MENTAL HEALTH URGENT CARE AND ASSESSMENT PATHWAY REDESIGN CCG Summary paper 1. Purpose of this paper

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1 MENTAL HEALTH URGENT CARE AND ASSESSMENT PATHWAY REDESIGN CCG Summary paper 1. Purpose of this paper Over the past 2 years partners across North West London have been working to co-produce improvements to the secondary care urgent mental health assessment pathway, agreeing key principle, such as ease of access and speed of response. This paper brings together that work, including a proposal for additional investment in West London Mental HealthTrust (WLMHT) to deliver the required changes. It sets out the rationale for investment in new, more effective urgent care pathways for people in mental health crisis which will improve the quality of care and outcomes for patients and value for the local health and social care economy. It represents the first stage in transforming the way in which mental health services are delivered locally. 2. Context and background National guidance and best practice Nowhere is the parity of esteem gap between physical and mental health services more obvious than for people experiencing a mental health crisis. People in physical health crisis have a clear path to care and support, with clear access standards, whilst those in a mental health crisis and GPs have to navigate multiple entry points and hand offs which delay the start of treatment and support. When people experience, or are close to experiencing, a mental health crisis, there should be services available to provide urgent help and care at short notice. This includes advice from telephone help lines, assessment by a mental health professional, intensive support at home or urgent admission to hospital. The recent Care Quality Commission report Right here Right now i found that far too many people in crisis have poor experiences due to service responses that fail to meet their needs and lack basic respect, warmth and compassion. The CQC found that there was a clear need for better 24 hour support and access to ensure that people receive care straight away rather than go to A&E departments or police cells 1. The Government s Mental Health Crisis Care Concordat, signed by 22 national agencies and government departments who have a stake in the mental health urgent care pathway, sets out the principles and conditions to consistently improve the entire acute mental health pathway, including access to support, advice and assessment services, through prevention and self help, to the role of primary and secondary care in providing a high quality, timely and effective crisis service across the whole system, including importantly criminal justice agencies. The Concordat describes exactly how local commissioners, working with partners, can make sure that people experiencing a mental health crisis get as good a response from an emergency service as people in need of urgent and emergency care for physical health conditions 2. NWL CCGs and their partners across health, social care, the third sector and the police were amongst the first in the country to develop and submit a signed local crisis declaration and action plan. The new model of urgent care and assessment summarised in this paper is an important step forward in delivering the local crisis concordat action plan. 1 Care Quality Commission, Right here Right now, June HM Government, MIND, Mental Health Crisis Concordat, Feb

2 3. North West London Like Minded Mental Health and Wellbeing Strategy NWL Collaboration of CCGs has a significant history of working together to deliver innovation and improvement in mental health. The Like Minded Strategy builds on this success and the lessons learned. People with episodes of severe mental illness tell us they want to be treated as equal partners in their care, that they prefer to be treated in their own home, with seven day care and support for them and their families. They want holistic care that addresses their social, mental and physical health needs. People with serious mental illnesses die up to 20 years earlier as a result of poorer physical health and wellbeing and social outcomes such as employment and housing which are also significantly worse than for the general population. For people who need access to specialist mental health treatments, there is major variation in rates of early identification, timely access to treatment and access to the evidence based treatments that deliver the best outcomes 3. The Like Minded Strategy aims to develop partnerships to prevent mental ill health and promote mental wellbeing for people across North West London. When people have an emerging or existing mental illness we want to ensure earlier intervention and a reduction in the amount of time people spend in hospital through the co-production of integrated care and support in the community which focuses on people s needs and not their diagnosis. It is a major programme of transformation. The urgent care and assessment model has been co-produced by people with lived experience of mental illness, clinicians, social care and the third sector and brings us a significant step closer to ensuring that everyone s mental and physical health is equally valued. It is the first stage of transformation across the whole system of delivery of current mental health services. People with a lived experience of long term mental health problems want the same things from life as everyone else friends, stable housing and a job and the ability to self-manage their illness. 4. Development of the local Urgent Care Model The NWL journey towards achieving better mental health crisis care began in April 2013 with a series of large-scale co-production events involving GPs, service users, carers, secondary health clinicians and managers, local authorities and third sector. This culminated in a clear set of standards for assessment, available to all referrers, 24/7/365, standardised processes and paperwork, a requirement to create a single point of referral and that when a crisis assessment in the community was requested it was provided within these standards. A clinically led Urgent Care Expert Reference Group was established, jointly chaired by the NWL Lead Urgent Care GP, Dr Beverley McDonald, and DCI Daniel Thorpe, Metropolitan Police. The ERG defined a model whole system pathway and agreed the data set to inform a NWL wide demand mapping exercise. This work would inform urgent care business case development by West London Mental Health Trust, to include clear plans to deliver: Implementation of a Single Point of Access to adult mental health services across CCG areas to provide a central point for referrals and assessment; Extension of operational hours in home crisis/urgent assessment and initial crisis resolution service, operating 24 hours per day, 7 days per week, 365 days per year; Achievement of agreed performance trajectories for crisis/emergency, urgent and routine. 3 Carnall Farrar. Mental Health Outcomes NWL. May

