Mental Health Crisis Concordat CCG Response Melanie Corish, Programme Director Modernising Mental Health
Effective Commissioning • • • • •
Effective local system Where possible prevents crisis 24/7 provision Meet local need Individuals treated as close to home as possible
CCG’s approaches • • • • • •
Committed to partnership working Aiming for a ‘no wrong door’ approach Training for GP’s Multi-agency crisis training Acute Psychiatric liaison services Effective commissioning of crisis services
Planned New Mental Health Services for
Bristol
Bristol Crisis Services Purpose: To provide 24/7 emergency mental health service For: People in severe mental health and emotional crisis and those supporting them – family, carers, GP’s, the police service, the ambulance service etc How: •Single point of access and telephone triage •Rapid assessment and planning •Intensive home treatment •Admission to inpatient services •Onward referral and signposting Where: •By telephone / In the persons home / In a safe place
B - Urgent and emergency access to crisis care
Bristol Crisis Services When: Immediate telephone response, rapid attendance (within 90 minutes) and rapid short term intensive home treatment all provided 24/7 Outcomes: •People experiencing acute mental health crisis receive rapid response and assessment •Patients receive effective intensive home treatment services at home that result in them recovering their stability •Only patients who cannot be managed in a community environment are admitted to hospital through the crisis service •All agencies who encounter people in serious mental health crisis can obtain immediate advice and support through a telephone service Crisis Sanctuary: Friday to Monday, 7pm – 2am, support in emotional crisis and to avert mental health crisis from support workers and peer supporters in a calm environment. To be commissioned separately in early 2014 Crisis Houses: Alternative to inpatient admission, up to 1 month stay to recover from a crisis and build resilience
Collaborative approach • • • • •
All services focussing on the individual not organisational boundaries Individual services incentivised to work together Using the experience, best practice and knowledge from a range of organisations Working both within and outside the mental health system Holistic approach – using all the resources available
Commissioning Perspective • Re-commissioned Section 136 suite opened in February 2014 • Increase in capacity from 1 bed to 4 beds for Bristol, North Somerset and South Gloucestershire and Bath and North East Somerset. • Bristol funds 2 beds based on activity data from 2012/13
2012/13 Activity ( one place of safety bed) Section 136 suite Activity
Bristol Activity
408
228
Custody Activity
477
Bristol Activity
257
Admitted to inpatient services
167 (total)
93 (Bristol)
Admitted to inpatient services
125 (total)
68 (Bristol)
Activity 03rd Feb-16th April 2014 (four beds) Section 136 suite Activity
Bristol Activity
176
107
Custody Activity
4
Bristol Activity
1
Admitted to inpatient services
54 (total)
33 (Bristol)
Transferred to Section 136 suite
3 (total)
1 (Bristol)
Outcome data • 71% of Bristol activity is between 6pm and 6 am with highest activity from 6pm to 3 am. • Activity across days of the week is between 12% and 19% ( 19% on a Tuesday 15% Saturday and Sunday) • 41% were male, 53% were female attending place of safety • 63% of people attending place of safety still wait over 9 hours for admission with 19% of these relating to intoxication • 43% of those admitted to the place of safety were discharged with no mental health follow up
Outcome data • Use of custody cell is already the exception ( two occasions related to lack of beds since the unit opened) • 11% are seen in under 4 hours and 28% in 4-9 hours • Delays remain in the pathway (over 9 hours) from accessing place of safety to assessment and admission or discharge that still need to be addressed
Bristol Picture - Delays in service • Bed availability (for admission following assessment) • Individuals under the influence of drugs and alcohol • Team availability ( Doctors/ Approved Mental Health Practitioners) • Individual patient risk factors • Accident and Emergency Department involvement
Future Developments • Close working with Bristol Crisis Service single point of access and home treatment alongside the place of safety • Follow up for individuals with repeat admissions to place of safety. • Possible Street Triage pilot based on out of hours activity • Whole system working with drugs and alcohol services
Modernising Mental Health Services in Bristol 2010
2011 - 2013 May 2013
May – Oct 2014 Autumn 2014
New services from October • • • •
Responsiveness Prevention, early intervention, effective care and management Supporting recovery Effective emergency care, rapid response, preventing admission and deterioration People who are known to services have: • A point of contact within their local team • An understanding of how to manage their mental wellbeing and when and where to seek help • A recovery plan that they were involved in developing and that matches their aspirations • An up to date agreed crisis plan The service feels positive, optimistic, caring, supportive, accessible, responsive, personal