County Durham Crisis and Liaison

After the launch of the Mental Health Taskforce strategy, the County Durham CAMHS Crisis and Liaison Team reveals the impact of its service on urgent care and recovery.

An ‘experiment’ to test out a mental health crisis care and liaison service for children and young people has cut the expected response time from 18 hours to an average of around 90 minutes.

The County Durham CAMHS Crisis and Liaison Team run by Tees, Esk & Wear Valleys NHS Foundation Trust, was launched as an £827,000 pilot in January 2014.

The nurse-led service runs 8-10pm, seven days a week, and aims to see those in crisis within an hour but with a maximum wait of four hours. Previously young people in distress could wait up to 26 hours for an assessment.

Service lead Clare Anderson, a clinical nurse specialist, said: “We generally have two or three nurses on duty at any one time and we’re covering a really huge area so we’re very proud of that response time.

“It really was an experiment and it’s thanks to the support of our Head of Service and commissioners that we were able to try out and evaluate new ways of working. But the idea was very, very simple, and I always say this is the reason it’s worked. It’s nurse led and our criteria is very basic, in that if you’re under 18 and are having a mental health crisis we’ll see you, and we’ll see you wherever you look for help.“

The six nurse team is based alongside the adult Crisis, Home Treatment and Liaison service at the Lanchester Road Hospital, in Durham, but works across the Durham and Darlington area. It also provides phone support for parents, carers, service users and other professionals, such as NHS 111, GPs, the police and social services.

Once a young person with mental health needs is assessed, the team provides intensive support for up to 72 hours, or as required, either at home or an appropriate setting.

Every service user gets a care plan so they know what action is being taken by all involved, including parents and carers.

Longer term ‘Crisis Recovery Plans’ have also been developed to support repeat service users, such as those with complex issues and more severe mental health conditions.

These award winning plans, which are helping to prevent crises, cover issues such as triggers, self-management, and details of what interventions have been agreed in the event of another crisis.

Mrs Anderson said: “Young people have said they can’t think straight when they’re in a crisis. We listened to that and said we’ll let’s plan for that in advance. It means those interventions that are needed in a crisis then don’t come as a shock to them and it allows young people to keep a level of control.”

From its launch in May 2014 to January 31 this year, the service carried out 686 mental health assessments at Darlington Memorial Hospital or University Hospital North Durham, and an additional 444 outside of hospital premises.

Of the 341 assessed in A&E, just 51 young people needed admittance to a paediatric ward. The team was able to free up 290 paediatric overnight beds that would otherwise have been used if those young people had to be admitted to wait for an assessment, which helped to ensure bed availability for those most in need.

Out of the 444 assessments conducted outside of the acute hospitals, most, 334, would have previously been handled at A&E, with those young people reporting issues such as thoughts of suicide or self-harming.

Overall, most assessments, 770, were done within two hours, with more than half completed within 60 minutes.

Close working with adult services allows for joint assessments for those due to move from CAMHS, helping to prevent those in transition from falling into any gaps between services.

Similar cross-agency working and training offered by the team for others in the local workforce, such as care home staff, teachers, and police, is helping to identify children and young people with mental health needs earlier.

It also allows agencies to work together, such as attending youth events to publicise services following a suicide to ensure young people know what help is available and how to reach it.

Mum Wendy first received help from the team last year. Her 17-year-old daughter has complex mental health issues and has been involved with CAMHS since she was about 14.

“The crisis team got involved when things were at the worst point imaginable, on the day she was admitted to an inpatient ward after a serious incident of self-harming,” she said.

“Even after a range of community treatment and an inpatient admission it felt like we were going round and round in circles, then the crisis team offered something different.

“They came up with a patient centred care plan that involved my daughter, her needs, and also my needs as her single mum. It took courage to do but it marked the start of my daughter’s recovery.”

Their plan, which also details safe interventions for Wendy to make with her daughter, is based on a traffic light system giving her daughter control in her own management.

“In the green she’s able to completely self-manage, when she’s wobbling, and needs a bit of support, it’s amber, and when she’s in the red zone, in crisis, then other people need to take over,” Wendy said. “It also covers voluntary inpatient admission, which she would choose. It’s only happened once, and it set her back on the right path to recovery.

“You wouldn’t think something so simple could be so effective but because it’s been done from her point of view and my point of view, it’s been great. She’s living a positive life and she has more control of it. And it’s down to the team, and what they did that made that difference.”

Dr Jackie Cornish, NHS England’s national clinical director for Children and Young People said: “The service is a tribute to the innovative thinking and responsiveness of the Team. With the help of local commissioners they have proved that they can deliver intensive support which is personalised and completely tailored to the needs of the young person and their family, enabling them to stay safely in their community.”