2. Commissioning to allow earlier intervention and responsive crisis services No Objective Action Led By Outcomes Timescale 2.1 A coordinated response from all services for people of all ages who find themselves in crisis 24 hours a day Establish a baseline position across the City and County. Clarify CAMHS crisis pathway in line with work on adult pathways to ensure consistent approach and appropriate/effective transition pathways. Map all relevant agencies and how they work together to respond to/ prevent crisis and ensure collaborative working. Work to include:- Definitions of levels of urgency of response Detailed information on capacity and demand (data by CCG populations) Map all crisis facilities available Gaps in service identified All stakeholders, to include: Mental Health Primary Care Substance Misuse Police Emergency Departments Ambulance Service 3rd Sector providers Local Authorities MHCCN SSJIG MHCCN SSJIG Commissioners Clinical Leads Mental Health / Substance Misuse leads Clear pathway detailing all stakeholders available to all referrers, users, carers and the public. Recommendations for future commissioning made. Early feedback from user involvement to be included. 1.09.15 – Partially complete. Pathway event held in South Staffs September 2015. Outcomes from this event are to be embedded across the North Staffs pathway. 2.2 Contract for Parity of Esteem: Make clear links, across contracts for all services, with the Concordat Outcomes including CQUIN, Service Development Improvement Plans, Performance and Quality Plan to support invest to save to be submitted 9th November and Commissioning intentions translated into contract actions for 2016/17 CCGs (CSU) and Local Authority Commissioners CCGs and Acute partners / Contract Support the principles of the Concordat and Parity of Esteem across services 31.03.2015- Ongoing. Embedded into the commissioning intentions for 2015/16 and local business plans.
No Objective Action Led By Outcomes Timescale Mental Health Improvement in the wider population Work with health improvement / public mental health to support preventative work in the population Public Health Teams / MHCCN SSJIG Mental Health improvement support preventative approach Ongoing. Embedded through the local Mental health implementation delivery plan. 2.3 Services are accessible to all of the community Revisit Equality Impact Assessments across all services Review and update local JSNAs Police to take responsibility for sharing awareness of vulnerable communities and processes in Review access to services from rural communities Equality Public Health Police CSU Services will be responsive to ‘seldom heard’ groups and vulnerable communities 31.03.2016 Improving mental health crisis services No Objective Action Led By Outcomes Timescale 2.4 Based on current baseline position set out clear crisis pathway(s) and access to services across the whole system Share crisis pathway with all front line professionals and service users Develop training and awareness programme to all front line staff MHCCM SSJIG Improved access to appropriate and timely response Improved outcomes for people in mental health crisis 31.10.2015 From 2015 Mental Health access team providing 24/7 service. Training has been identified as a priority and a small task and finish group to be established.
2.8 All staff will have the right skills to respond to mental health crisis accordingly Map training needs within and across organisations and develop a clear Programme of training options to support people in emotional distress, with mental illness, Substance Misuse / Alcohol Awareness, Suicide Awareness and restraint techniques (Safe and Positive principles) Co-ordinate programme of shared training where appropriate for front line workers All Organisations Improved quality of response for people with mental health 01.09.2015 Ongoing. Task and Finish Group to be established with partner agencies. 31.03.16 Improved partnership working in Staffordshire and locality No Objective Action Led By Outcomes Timescale line staff are able to share appropriate information to inform practice / response Develop, agree and implement protocols for information sharing between all partner agencies working across crisis care MHCCN SSJIG Improved response to people in crisis. 31.03.16 Early development work going on across the local health economy 2.10 organisation understanding of vulnerable and frequent users of crisis services Develop operational arrangements between professionals and partner agencies that support joint working and identification of individuals know to services at all levels. We will commit ourselves to being able to MHCCN SSJIG Clear protocols agreed for partners in respect of the management of frequent / high volume users Consistent response across organisations 31.12.15 Ongoing provide simple and clear information to our local divisional and sub divisional leads that will identify the level of mental health and suicidal activity within a given area BTP To support local health teams to understand and support those in crisis within their area where the rail infrastructure creates a risk.
