Working to deliver the care mental health patients deserve
In the second of two blogs, NHS England’s National Clinical Director for Mental Health, takes a further look at crisis care innovations in action:
The commitment to change, the numerous examples of innovation and transformation and the willingness to share best practice across the country gives real hope that significant progress to mental health crisis care can, and is, being made.
In this second blog, I wish to highlight more areas where these innovations are already unfolding, namely: improving timely access to the right care, first time and suicide prevention; out of hospital home care, and acute hospital A&E liaison mental health teams.
NHS111 and single point access services
The highest cause of death in young men and women in England is death through suicide, and rapid skilled response through a well-publicised access route is essential to reduce this premature mortality.
The NHS111 Mental Health Programme has been set up specifically to improve services. NHS England is working with Mind and the Telephone Helplines Partnership to develop a training course designed by people with lived experience specifically to support 111 call handlers deliver the best possible response in times of crisis.
Eight NHS111 services are being piloted and evaluated to explore the impact of different service models. These include direct referrals from NHS111 to local specialist crisis teams, access to mental health professionals within call centres and direct links to street triage services.
The full report will not be available until autumn 2015 but emerging findings have highlighted that the greatest benefit is derived from strong connections and integrated services with NHS111, local MH crisis teams and commissioners of both urgent and MH services working seamlessly and access to a comprehensive local Directory of Services.
Whole system new models of care redesign
In advance of the formal vanguard New Models of Care programme, four local areas have undertaken whole system urgent care transformational redesign. Two are described here:
Northumberland, Tyne and Wear whole system vanguard redesign: One of the most outstanding examples is the large-scale emergency and acute care pathway transformational redesign has been undertaken by the CCG commissioners and Northumberland, Tyne and Wear mental health trust in collaboration with local patients and carers. The service now offers integrated teletriage and telehealth and rapid access to a range of services from housing, social care, 3rd sector services, alcohol and drug, psychological therapy, and other specialist mental health services.
The evaluations are excellent, with high levels of patient, family, GP and other referrer satisfaction. The service is also notable by its productivity, through adaptation of digital technology, which enables staff to provide more treatment in the community through remote access to care records, and the use of digital dictation to reduce clinical time spent at computers.
Bradford whole system vanguard redesign: Bradford District Care trust and its CCG and local partners launched a major ‘whole care pathway’ redesign, with excellent outcomes in the first three months. Importantly, they are evaluating the use of routine suicide assessment, learning from the success of that initiative in Australia.
Street triage and access to healthcare S 136 places of safety
The new collaborations between police forces and local mental health services have been one of the outstanding successes of the Concordat programmes. There are now 26 street triage schemes across England.
Evaluations show that people are triaged more rapidly into specialist mental health, or other appropriate crisis response services, and admissions and detentions under the mental health act are prevented.
Data collected from police forces shows that there has been a reduction in the use of police custody as a place of safety for people detained under Section 136 of the Mental Health Act 1983. The data, recorded the figure falling from 6,667 incidents in 2013/14 to 4,537 in 2014/15 (32% reduction). For more info see: ·
Devo Manc area has a highly evaluated street triage and wider crisis service operated between the local police force and Pennine Care trust in Oldham.
Out of hospital community care
Mental health can be rightly proud of its long tradition as the leading specialty in offering care out of hospital care through intensive treatment teams, crisis houses and other alternatives.
Crisis home treatment teams seek to offer commissioned 24/7 response, 365 days a year for rapid response and home care. Currently there is major variation in the services commissioned and provided, and a robust programme of research and evaluation is being undertaken to help commissioners identify how to get the maximum effectiveness and efficiency.
Crisis houses are alternatives to hospital admission and examples include:
- Leeds Survivor led Crisis service is highly respected and valued
New pathway models of urgent care: Hertfordshire Urgent and emergency care commissioner
Commissioned 111 and Hertfordshire Partnership University NHS Foundation Trust (HPFT) have commissioned a fast track service whereby callers to 111 are immediately tele triaged to an expanded crisis home treatment team service, with choices of day treatment services and Host family placement schemes as alternatives to admission.
Acute hospital A&E and liaison mental health teams
People with mental ill health have double the ED attendance rate of the general population.
Deliberate self-harm features in the top five reasons for an emergency medical admission year on year – more than 150,000 Emergency Department (ED) attendances a year.
More than 25% of people admitted to acute hospitals have a co-morbid mental health problem. Liaison mental health teams support A&E staff, and provide ‘Right first time’ expert assessment and treatment.
This means that admissions to both acute beds and care homes can be prevented especially for older adults with delirium and dementia and they can be offered care at homes as they prefer
An effective liaison psychiatry service offers the prospect of saving money as well as improving health.
Birmingham RAID is an award-winning service which offers comprehensive mental health support, available 24/7, to all people aged over 16 within the hospital.
So what’s next?
In summary, it’s been a dynamic and active first year of the reform of the mental health urgent and emergency care system.
Mental health champions from all agencies have risen to the challenge, and new collaborations and innovations are being developed and evaluated at increasing pace.
There is a great deal to do to ensure that people in mental health crisis can get the right, compassionate, expert service they need to the same standard of care they receive for physical health.
If we can continue to design the new models of care with people and their families and work together in partnership, we can be optimistic that we can deliver what our patients deserve.
Dr Geraldine Strathdee OBE
Dr Geraldine Strathdee, OBE, MRCPsych, is the National Clinical Director for Mental Health, NHS England, a consultant psychiatrist in Oxleas NHS FT, and Visiting Professor, Integrated mental health education programme at UCL Partners.
For over 20 years she has held senior roles in mental health policy, regulation and clinical management, at national and London regional levels, and advises internationally on mental health service design and quality improvement, while working as a practising clinician. She has been involved in transformational large scale service development programmes, moving services from hospital based, to 24/7 home care and primary care models, in roles which have included: the Trust Director of Clinical services in Oxleas NHS FT (2005-2007), Director of Service development at the Sainsbury Centre for Mental Health and Senior Lecturer, UMDS ( 1995-1998). She was the National Professional Adviser in mental health to the Healthcare Commission and the Care Quality Commission (2005-2012).
Her particular commitment is to the translation of policy and best practice evidence into front line routine clinical practice, empowering service users to reach their potential, and staff to maximise their time to care. She is passionate about the development of leadership competencies and using information to enable informed decision-making.
As London SHA Associate Medical Director (2009-2013), with responsibility for mental health, she led transformational change through the development of clinical networks for dementia and primary care mental health CCG leaders, developed ground breaking commissioning support care pathway profiling informatics tools, and high impact educational programmes. She was awarded the prestigious RCpsych Psychiatrist of the Year award in 2012.
Clinically, she has worked in a wide range of primary care, inpatient and community services, and latterly with people with complex and multiple needs, as a Consultant Psychiatrist for the Bromley Assertive Community Treatment team in Oxleas. She is committed to providing services which enable services users to live in their own homes, develop their own personalised care plans and self management expertise to achieve recovery, while at the same time working with community agencies to deliver coordinated, responsive, care pathways.
Service evaluation and research interests: Her teams have won awards for their use of technology in improving care, using patients as experts in staff training and leadership awards for new Ways of Working, the redesign of roles. Her research interests have included the fields of primary care mental health, evaluation of community services and dual diagnosis. Current research interests include the evaluation of competency based leadership programmes and clinical networks to drive transformational improvements, and high impact educational programmes.