3 The 2014/15 contract included a CQUIN which was put in place to support the development of the business case. Following the submission on 26 th June 2014 the NWL Collaborative provided feedback to WLMHT on 23 rd August. They expressed satisfaction with the clinical model and appreciated the transparency relating to skill mix and costs. Concerns were raised regarding the capacity and productivity assumptions, the lack of agreement on how the transformation would be funded and how the redesign would release funds. A revised version of the business case was submitted on 30 th September Detailed feedback to the Trust highlighted the need for further modelling of the efficiencies related to the to be model of care. It was agreed that support in further developing the business case would be provided to WLMHT by Northumberland Tyne and Wear NHS Trust representatives; and this support was commissioned by NWL Strategy and Transformation Team. Ongoing review has been undertaken with the oversight of West London Mental Health Transformation Board, and the Urgent Care Sub-group, co-chaired by the Trust Clinical Director for Urgent Care, Dr Murray Morrison, and Dr Beverley McDonald, NWL Clinical Lead for Urgent Care and GP Mental Health lead for Hammersmith and Fulham CCG. A revised business case was produced and presented to commissioners on 22 nd June 2015 by the Trust. The new model of care is summarised in the diagram below. This is in line with the pathway co-produced with partners across NWL during New Urgent Care Pathway Who? SUTS Assessment Team CRHBT Call Handlers Clinical Experts Hub What? Advice Line Receipt Review Triage Signpost Assessment Allocation Initial Response Initial Full Assessment (MH Act) Rapid Response Nurses Initial Assessment Street Triage Urgent Access Pathway Full Assessment (MH Act) Routine Access Pathway Home Based Treatment Bed Based Provision 24/7 Primary Care Mental Health Treatment Teams eg IAPT, EIP, Recovery Teams etc The table below outlines the key differences between the current model and the future model described above. One element which has been added in the revised business case is the proposal for Street Triage the introduction of a multi-agency street triage team providing an assessment, diversion, liaison and referral service across the three boroughs. The approach suggested is a service in which a mental health nurse accompanies a police officer and paramedic in an allocated vehicle to emergency response with individuals who may be experiencing difficulties with their mental health, learning disability, personality disorder or substance misuse. The team is then able 3

4 to help officers decide on the best options for individuals in crisis, reducing the use of s136 and avoiding inappropriate detentions. This service proposal was discussed at NWL Mental Health Strategic Implementation and Evaluation Board who are proposing to review best practice across the country and recommend a common approach across North West London, in discussion with the Metropolitan Police and other stakeholders. Street Triage is a feature of the longer term plan for Urgent Care services and it is proposed to adopt a phased approach to the redesign of Urgent Care services with further consideration of introducing Street Triage later in 2016/17, if research shows it to be appropriate for West London. Current model Trust defines whether or not the person is in crisis Multiple access points Various access points to service, not all of which operate on 24/7 basis Limited capacity to provide rapid response to crisis out of hours and at weekends Home treatment team only available for patients already known to the service Urgent advice line unable to book or change appointments Onward referral from Assessment Teams can be lengthy or delayed Future model If you say it is a crisis the Trust treat it as a crisis Single point of access which will deal with your call and not tell you to contact a different service. A handshake not a hand off. 24/7/365 Single point of access 24/7/365 response to crisis with the following standards: Emergency < 4hours Urgent < 24 hours Routine plus < 7 days Routine < 28 days Provided by a newly formed Rapid Response Team Home treatment rapid response available to all referrals that require it. Single point of access can book and change appointments Standardised triage and trusted assessments improves continuity of care and access to the right service 5. Local Context Ealing, Hammersmith & Hounslow CCGs invest approximately 84m pa in WLMHT in secondary functional and organic mental health services and also the primary care mental health services. Prevalence of mental health conditions in the three boroughs is estimated at around 105,000 of whom 8940 have a serious and enduring mental illness such as schizophrenia and bi-polar. Over the last year, through wide engagement, we have been laying the foundations for a simplified mental health referral, assessment and treatment pathway for all, covering routine (lower risk) as well as urgent/crisis (higher risk) referrals, for getting the expert advice that GPs need, when and where they need it, and for improving the interface with providers for those already in treatment. 4

