Nottinghamshire street triage scheme

After the launch of the Mental Health Taskforce strategy, the commissioners of the street triage team in Nottinghamshire discuss the scheme’s impact on their response to people in a mental health crisis and detention rates.

A street triage team of nurses and police in Nottinghamshire more than halved the use of police custody for people in a mental health crisis in a year.

Two cars with two trained police officers and two community psychiatric nurses, employed by Nottinghamshire Healthcare NHS Foundation Trust, are available at peak times from 4pm-1am.

The team, costing £472,800, supports people with a mental health problem who have been reported to police for various reasons and might otherwise have been taken to a police cell if needing to be held under section 136 of the Mental Health Act.

The officers and nurses can check if the person is known to mental health services and either respond in person or the nurses can give advice to officers over the phone.

The team is commissioned by seven Clinical Commissioning Groups (CCGs) in Nottinghamshire and Nottinghamshire Police and offers a range of services to resolve incidents including: taking someone home, offering advice on how to cope with a situation, referring to crisis or other services, returning someone to an inpatient unit, or requesting a GP appointment.

Sgt Anthony Horsnall, Mental Health Operational Lead for Nottinghamshire Police, said: “The Street Triage Team working in partnership have significantly reduced the number of people detained under the mental health act by identifying those who can be dealt with in a less restrictive manner. This ensures they receive the right help from the most appropriate service.

“People suffering from a mental health crisis are now widely cared for in a health-based place of safety by nurses instead of being detained in a police cell. This is the best environment to de-escalate someone who is in crisis and to support recovery.”

A crisis resolution and home treatment team operating 24/7 supports the work to improve crisis management in Nottinghamshire and they have increased the numbers of health-based places of safety; a 24 hour six-bed crisis house has also opened.

In the year from April 2013 to March 2014, there were 321 S136 detentions in police custody. The launch of the pilot in April 2014, combined with improved partnership working, saw that figure drop to 152 over the year 2014-15 – a 53 per cent reduction.

Between January to December 2015, the use of police cells was down 75 percent compared with 2014, with just three people detained in cells over the period October to December 2015.

The average number of overall S136 detentions per month, which can also result in admission to a hospital-based place of safety, is down 52 per cent on 2013/4 with an average of just 41 detentions per month during April to December 2015.

Dr Geraldine Strathdee, NHS England’s National Clinical Director for Mental Health, said: “Street triage teams can make an immediate and positive impact on the lives of people when they are particularly vulnerable.

“This scheme clearly shows just how quickly change can be made for the benefit of the public, the police and mental health services.”

No children have been held in police cells for assessment at all since over the past year ahead of legislation to ban the practice, which is expected in 2017. A similar local zero custody policy began for adults began in October.

Katherine Biddulph, commissioning manager for mental health at Nottingham City CCG, said: “Due to the success of the pilot, a decision has been made to continue funding the street triage initiative on a recurrent basis.

“Before 2014 there may have been liaison between police and nurses but the difference now is that this is them actually working together. It’s very much a partnership arrangement and close joint working is the key to the project’s success.”

The scheme covers seven CCGs across Nottinghamshire with a car for each of the two divisions of operation – city and county.

From April, the CCGs will be paying a combined £288,500 for the nursing element of the scheme, with annual police funding of around £184,300 for four police officers and the lease of two cars.

Officers are now free to focus on other calls and they say they have more confidence in dealing with mental health-related incidents and feel less at risk. Specialist mental health training has been given to 2,000 officers so they can support and use the street triage team more effectively.