NATIONAL COLLABORATIVE COMMISSIONING UNIT BEYOND THE CALL NATIONAL REVIEW OF ACCESS TO EMERGENCY SERVICES FOR THOSE EXPERIENCING MENTAL HEALTH AND/OR WELFARE CONCERNS OCTOBER 2020 BEYOND THE CALL // A NATIONAL REVIEW 1 NATIONAL COLLABORATIVE COMMISSIONING UNIT AUTHORS: S . MILLS , R . BAGSHAW & A . WATT BEYOND THE CALL Authors of this Acknowledgments • Members of the Expert National Review The author would like to thank Reference Group who This National Review was the following for their support provided invaluable advice written by Mr. Shane Mills, during this National Review: and support. MSc, RMN, Director of Quality & Mental Health/Learning • Police and ambulance call • Staff of the National Disabilities at the National handlers, control room staff Collaborative Collaborative Commissioning and mental health support Commissioning Unit for Unit with research, analysis teams for answering the coordinating and supporting and contributions by Dr calls and collecting the the National Review. Andrew Watt, BSc, PhD SFHEA, information used in this and Dr Ruth Bagshaw BSc, National Review. ICAN Notes DclinPsych senior academics volunteers and staff for • Some of the trigger words and lecturers from Cardiff collecting information used in the bespoke data Metropolitan University. in this National Review. collection can be viewed as plainspoken and no offence • Welsh Alliance for Mental is intended by the use of Health, Welsh Ambulance colloquial terminology Service Trust, Dyfed–Powys Police, Gwent Police, North • The data and information Wales Police, South Wales used in this National Police, Mid and West Wales Review was collected Fire Service, North Wales before the Coronavirus Fire Service, South Wales pandemic which may affect Fire Service, NHS Wales future demand and service Heath Boards and the Local response. Authorities in Wales for their cooperation during this National Review. 2 BEYOND THE CALL // A NATIONAL REVIEW NATIONAL COLLABORATIVE COMMISSIONING UNIT About this National Review This National Review has been commissioned production of this National Review caused by by Welsh Government as part of the Together the Coronavirus Pandemic, this aspect will be for Mental Health Delivery Plan through the addressed through a supplementary report. National Crisis Care Concordat Assurance Group. It was planned to undertake a ‘lived experience’ This National Review was commissioned to survey in collaboration with the Mind mental achieve greater understanding of the issues health charity and the Wales Alliance for Mental leading the public to access emergency services Health. This survey was to better understand when experiencing mental health and/or the personal experiences involved in contacting welfare concerns. emergency public services for a mental health or welfare concern. Due to the disruption caused This National Review initially covered the by the Coronavirus pandemic this survey will be method and instances of conveyance by undertaken at a later date and published through emergency or dedicated transport services for a supplementary report. person experiencing mental health issues post- assessment but, due to the disruption in the BEYOND THE CALL // A NATIONAL REVIEW 3 NATIONAL COLLABORATIVE COMMISSIONING UNIT Around 950 people a day in Wales seek support from the public sector for mental health or welfare concerns, 300 of these for an emergency 109 50 Referrals to NHS People assessed Secondary by NHS 215 Mental Health Psychiatric 53 Referrals to NHS Support Services Liaison Teams Referrals to NHS Primary Care Mental Health Mental Health Crisis Teams Support Services 41 14 Calls to the People seen C.A.L.L helpline face to face by the BCUHB ICAN service 1 5 DAY 12 Section 136 People call Mental Health Beyond the NHS 111 Act assessments the call Service A day in Wales 35 31 People call People call Gwent Police Dyfed-Powys Police through 999 (14) through 999 (13) 1 or 101 (21) or 101 (18) DAY 129 37 People call People call South Wales 73 142 North Wales Police through People with a People with a Police through 999 (53) mental health/ mental health/ 999 (19) or 101 (76) welfare concern welfare concern or 101 (18) call the Welsh attend Emergency Ambulance Departments Service in Wales Graphic is for illustrative purposes only. Numbers are averages. department attendance or NHS mental health services referral, Exact figures are946 overall, 319 classed as emergency (‘999’ similarly calls to ambulance or NHS 111 could result in police calls to police and ambulance, Sec 136 and attendance at calls, emergency department attendance or referral to NHS emergency department). Police data is from MH snapshot day mental health service. Some emergency department figures could November 2019. Emergency department is 4% of attendances. include subsequent referral to psychiatric liaison or ICAN services. Other data is from bespoke data requests or published data. Data Many calls or referrals could result in an assessment with no does not include social care, third sector or telephone helpline determination of a mental illness. Numbers could refer to single support. Police figures do not include persons in custody with calls from single person, multiple calls from a single person or mental health flags or missing person calls. Some overlap may multiple calls about a single person. Further explanations can be occur as calls to police could result in ambulance call, emergency found in this National Review. 