heard groups identify whether they are aware of pathways and access points, establish how mental health services respond to their needs, and whether action is necessary to improve responsiveness Identify whether there are issues for BME communities and other seldom heard groups in accessing MH services including crisis services and whether there is a cultural/historical/based on poor experience. Identify actions to overcome any barriers identified Carry out capacity and demand mapping for BME communities and other groups accessing service and compare with public health data on BME population. NSUG Voices entering service for all groups (BME/transient/seldom heard/complex populations/LGBT). Knowledge of ways to improve access Knowledge of of good practice. Numbers of users currently accessing the services and understanding if this is representative of the population. Insight to see if services working together. Ongoing. Consultation done in day services in Biddulph, Leek, Newcastle. 3 consultation events held in Staffordshire. Online forum in place and Programme of targeted focus groups underway 4. Urgent and emergency access to crisis care No. Objective Action Led By Outcomes Timescale Improve NHS emergency response to mental health crisis 4.1 Ensure new arrangements for Access and AHT deliver crisis response and that sub-acute crises are responded to appropriately. Project plan and milestones to be reported to MHCCN Combined Health Care MH Trust Timely and supportive response to all patients accessing Access and AHT. COMPLETE Mental Health Access team is now operating a 24/7 service. 4.2 Engage with partners to develop the strategic approach that will Improve the NHS emergency response to mental health crisis in line with the Actions set out in the Crisis Care Concordat. Review commissioning of RAID in UHNM to secure 24/7 response in ED. Review psychiatric liaison provision (Demand and Capacity) across acute providers, complete gap analysis and options for improved response Audit ED/acute care in relation to Concordat Clinical Leads: ED/MH/CCG/ Clinical leads Mis/CAMHS Lead Commissioners Timely access to RAID / Psychiatric Liaison services for patients in ED. Ensure patients are directed to the most appropriate pathway to promote recovery. Improved access to specialist psychiatric support in ED Clear specification for liaison psychiatry in each acute Trust 31.03.16 31.3.2016
standards / Parity of Esteem and identify gaps and any actions required Develop strategic plan for psychiatric liaison provision ED lead Commissioning lead Compliance with Concordat standards within care 09/11/2015 A&E task and finish group established with partner agencies – WMAS, Police No. Objective Action Led By Outcomes Timescale 4.3 Embed crisis care planning for those people known to services Review all current care to ensure valid crisis/ relapse plan is in is available to all parties to the plan and can be shared electronically where appropriate. Plan should be agreed by both service users and carers and that all parties to crisis plans are aware of their and others roles and are able to respond if the plan is triggered. Combined Health Care MH SSSFT MH Trust Service users have up to date care plans in case of crisis and know what to do should a crisis occur. Evidence of plan discussed and agreed with service users and carers. Crisis available to front line professionals Task and Finish group to be established. Awaiting CQC for CHC. Project to set out how crisis management VAST Crisis planning extended to people 31.03.16 plans can be developed for people not accessing secondary care services supported through 3rd sector providers 4.4 Ensure acute physical health needs are identified and responded to appropriately Review protocols / arrangements for paramedic involvement in assessment to ensure speedier response and ensure individuals to most appropriate service Integrated and standard response Ongoing Social services’ contribution to mental health crisis services No. Objective Action Led By Outcomes Timescale 4.5 Improve AMHP response Review AMHP capacity and rota arrangements – especially where out of hours services (EDT/EDS) are responsible and to make arrangements to ensure response times can be met wherever possible and provision is sufficient to Social Care leads in County and City Councils Adequate cover provided by AMHP’s 24/7. Agreed circumstances where 3 hour response is not appropriate promoting a 31.03.16 Looking to increase capacity by having a joint
5.2 Extend options for PoS provision appropriate to meet presenting need Develop strategic plan for extending Place of Safety Options forward to inform 16/17 commissioning intentions to include:- ED CAMHS People who are intoxicated Clinical Leads CCG and PH Improve response to people in crisis detained Section 136 31.03.16 Awaiting announcement from Goveremnt on money allocation for Place of Safety. Sect.135/136 groups to look at options. Improved information and advice available to enable better response to individuals No. Objective Action Led By Outcomes Timescale 5.3 Enhance options to improve information available to improve the response to people in crisis Continue to build on Single Phone Number to improve access to professional advice and support for police, ambulance and other professionals Develop a support pathway for DOS / 111 provision to support Patients, carers, professionals MH Trusts CHC) WMAS Improved response to people in crisis Reduce demand upon emergency services managing MHA Section orders Ongoing 5.4 Enhancing Community Triage response across City and County Continued working with CTT/Diversion and Liaison and police. Implement, monitor and evaluate pilot CT model in South Staffordshire Review protocol and/or arrangements for paramedic involvement in assessment with WMAS to ensure speedier response and that individual are taken to most appropriate service. Community Triage Group reporting into the MHCCN WMAS Continue to upon the relationships/ improvements made. Integrated and standard response to all calls across the West Midlands. Ongoing. Countywide group established to look at trends, gaps and issues.
