programme of training options to support people in emotional distress, with mental illness, substance misuse and suicide awareness training courses which will improve their ability to identify crisis situations and negotiate the crisis care pathway. Specific courses include Mental Health Awareness, Signs and Symptoms in Safeguarding, joint s136 workshop with Trust, Met Police, DESS and LAS attendance. , Support before Crisis Point 2.1 Develop support for carers in line with changes to the Care Act On-going WCCG/WBC commissioning with Carers Providers People will be protected when their circumstances make them vulnerable DESS Operational Manager has met with a group of Carers at the Carers Centre. This will be repeated in the new year. 2.2 Use MH CRG and other available Forums to ensure that service users and carers are available and contribute in the developments of local solutions to support people in crisis On-going Mental Health Clinical Reference Group Feedback given from patients and public regarding the potential effectiveness of the crisis Action Plan and commissioning decisions. Local forums identified to support the achievement of the crisis declaration and Action Plan The Crisis Concordat Action Plan is part of the CCG Workplan and is discussed as part of the CRG Agenda. 2.3 A single MH support/crisis line to be available 24/7, 7 days a week 365 days a year March 2015 South West London and St Georges NHS Trust/NHS Commissioners in South West London Establishment of a helpline which is well publicised among people with Mental Health problems, carers, health and social care professionals, emergency services and the wider public. The Mental Health Support Line is in place.
professionals who are appropriately trained, supervised and supported. 3.2 St. George’s hospital to have a dedicated area for mental health assessments which reflect the needs of people experiencing a mental health crisis. March 2016 WCCG Commissioners/ St. Georges Hospital FT Dedicated areas within St. Georges Hospital which are designed to facilitate a calm environment while also meeting the standards for the safe delivery of care St George’s Hospital has a dedicated area for Mental Health clients presenting in A&E. These arrangements to be discussed in the Crisis Concordat. CCG Commissioner and DESS Operational Manager to meet with Psychiatric Liaison Consultant to discuss developing a written protocol between Wands AMHP Service and Liaison Psychiatry and area’s for future development within the service. This to take place in January 2016. 3.3 Systems to be in place to ensure that people who regularly present to emergency departments in crisis are identified and their care plans appropriately reviewed October 2015 South West London and St Georges NHS Trust Care plans identify triggers and treatment options to avoid inappropriate A&E attendances (or) divert/transfer people from A&E in a timely manner into appropriate services. The Liaison Psychiatric Dept. at St Georges Hospital has identified the 10 most frequent attenders at A&E. A decision will be taken as to the most appropriate response to be taken – frequent attenders group, care plans for each person etc. Currently an alert flashes when there record is accessed.
alternative to admission or when home treatment is not appropriate access a crisis/respite bed when it is clinically indicated 3.8 Crisis Resolution Teams/Home Treatment Teams will be provided and accessible 24 hours a day, 7 days a week 365 days a year and meet the national safe staffing benchmark October 2015 WCCG MH Commissioners/South West London and St Georges NHS Trust People who are experiencing a mental health crisis will access services when they need them which are staffed by qualified, competent and compassionate mental health professionals who are appropriately trained, supervised and supported. The Mental Health Trust already provides a 24 hour 365 day a year service. 3.9 Assessment by the mental health Home Treatment Service following a crisis referral should take place within: 4 hours in an emergency 24 hours if urgent October 2017 South West London and St Georges NHS Trust People who are experiencing a mental health crisis will receive rapid assessment and access into services which achieve parity of esteem 3.10 People who require a mental health acute admission must be able to access this in a timely manner and as close to their home as possible April 2015 South West London and St Georges NHS Trust People will be able to access acute in-patient services when this is clinically indicated The Crisis Concordat to promote the provision of local inpatient resources with the CCG and Wandsworth CRG. 3.11 Develop a Street triage through CHTT that will be available to October 2015 WCCG MH Commissioners / SWLSTG Mental health practitioners will be available to accompany police officers to mental health related call A street triage service has been piloted in the borough. The Crisis Concordat to
support police officers when dealing with people who are in crisis due to mental health problems outs and provide a telephone service to officers on the grounds who are responding to people in a crisis. The mental health practitioner will help officers by offering professional, on the spot advice and assessment thereby reducing the use of Section 136 and inappropriate A&E attendances review the evidence produced and promote the service if the evidence supports this provision. 4.Recovery and Staying Well 4.1 All people under the care of secondary mental health services and people who have required crisis support in the past should have a documented crisis plan which is by the person with mental health problems, their carer and their mental health professional (Care co-ordinator) In place South West London and St Georges People will be enabled to make advanced decisions about their care in times of mental health crisis. Advanced directives will positively impact on clinical outcomes through an increase in provision of preferred services and improved engagement Co-produced crisis plans empower service users while facilitating early detection and treatment of relapse The Mental Health Trust already requires all service users to have Crisis and contingency plans. 4.2 Explore the feasibility of arrangements to ensure that crisis plans are accessible to GP, OOHs and NHS 111 teams September 2015 WCCG Commissioners / SWLSTG To ensure service users receive a joined up response when in crisis. The Crisis Concordat forum to promote the appropriate sharing of crisis plans. Currently DESS Out Of Hours staff, Psychiatric Liaison have access to RIO. Only the GP’s and 111. 4.3 Transitions between primary and secondary January 2016 WCCG MH Commissioners/South Clear protocols are in place regarding access into secondary
care must be appropriately managed with clear criteria for entry and discharge from acute care West London and St Georges NHS Trust/Primary care care from primary care and Fast-track access back to specialist care for people who may need this in the future Integration of care ensuring that a pathway of services is organised around the patient 4.4 Joined up care for people who have experienced mental health crisis with substance misuse problems October 2015 SWLSTG/IDAS People receive a joined up care pathway to meet their multiple needs Pathway Meetings have been organised by the CCG to develop the pathways from primary care for dual diagnosis, WCDAS, Secondary Mental Health. 4.5 Carers are supported and know who to contact at any time, 24 hours a day, seven days a week for fast access into services March 2016 Wandsworth DESS / SWLSTG Carers are offered a carers assessment and services established to meet the identified needs Carers are given information about, and referral to, services that will support the recovery and help the person they care for to stay well . 5 Operational Development 5.1 Identify the information (statistical, resource availability and procedural) to assess the level of local need January 2016 DESS Operational Manager Improved local date to inform operational practice and frameworks. Crisis Concordat to identify the sources of information held in partner agencies with a view to improving the knowledge of how services
5.5 Discuss within the crisis concordat forum the appropriateness of a “Section 136” triage service as a means of reducing inappropriate use of the Section 136 suite within the Mental Health Trust. July 2015 All Feedback to commissioners the appropriateness of having a Section 136 triage service. S136 Triage nurse in place Thursday to Sunday. 5.6 Support, develop and improve GP’s knowledge and experience of referral of their patients in acute mental health crisis. November 2015 All GP’s to have a referral pathway endorsed by the crisis concordat. GP Acute Mental Health referral pathway is described in the CMHT Operational Policy. 5.7 Crisis concordat forum to monitor AMHP staffing levels April 2015 All AMHP staffing levels to be maintained at an effective level. AMHP staffing levels to be shared with the Crisis Concordat. 5.8 Crisis concordat forum to review 2010 guidance on responding to people with mental ill-health or learning disabilities Feb 2016 All Crisis concordat partners to update their practice guidance as required