4 BEYOND THE CALL // A NATIONAL REVIEW NATIONAL COLLABORATIVE COMMISSIONING UNIT Foreword I am pleased to present this National Review on Although there will always be people who require access to emergency services by people in crisis specialist mental health services, there are many who have mental health and/or welfare concerns. others who need access to a range of other help, The Review has found that each service responds advice and support services, including people who to the needs of people in crisis in a way that need support out-of-hours. We must ensure is informed by their own organisation’s we have the appropriate response in Wales to understanding of what ‘crisis care services’ deal with this range of health and welfare issues mean. We need to ensure that the planning and through a preventative agenda. The current delivery of crisis care services is better joined pandemic and its resultant impact on wellbeing up and coordinated across a range of public reinforces this need. sector services, and that the use of resources and expertise is better targeted to meet people’s needs. I would like to take this opportunity to thank Shane Mills and all the other contributors The Review has highlighted where there are gaps for their work on producing this report. in data and evidence, and stresses the need to I appreciate the challenges in completing the focus on a whole system approach to planning Review and producing the report during a and delivering crisis care services. The Review worldwide pandemic. has also found that issues classified as ‘a mental health issue’ are not always indicative of mental This Review will help to set the direction for illness, and that some people present in crisis as a ensuring that high quality crisis care services consequence of social or welfare issues. are planned and delivered across Wales over the next decade. The Review highlights the complexity of planning and delivering crisis care services across multi agencies, and how presentations do not just relate to health matters but also to matters such Emrys as confusion, intoxication, loneliness, debt and homelessness amongst many others. EMRYS ELIAS- CHAIR, NATIONAL CRISIS CARE CONCORDANT GROUP AND VICE CHAIR, ANEURIN BEVAN UNIVERSITY HEALTH BOARD BEYOND THE CALL // A NATIONAL REVIEW 5 NATIONAL COLLABORATIVE COMMISSIONING UNIT BEYOND THE CALL // A NATIONAL REVIEW NATIONAL COLLABORATIVE COMMISSIONING UNIT PART A BACKGROUND & METHODOLGY Contents 1. BACKGROUND................................ 8 2. SCOPE........................................... 8 3. METHODOLOGY.............................. 8 3.1. EXPERT REFERENCE GROUP............. 9 3.2. DATA COLLECTION.......................... 9 4. DEFINING MENTAL HEALTH & WELFARE CONCERNS...................... 10 5. OVERVIEW OF ‘CRISIS’..................... 10 6. CRISIS CARE CONCORDAT............... 11 BEYOND THE CALL // A NATIONAL REVIEW 7 NATIONAL COLLABORATIVE COMMISSIONING UNIT ‘[A CORE PRINCIPLE IS] SECURING BETTER QUALITY AND MORE MEANINGFUL DATA’ STATEMENT FROM: WELSH GOVERNMENT AND PARTNERS MENTAL HEALTH CRISIS CARE CONCORDAT (2015) 1. Background acknowledging their critical role in supporting people in crisis, were excluded as not being In May 2019 the Welsh Government, through statutory public services. the National Crisis Care Concordat Group, commissioned the Director Of Quality & Mental Health/Learning Disabilities at the NHS Wales 3. Methodology National Collaborative Commissioning Unit to In order to ensure the Review was evidenced undertake a National Review to achieve greater based, data informed, cognisant of lived understanding of the issues leading the public experience and took account of expertise and to access emergency services when experiencing knowledge the following were proposed: mental health and/or welfare concerns, henceforth referred to as ‘the Review’. • An Expert Reference Group, • Partnership with Cardiff Metropolitan The Review supports the Together for Mental University for research and data analysis Health Delivery Plan 2019-2022 aim that purposes, ‘outcomes are improved for