All Age Mental Health Services Crisis Care Concordat Action Plan

Buckinghamshire All age Mental Health Services – Crisis Care Concordat Action Plan

1. Commissioning to allow earlier intervention and responsive crisis services

No. Action Timescale Led By Outcomes Improving mental health crisis services 1.1 Commission services so On-going NHS England  The needs of service users with co-existing that Liaison and Diversion CCG / BCC mental health and substance misuse needs are Services and Street Triage better addressed in the development of refer individuals with services. coexisting mental health and  Provision of integrated services substance misuse problems to services which can address their needs. 1.2 S136/135 Develop a ‘street triage’ June 2015 TVP/OHFT  Street Triage service is provided in Bucks service in Buckinghamshire  Service Users in Mental Health crisis receive appropriate and timely support.  Application of S136 reduces

Record, monitor and report Ongoing TVP/BCC  TVP will record, monitor and report on all use on all uses of S135/136. of S135(1) Unless in emergency, S136 is  BCC AMHP/EDT service will record, monitor used only when alternative and report on S136 activity forms of mental health assessment and support have been considered and precluded.

Buckinghamshire ‘Problems Ongoing OHFT  Overall reduction in cost for S12 doctors to in Practice’ forum monitors NHS England.

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and reviews all use of Police  Health based place of safety is used in all but Custody as a Place of safety. the most exceptional circumstances (less than Contingency arrangements 5% of all S136 detentions) are considered and published to ensure that custody is  TVP will ensure that health based places of used as a place of safety safety are the default location for all persons only in exceptional cases and detained under S136 the use of custody for under 18s is a NEVER EVENT

Develop model of joint agency response where  Joint agency care plans agreed for individual individuals present to with multiple presentations to emergency emergency and mental services health services on repeat occasions  Clear joint agency response model is in place

Match local needs and resources 1.3 Local Authority Buckinghamshire county July 2015 OHFT  Buckinghamshire County Council is able to AMHP Resource council to complete the demonstrate application of S114 MHA 1983. remodelling of the AMHP  There is a ‘seamless’ AMHP service 24/7 within service to maximise use of Buckinghamshire. the current AMHP resource.  Ensure that police custody suites are considered to be part of the AMHP service responsibilities  Custody data will be provided by TVP as performance information

OHFT continue to support Ongoing BCC  The AMHP rota is resourced effectively to AMHPs contributing to the agreed standards. countywide AMHP service.  The current number of AMHPs is sustained

Buckinghamshire CC and OHFT  All Adult Mental Health Teams and Older Adult OHFT continue to support Mental Health Teams have AMHPs among staff members in undertaking substantive team members. AMHP training. 1.4 Crisis Accommodation To undertake a review / July 2015 OHFT  The need for a ‘crisis’ facility within audit of admissions to BCC Buckinghamshire is clarified and also includes hospital to identify the need admissions from police custody suites for a ‘crisis’ facility within Buckinghamshire and/or Thames Valley as a whole. 1.5 Staffing levels In-patient facilities are Aug 2015 OHFT  In-patient facilities are able to manage the adequately staffed at levels safeguarding of patients in the majority of that maintain patient situations without cause to involve external safeguarding. agencies.

2. Access to support before crisis point – operational services

Improved access to information and support 2.1 Public Facing Buckinghamshire Agencies / Nov 2015 OHFT  Service users and families are able to access Information signatories of the concordat Communications appropriate and up to date information from will develop information for Team OHFT website. service users and carers  To be shared with the 111 Directory of regarding resources available Services in a mental health crisis 2.2 NHS Social /Care Social Care Teams to have July 2015 BCC  For there to be a ‘no wrong door’ approach to Interface clear guidance regarding OHFT those seeking mental health support in crisis. accessing mental health services in a crisis for service users who may present to Social Care in the first instance. Early intervention 2.3 Advanced For agencies in March 2016 OHFT  Care coordinators have an increased Statements / Anticipatory Buckinghamshire to develop understanding of Advanced Statements care plans. information sharing and  Service Users are supported to produce an practice with regards to advanced statement. Advanced Statements and  Advanced Statements are recorded anticipatory care plans. consistently on OHFT clinical database.  Advanced Statements are shared with Primary Care and Carers where appropriate.  Content of Advanced Statements is considered when making care and treatment decisions.  Anticipatory care plans are shared with other agencies as appropriate in order for

presentations to be managed in accordance with agreed care plans.

2.4 Criminal Justice For providers of Mental July 2015 NHS England Health  Both mental health and criminal justice provide Liaison and Diversion Health Liaison and Diversion and Justice Team. services following the agreed pathways services to link with OHFT / CCG and or providers to ensure Providers that clear pathways are in Community / Crisis place to access appropriate teams mental health crisis services.

