unable or unwilling to return to their home but who do not require hospital admission November 2015 Revised date: Delia Amos Fostering & Adoption Gloucestershire County Council Simon Bilous, Joint Commissioner Gloucestershire County Council Quicker ‘step down’ arrangements Avoid unnecessary admission to Gloucestershire Royal Hospital 4.22 Review and consider combining s135(1) and s135(2) policies June 2015 Karl Gluck Gloucestershire County Council Interagency Monitoring Group Revised multi-agency policy and implementation plan that reflects best practice which meets the requirements from the revised MHA Code of Practice 4.23 Review of Gloucestershire multiagency S136 Policy, Procedure and Guidance following the outcome of the DH review of Sec 135/136 and revised 2007 Mental Capacity Act Code of Practice. This should include management of intoxicated detainees June 2015 Revised date: January 2016 Les Trewin 2gether NHSFT with Inter-Agency Monitoring Group Supported by David Pugh Independent Consultant An improved common framework for operation of Section 136 where partner agencies roles and responsibilities are clearly understood and reflects best practice along with alignment of partner expectations Policy reflects current DH requirements including revised MHA Code of Practice and other key reviews/policy statements over the past 18 months
2.10 Scope the gap between need and current provision for children and young people (including those with behavioural problems) within GHNHSFT inpatient care and paediatric wards October 2014 Revised date: June 2015 Maggie Arnold/ Delia Mortimore Gloucestershire Hospitals NHSFT Scoping exercise complete Recommendations made to Commissioning bodies Improved provision for children and young people with ‘behavioural issues’