County Durham Crisis and Liaison – one year on
Case study summary
From March 2017, a 24/7 service will commence aiming to provide a one hour response to liaison and up to a 4 hour response to community crisis assessments for children and young people.
One year after the launch of the Mental Health Taskforce strategy, the County Durham Child and Adolescent Mental Health Services (CAMHS) Crisis and Liaison Team continue to improve service on urgent care and recovery.
The original ‘experiment’ set to test out a mental health crisis care and liaison service for children and young people, and cut the expected response time from 18 hours to an average of around 90 minutes for all assessments. The team are now working a crisis and liaison model with an up to one hour response to liaison and up to a four hour response to community crisis assessments.
Currently the service operates over seven days, 8am-10pm, however from the beginning of March 2017, a 24/7 service will commence.
The original pilot launched with an investment of £827,000, fixed for an initial two years – they now have recurrent funding for crisis and liaison and additional funding to the end of March 2017 as part of the Urgent and Emergency Case (UEC) Vanguard Children and Young People (CYP) mental health acceleration monies. They are using this money to extend the service and provide an Intensive Home Treatment model for up to eight weeks. This work will facilitate prevention of admission to hospital, facilitate early discharge and provide an opportunity to support young people during very difficult periods in an intensive way. This will be offered to both young people not known to service who present to the crisis team via self-referral and also young people who are currently being cared for in community CAMHS teams but need a greater level of support. They are supported by local CCGs and Sustainability and Transformation Plans (STP) to commit to streamlining the Intensive Home Treatment service.
Since the pilot launched additional staff have been recruited in preparation for the 24/7 service and intensive home treatment. This means currently in place is a team manager, one Band 7 clinical nurse specialist, nine Band 6 crisis nurses, two Band 5 newly qualified nurses and a Band 3 support worker temporary to the end of March 2017. They also have the original team secretary and an additional 0.6 admin resource temporary to the end of March 2017.
The service still use the crisis recovery care plans regularly, ensuring the young person and immediate carers remain central to the process. Following on from this work they are now developing parent/carer safe plans to help them to cope in a crisis situation with their young person. They are also looking to develop employed parent peer support workers to further enhance the provision offered to support parents. They are working closely with a local parent support group to offer advice and formal training to parents around coping in a crisis. They have also delivered numerous training events jointly with a parent with lived experience to help professionals understand self-harm and how they can support young people and parents/carers. This has been very well received and feedback has been excellent.
Additionally, as a team they have been involved in national initiatives such as the Emergency Care Expert Reference Group, Crisis Care Concordat work as well as being invited to other areas of the country to share experiences and support development of other crisis services for young people. They were delighted to be invited to judge this year’s Nursing Times Awards following their success in winning last year.
Please see the following information regarding assessment locations and bed use:
- 100 percent (1665) assessments with young people were conducted by the Crisis Team to date (from May 2014)
- 61 percent (1017) were assessed within the acute hospitals in Durham & Darlington. (Liaison)
- 39 percent (648) were assessed within community settings. (Crisis)
- Of the 1017 young people assessed during opening hours in acute hospitals, 47 percent (477) were assessed in the A&E department. Of the 477, 70 young people were subsequently admitted to a paediatric ward.
- 53 percent (540) were assessed on the paediatric wards due to admission to hospital outside of current crisis team working hours or unable to be assessed in A&E due to medical needs. (24 hour service would reduce bed use further).
- From May 2014 to date, the crisis team were able to free up 407 overnight beds that would otherwise have been used whilst young people awaited a duty mental health assessment the following day.
- In addition, 527 young people presented in community settings with suicidal ideation, panic attacks or threats of self-harm. Traditionally, presentations such as these would be directed to A&E, so the presence of the crisis team has alleviated pressure on A&E departments within the county by an additional 527 presentations and subsequent admission to a paediatric ward.
Potential cost savings for reduced use of paediatric beds since May 2014 is £764,946.00 (934 x tariff) plus presentations at A&E £75,361 (527 x tariff).
For further information please contact:
Clinical Nurse Specialist
CAMHS Crisis Team
CYPS County Durham and Darlington
Tees, Esk and Wear Valleys NHS Foundation Trust
Lanchester Road Hospital
Lanchester Road, Durham, DH1 5RD