5 As is Currently there are multiple points of referral for MH assessment and support: Multiple points of referral and response for Primary Care Mental Health Services (PCMHS) for people with common mental illness (CMI) and complex/stable Serious and Enduring Mental Illness (SEMI) Multiple points for complex/high risk cases to secondary services, depending on the time of day and whether the service user is already on the WLMHT caseload, and varying responses. The secondary referral point and initial response requires redesign into the pathway model and standards set out at 4, above. This engagement has also set out a requirement for absolute clarity on the relationship between the two points of referral and the nature of the services behind each. To Be The plan is to have a single access to Mental Health and Services for those aged 18+ with simpler criteria: Primary Care Mental Health Services: PCMHS linked to GP networks in each borough to work with GPs to support people with common mental illness or stable serious and enduring mental illness Mental Health Urgent Care: Single referral, response and treatment service for complex and higher risk patients who need an intensive or highly specialist service, 24/7/365. The Urgent Care Pathway Business Case is a key step towards realising this To Be vision locally. Agreement to fund this transformation will enable us to take forward local discussion September October 2015 to agree exactly how this model will be implemented. The Vignettes set out in Annex C give some examples of how the service will be different for patients. 6. Benefits realisation This plan provides an outline of the key benefits that we expect to be realised as part of the implementation of the Urgent Access and Care business case. WLMHT are working with Northumberland Tyne and Wear (NTW) to ensure that we establish from the outset the benefits we expect as a result of this change. They are mindful that they need to address the service user/patient expected outcomes as outlined in the Mental Health Crisis Care Concordat and are keen to continue to engage service users/patients in the development and monitoring of the benefits to the new model of care. The table below summarises the anticipated key benefits which would be realised from implementation of the new model of care. Further work to confirm the benefits to be delivered and the timescale for delivery would be undertaken as part of the service mobilisation. Benefit Benefit to patients Expected range of improvement Improved patient outcomes Referrals will be consistently triaged and people will be given consistent advice; and where required be given a timely appointment In 2014/ referrals were accepted from the referrals received across the three boroughs. Acceptance rates ranged from 88-95% With the future model there will be greater consistency in applying thresholds for care 5

6 Benefit Benefit to patients Expected range of improvement and assessment and support from secondary care. All calls to the SPA will be dealt with and patients will not be bounced around the system Improved patient reported outcomes Improved patient assessments Improved continuity of care Improved patient experience Patient reported outcomes are expected to improve for this client population People will have timely specialist assessment that meets new standards Continuity of care will be improved People will be cared for in the least restrictive setting. Improvement in patient experience will be reflected in patient reported outcomes such as the family and friends. Urgent and emergency assessments improve from 60% of people seen in < 4 and 24 hours to over 95% of people seen < 4 and 24 hours. Over 800 more people have timely urgent assessment. Specialist routine assessments could improve from 75% of people seen in < 4 weeks to over 95% of people seen in < 4 weeks. Over 600 more people have timely routine assessment. All routine assessments will take place in primary care as appropriate. There will be no handoff and delay following assessment and initial treatment. Trusted assessments will reduce bureaucracy and delays in accessing treatment. Face to face contact time of staff will be increased from 25% to 50%. Timely face to face assessment for people in crisis will reduce the depth and breadth of the problems that ensue. Reduction in A&E attendance Increased GP Satisfaction Improved Efficiency Reduced Reliance on beds Improved efficient workforce There will be a reduction in people presenting to A&E in mental health crisis Reduced waiting times and increased responsiveness Reduction in DNA rate Re-admission rates Engaged workforce Reduction in A&E attendances for an urgent assessment for around ~ 550 patients will no longer be necessary with savings to the health system. Waiting times throughout the pathway should be minimal if services are operating efficiently. Including waiting times from referral to first assessment and GP notification. The number of DNAs is expected to reduce this will result in reduced duplication and better use of resources leading to improved efficiency Re-admission should reduce as the skills of community teams will be enhanced to keep service users well. Staff survey results are expected to improve Sickness levels will reduce Staff turnover will reduce with a motivated workforce 6