Develop business case. Improved services for those with co-existing mental health and substance misuse issues No. Objective Action Led By Outcomes Timescale 5.5 Committed to enhancing crisis / home treatment to a more integrated approach with Substance Misuse services Staffs/County and Stoke-on- Trent) Monitor use of ED for cases where both mental health needs and intoxication and review protocol for managing these cases Ensure arrangements specified in Dual Diagnosis protocol (Stoke) or other protocols/processes elsewhere are functioning to ensure needs are being met and people are not excluded from support in order to prevent a crisis. Drugs and alcohol services to identify mental health lead/champion to ensure MH issues are addressed and to support joint working across agencies. ED/Commissioner to audit and report to MHCCN commissioners/ providers/service to audit and report to MHCCN Commissioners to report back to NSMHCCN leads for service Services provided to all service users regardless of presentation. Dual diagnosis protocol being utilised and complied with. Patient experience demonstrates that the protocol is effective and no- one had been excluded from services working across the agencies with issues being addressed and resolved. 31.12.15 31.12.15 COMPLETE
7.4 Embed mental health / mental wellbeing response as part of management of frequent of emergency services Ensure robust are maintained across the ED, RAID, Alcohol, drugs services, homeless service, police CTT and Section 136 services. WMAS to reduce the number of frequent attenders across the area. Engage with Frequent Attenders coordinator to strengthen protocols for supporting frequent attenders Frequent Attenders reporting into MHCCN Commissioners Ensure patients are accessing the appropriate services and receive the support they need in to reduce call to the various agencies. 31.12.15 Ongoing Appendices: Appendix 1. Staffordshire Police Operational delivery Plan
Justice Services Local shared training policies and approaches should describe and identify who needs to do what and how local systems fit together. Local agencies should all understand each other’s roles in responding to mental health crises. Each statutory agency should review its training arrangements on a regional basis and agree priority areas for joint training modules between NHS, social care and criminal justice organisations. Although it is desirable that representatives of different agencies be trained together, it is not essential. It is more important that the training ensures that staff, from all agencies receive consistent messages about locally agreed roles and responsibilities. Lack of training policies to support these groups New Recruit Training Targeted Training to specific units including Custody, Contact Services, CADRE, Frontline Response. Training by Health service within Criminal Justice. Catalogue of Services – Agreement that such services will support Staffordshire Police in allowing Officers/ Staff to ‘shadow’ to gain an understanding of partners roles and responsibilities. Staffordshire Police - Learning & Development Unit Staffordshire Police - Learning & Development Unit Staffordshire Police - Justice Services Shared training policies and increased understanding of roles and responsibilities. Objective Action Led by Outcomes If people are already known to mental health services, their crisis plan and any advance statements should be available and followed where possible. Police Officers and Police Staff to agree information sharing protocols. Access to information should be readily available to Officers in order to help Staffordshire Police Police/Health Police Officers and Police Staff will have access to information which will allow decision making and crisis plans will be followed.
decision making through Triage Teams, SPA’s. Access to such plans through specialised units such as IOM Staffordshire Police - Integrated Offender Management Care plans to be made accessible and can be placed on Citizen Focus Toolkit, SPIN and tasking for Staff to view. Staffordshire Police - Justice Services Objective Action Led by Outcomes Police officers should not have to consider using police custody as an alternative just because there is a lack of local mental health provision, or unavailability at certain times of the day or night. To support this aim, it is essential that NHS places of safety are available and equipped to meet the demand in their area. The signatories of the Concordat will work together to achieve a significant reduction in the inappropriate use of police custody suites as places of safety. Police officers should undertake appropriate training, to enable them to recognise risk and vulnerability and identify the need for health care. This training will support the police to decide whether individuals should be detained section 136, or whether they can be helped in some other way. Training should also cover the roles and Address availability of beds Pan Staffordshire. Agreement needs to be in place between the three hospitals in order to utilise all available beds. New Recruit Training Targeted Training to specific units including Custody, Contact Services, CADRE, Frontline Response. Training by Health service within Criminal Justice. Staffordshire Police, Health, Commissioners Staffordshire Police, Health, Voluntary Sector will present at a Custody site unless under ‘exceptional circumstances. Reduction in inappropriate use of Police Custody sites. will be able to identify risk and vulnerabilities and will be able to make decisions based on this training in way of identifying the most appropriate pathway for the individual and the most relevant service.
