Bedfordshire Mental Health Crisis Care

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1 Bedfordshire Mental Health Crisis Care BCCG is asking patients and the public to think about the following questions when considering the crisis response in Bedfordshire:- What do you need when in crisis? [This can be anything or some of the things considered ] Where would you want to go when in crisis? [Locations, meeting points, inpatient, a sanctuary, a café?] How do you want to communicate with others when in crisis? [When is crisis would you want to see someone face to face, telephone someone, who?] How can we make people safe when experiencing crisis? [Professionals, host families, telephone lines] What is crisis care? A mental health crisis can mean different things. It generally means when someone s health worsens to the point where they need urgent help from professional services. Emergency support for people in mental health crisis includes primary care (GP s), secondary care (A & E, inpatients, ambulance service), other emergency services such as the police, voluntary services, national help lines such as the Samaritans, crisis cafes and sanctuaries. What are the challenges? We want to work to prevent crisis, before it happens. When someone is in crisis, we want there to be a variety of mental health support to help patients stay well. We don t want individuals to be admitted into inpatient settings unless they need it and when they are admitted we want the length of their stay to be kept to a minimum. Expansion of community-based services for people with severe mental health problems. For patients, carers and professionals to have rapid response to their mental health needs for both individuals known to services and those that are not. To ensure we have considered differing approaches to supporting specific community groups. Page 1

2 What are we considering in Bedfordshire as part of our crisis response? 1. Mental Health Professional in primary care (GP practices)-primary care liaison 2. Mental health professional in secondary care (Hospitals & A & E). Psychiatric liaison. 3. Mental Health Street triage 4. Crisis Café 5. Crisis Sanctuaries 6. Crisis Families Further details on what we are considering including some case examples 1- Mental Health Professional in primary care (GP practices)-primary care liaison The provision of a comprehensive PCMH service will improve the care pathway, in particular by impacting crisis response pathways through: Services will: preventing deterioration of long term conditions improving communication and appropriate referrals enabling problems to be dealt with early to reduce admissions to hospitals offering alternatives to secondary mental health care the emphasis on providing care as close to the patient s home as possible the need to take patients views into account patients and their carers preference for being treated in primary care, where the environment is less stigmatising and where physical and mental health care can more easily be delivered together. support GPs to manage patients within primary care improve patient engagement, access and outcomes, reduce mental health stigma, deliver a more cost-effective and streamlined pathway, and lead to the sharing of expertise and knowledge with GPs. The following support can be provided: Mild to moderate brief treatment Medication initiation / adjustment Assessment, advice, triage and teaching Crisis assessment (and appropriate link to crisis pathways in secondary care when indicated) Page 2

3 2- Mental health professional in secondary care (Hospitals & A & E) Liaison Psychiatry. The proposal is to enhance the existing levels of liaison psychiatry provision in Bedfordshire. The enhanced service will: See all patients attending A&E with mental health needs, and no exclusion criteria will apply. Provide a first assessment for all patients from the age of 16 upwards. Provide a same day assessment (within one hour for urgent referrals) for all inpatients. The enhanced Liaison Psychiatry Team, working in partnership with the acute general medicine service, will enable the medical and psychological needs of adult and especially elderly patients admitted to Hospital to be addressed synchronously. 3- Mental Health Street Triage Mental Health Street Triage schemes across the country incorporate joint working with police, paramedics and mental health services. These pilots have demonstrated a significant reduction in the use of detention of people with mental health needs under S136 of the Mental Health Act (2007). They have avoided people being transported to A&E and they have also contributed to those individuals avoiding becoming entangled with the criminal justice system. The aim is to provide a service which can rapidly respond to people experiencing a mental health crisis delivering rapid treatment and intervention and ensuring any ongoing needs or support takes place in the most appropriate environment. The service will prevent the emergency services wasting time and effort in trying to resolve a situation beyond their expertise and control and prevent unnecessary attendance at A&E and unnecessary detentions and mental health assessments. 4- Crisis Cafés Example 1 South West London and St. George s Mental Health NHS Trust is delighted to announce that it will be opening two Crisis Recovery Cafes in partnership with third sector organisations, scheduled to launch in April These cafes will provide an accessible and normal café environment in south west London operating in the evenings and weekends where people who feel they are in mental health crisis can attend and receive peer support as an alternative to presenting at Emergency Departments. The cafes will provide hot and cold snacks, support and a range of activities which can support and alleviate their crisis. The cafes will also be supported by the Trust s Crisis and Home Treatment Teams where clinical Interventions are required. Page 3

4 Example 2 The Safe Haven at the Time Out Cafe The Safe Haven project provides an alternative to A&E for adults with (or developing) mental health problems in the North East Hampshire, Farnham and Surrey Heath areas. We offer a safe, supportive and therapeutic environment, promoting independence, opportunity and recovery in the community. We also promote empowerment to the people who use the service by giving them the opportunity to identify their own needs, make their own choices about what will help them and develop their own coping strategies. We help them recognise their strengths and talents, encourage hope and work towards improving their emotional wellbeing. What is different about your service? It provides a safe environment and access to mental health support when it s needed. There is also invaluable peer support which promotes integration into the community. People who use the service are welcome to walk in and speak to mental health professionals and have a choice to speak with peers or volunteers. Who works here? There is one member of staff from each service on each shift. This combination of personnel ensures people in crisis are fully supported, as the team apply their various skills and experience to provide help such as: mental health assessments where required, dialectical behaviour therapy, cognitive behaviour therapy, problem solving skills and psychosocial interventions skills, invaluable engagement, emotional and peer support while encouraging self-help and recovery, link people into community activities during the day, provide counselling skills and information for people with drug and alcohol problems. 5- Crisis Sanctuaries - Example A safe environment to de-escalate and support a person at risk of or experiencing a crisis. This could be a bedded unit staffed by specialist mental health professionals and volunteers from mental health charities. This unit could provide a safe alternative to A&E and acute admission in addition to a step down facility to facilitate early discharge from the acute sector. 6- Host Families Example A Host Family provides a caring, family environment for a guest, which avoids hospital admission, or allows early discharge from hospital, and focuses more on home, family and the community for people who are going through a period of mental health crisis. Guests are encouraged to get involved in all aspects of family life, from walking the dog to cooking family meals. Guests can go out if they want to and can to meet up with family and friends when they like. Page 4

5 The scheme is the first of its kind in the UK and is based on evidence that people with mental ill health recover better if they are out in the community, in a supportive family setting, taking part in a daily routine. Both hosts and guests get intensive support from the Crisis Assessment and Treatment Teams (CATT) and hosts are not expected to provide care or treatment, just a welcoming, caring environment. Hosts receive a payment to cover the costs of taking in a guest. What happens next? Two public events on 3 and 12 July Further engagement at existing user and carer groups Questionnaire to be promoted widely Changes to be fed into the commissioning cycle and developed for April 2018 Page 5