3. Urgent and emergency access to crisis care

Improve NHS emergency response to mental health crisis 3.1 Conveyance Work with SCAS and Aug 2015 CCG, SCAS, NHS  SCAS will have appropriate vehicles and are Commissioners (Mental England resourced to convey detained and informal Health and Ambulance) to patients to mental health acute inpatient care. ensure mental health  OHFT no longer commissioning private secure emergencies, including ambulances. patients detained under the MHA are responded to  TVP will request an ambulance on every appropriately. occasion for S136 transport Appropriate health care transportation will be  TVP will provide performance information commissioned and provided regarding the use of transport for S136 for all mental health transport (this will include additional support for non- compliant patients and secure transport)

Police are requested to assist July 2015 SCAS  Reduction in the occasions when TVP are in only the most exceptional requested to assist with mental health cases where there is no transport other safe means.

SCAS will comply with July 2015  Process for transport (particularly secure National protocol for the transport) provision is documented and transportation of S136 disseminated patients, which provides

agreed response times and a  CCG commissioners to commission based on standard specification for use nationally agreed protocol. by CCGs 3.2 Mental Health Practitioners July 2015 Oxford Health, SCAS  Better initial integrated assessment at point of to work as part of the team call coming into the Emergency Control Room in the Emergency Operations Centre offering 24/7 assistance (ambulance control room; 999 and 111). 3.3 Medical Input to For OHFT to produce a rota July 2015 Oxford Health  Doctors with prior knowledge of the patient Mental Health Act of Trust S12 doctors who are are involved in MHAA Assessments (MHAA) able to respond to MHAA out  Doctors employed by the Trust are involved in of hours. all MHAA  Trust Doctors are able to facilitate identification of inpatient resource.  Incidence of medical recommendations ‘left’ reduces.

For Trust doctors to prioritise April 2015 Oxford Health  For MHAA not to be delayed by lack of S12 attendance at MHAA for approved doctors. known patients.

NHS England to maintain a April 2015 NHS England local list of S12 approved Doctors, area and distribute to relevant parties.

3.4 Timely access to S140 protocol developed July 2015 CCG, OHFT  Reduction in delays in AMHPs making inpatient resource which clarifies arrangements application for admission for the admission of patients  Improved experience for service users and where there is no local bed families in times of mental health crisis

availability. To specifically explore the option of making an application to the relevant local mental health inpatient unit even if no identified bed. This should include detained  Reduction in delays for detained people people under the sections  People never held in custody pending 47/48/49 of the MH act and application without a power to do so AMHP responsibilities under S13 MHA

Use of ‘out of area’ acute June 2015 OHFT  OHFT monitors the impact on service users inpatient resource is and families of an out of area acute inpatient monitored with regard to admission. impact on service users and  Additional support needs are identified families. provided for where appropriate.

Discharge pathway June 2015 OHFT/BCC  Delays to discharge from acute inpatient care arrangements including for CCG are not as a result of lack of clarity regarding the funding and availability funding arrangements. of aftercare services is clarified.

Integrated health and social services impact on mental health crisis

3.5 Mental Health / Psychiatric In Reach and Ongoing OHFT  Service users presenting in crisis to Emergency Acute Medicine interface Liaison Service continues to Departments receive timely and appropriate provide timely assessments mental health assessment. for patients presenting to the  Assessed Mental Health needs are met in a Emergency Departments timely and appropriate manner.

medical wards, and provides  OHFT makes the case for ongoing funding. information and advice regarding relevant legal frameworks.

Adult Mental Health Teams Ongoing OHFT  Crisis care home service is available round the continue to offer a crisis care clock home treatment service as part of the integrated health and social care teams Staff Skills and training 3.6 Mental Health All organisations within Ongoing OHFT / BCC  Staff working within organisations within Training Buckinghamshire are able to SCAS Buckinghamshire have access to appropriate access appropriate mental TVP mental health training. health training.  Staff working within organisations are able to provide support to service users experiencing a mental health crisis.  Service users receive appropriate information, advice and guidance from staff working across all sectors.

4. Quality of treatment and care when in crisis

4.1 Place of safety Partners will work together Sept 2015 TVP and all partners The use of police cells as places of safety falling to to ensure that custody is below 5% of Section 136 detainees ensuring patients only used as a place of are accommodated in an appropriate health facility. safety on an exceptional basis (below5%) 4.2 Restraint All staff who have direct Dec 2015 OHFT The use of different techniques will lower the use of patient contact at The restraint and improve patient experience. Whiteleaf Centre will have received training in restraint and breakaway techniques

5. Recovery and staying well / preventing future crisis

5.1 For a local partnership to be Oct 2015 OHFT  For the need for a Recovery College to be formed to consider the co- CCG/BCC identified and agreed. production of a Recovery SUCO  For the form and function of a Recovery College within College to be agreed. Buckinghamshire  For agencies within Buckinghamshire to agree Include where appropriate, resource to support the establishment of a those going through the Recovery College criminal justice system 5.2 Develop and work in Oct 2015 CCG, OHFT  Partnerships developed with 3rd sector partnership with 3rd sector  Service users and 3rd sector becomes more and MH service users to involved in services identify their needs 5.3 Develop relationships with On-going CCG  Those released from detained settings able to resettlement prisons and Health & Justice access consistent treatment community rehabilitation companies to ensure speedy information is passed to GPs and MH services for prisoners on release

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