healthcare staff. There should not be an expectation that the police will remain until the assessment is completed. Partner organisations are clear about respective roles and responsibilities in that responses to people in crisis Training Community links with Agency Training overseen by Governance structures To ensure people with mental health issues are referred to specialists. are risk based, personalised, proportionate and safe, and that a guiding principle is to choose the restrictive option, for example not choosing to detain someone when there is a viable alternative option. Services SPA Access Teams Triage Teams MASH Arrangements are in place for escalation to more senior staff in case of disagreement. Section 136 Policy Identified Leadership within Staffordshire Police, Health, WMAS Staffordshire Police Issues are resolved quickly and fairly. Staffordshire Police Governance Structures. Custody, Mental Health and Vulnerability Steering Group Strategic Partnership Groups Health & Wellbeing Boards Lesson learned are used to promote best practice. Relationships with Partners are maintained. Objective Action Led by Outcomes When deciding upon any course of action, all professional staff should act in accordance with the Mental Health Act’s New Recruit Training Targeted Training to specific Staffordshire Police Police Officers and Police Staff will act in accordance with the Mental Health Act principle of principle of least restriction and to ensure that the services impose the least restriction on the person’s liberty. This units including Custody, Contact Services, Frontline Response. least restriction. Unmarked vehicles will be used includes avoiding the stigmatising appearance that a mental health crisis is a Training by Health service for the purpose of carrying out Section 135’s crime, for example, police forces should consider using unmarked cars to travel to within Criminal Justice.
hospital. Caged vehicles should not be routinely used. Objective Action Led by Outcomes Where a police officer or an Approved Mental Health Professional (AMHP) requests NHS transport for a person in mental health crisis under their section 135 and 136 powers for conveyance to a health based place of safety or an Emergency Department, the vehicle should arrive within the agreed response time. Police vehicles should not be used unless in exceptional circumstances, such as in cases of extreme urgency, or where there is a risk of violence. As mentioned above, caged vehicles should not be used. To be monitored using Contact services. All cases where Police vehicles are used will be recorded and justified. Staffordshire Police/WMAS Vehicles arrive within agreed timescales and individuals are transported in an appropriate vehicle. Staffordshire Police/WMAS Vehicles arrive within agreed timescales and individuals are transported in an appropriate vehicle. Objective Action Led by Outcomes The dignity of any person in mental health crisis should be respected and taken into to account. Service User feedback. Supervision Staffordshire Police - Justice Services To ensure that all demonstrate appropriate behaviour to deal with people with respect and dignity. Objective Action Led by Outcomes The quality of crisis care is monitored and reviewed locally and taking account of the following: The accessibility and responsiveness of services to support people through crisis and prevent admission to hospital The number of people who are admitted to hospital far away from home area because of pressures on their local acute or Staffordshire Police - Justice Services Staffordshire Police and Partners To ensure a responsive service.
admission wards Whether the powers of the Mental Health Act have been properly used by the of professionals involved in its operation, including AMHPs and the police Service providers are monitoring crisis response services The monitoring and review of services is reported regularly to relevant bodies with responsibility for commissioning and governance Staffordshire Police and Health Staffordshire Police - Justice Services Partners To ensure the review of services is regularly undertaken by those with responsibility. To ensure performance is at an acceptable level. Staffordshire Police - Justice Services Objective Action Led by Outcomes The relevant organisations to make sure staff are properly trained in the restraint and that staffing levels are adequate. There should be a clear local protocol about the circumstances when, very exceptionally, police may be called to manage patient behaviour within a health or care setting. In these cases, mental health professionals continue to be responsible for the health and safety of the person. Health staff should be alert to the risk of any respiratory or cardiac OPST department to ensure through national forums that developments are noted and implemented within training procedures. Police Intervention Protocol to be implemented. Staffordshire Police - Learning & Development Unit Staffordshire Police - OPST Staffordshire Police and Health To ensure that Officers are trained in the use of restraint and risk management regarding individuals experiencing Mental Ill Health. Clear protocols regarding Police Intervention within Healthcare settings.