7 Benefit Benefit to patients Expected range of improvement Improved Organisational capacity and capability Optimised staffing levels Use of bank and agency staffing will reduce Vacancy rates will reduce with a motivated workforce and optimal staffing levels maintained. 7. Financial Implications Investment The Trust has identified the need for an additional investment across the three boroughs of 2,193,000 for the Urgent Assessment and Care Model. This investment would enhance and develop the Home Treatment Teams into Rapid Response Teams to provide a 24/7 response to people in crisis within 4/24 hours. The Trust has also provided CCGs with an estimate of the additional costs for Street Triage, should further investigation indicate a willingness to invest in this service. Given confirmation from the commissioners in July/August, the Trust has indicated that the Single Point of Access and Rapid Response Teams would be fully operational from 1 st April The table below outlines the new investment based on share of registered population across Ealing, Hounslow and Hammersmith and Fulham CCGs, showing the Full Year Effect from 2016/17 and the part year costs for 2015/16. By Population Current Service Cost Cost of proposed model Urgent Assessment & Care Model Share of investment registered based on New population registered Investment % shares population shares 2015/16 Share of investment based on registered population shares 2016/17 CCG: '000 '000 '000 '000 '000 H&F 1,676 2, % Hounslow 1,534 2, % Ealing 1,844 2, % sub total 5,054 7,247 2, % 897 2,193 Cost Breakdown The Trust figures below show where the 15/16 figures are derived from and the full year amount. They have indicated that at a high level the implementation plan is to front load where possible around ICT and also infrastructure, with new staff recruitment from Jan Assuming the Trust didn t have issues on recruitment they would assume to be fully staffed and resourced by the end of 2015/16. 7

8 The additional costs of a Street Triage service have been indicated below, although this is not recommended for investment at this time, until further research has been done on the impact of such a service and its appropriateness for West London. Street Triage Current Service Cost Cost of proposed model New Investment registered population % shares Share of investment based on registered population shares CCG: '000 '000 '000 '000 H&F % 85 Hounslow % 118 Ealing % 166 Total for Street Triage Potential Savings The Trust business case does not offer cash releasing savings to the CCGs, nor to the Trust. The driver for the business case is improving the quality and effectiveness of the urgent care pathway and the benefit criteria against which the various options have been tested are as follows, with finance weighted accordingly. Benefit Criteria Weighting Option 3a (Preferred Option) Effective Care 15% 12% Safe Services (including Transitions) 20% 16% Patient Experience (and Carers) 15% 12% Effective Use of Staff 15% 12% Sustainability and Resilience 15% 12% Acceptability 10% 8% Finance 10% 4% 8

9 In the short term, however, further efficiencies would be realised to the health care system as a whole through the implementation of the new pathway in itself. For example, the proposed extension of the operating hours for Crisis Resolution and Home Treatment to 24/7 could have a significant impact on A and E attendances, in addition to reducing the demands upon the current Liaison Psychiatry services based within the acute hospitals. Between 26%and 39% of all work undertaken by LPS in A&E is assessing patients already on the caseload of WLMHT. Eliminating all avoidable duplication of assessment from LPS, as well as internal referral between services, could liberate significant capacity and potentially resource for use elsewhere, and will also represent a better experience for users, carers and clinicians. The development and implementation of the Single Point of Access and Response Teams constitutes the Front End of the wider transformation opportunities that will be achieved through community redesign and rationalising the acute capacity. Better expert tele-triage at this stage will ensure that resources are targeted to greatest areas of need and reduce unnecessary call outs. The Trust is currently running a pilot on police liaison and diversion services with three local police stations in Acton, Hounslow and Hammersmith, aiming to reduce numbers of local people spending time in custody suites and enabling faster mental health assessment and access to treatment where clinically appropriate. Implementation of the proposed Street Triage service would have a positive impact not only for service users but also on the Police and Criminal Justice Services and potentially on AMHP and S12 assessments. 8. Implementation Plan The Trust s Implementation for the Business Case is attached at Annex A. 9. Risk Log: Urgent Access and Care Business Case The Trust has prepared the Risk Log attached at Annex B for the implementation of this business case. 9

10 Annex A Urgent Access and Care Implementation Plan West London Mental Health NHS Trust Urgent Access and Care Implementation Plan SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT Nov DEC JAN FEB MAR APR MAY JUN High level Timeline and Governance Full Business Case re- submitted 30 th SEP 3 CCGs Review Business Case 3 CCGS Governance Review Full Business Case SEP Approval of finance in Business case will determine if proposed re-design can continue Official launch Staff consultation may extend timeline Trust 90 day Staff consultation Staff consultation ends Review and Evaluation Reconfigure Services Demand and Capacity Design Liaison Psychiatry Services (LPS) Trusted Assessment Model to improve access to secondary MH Trains/Shadow LPS staff on HONOS/PBR/CRHT Policy Task and Finish groups to review capacity and Demand across 3 CCGs Acute Trust, GP s for 6 months Identified external modeling support required Trusted Assessment model implemented across all 3 boroughs Mobilization work stream to over see project cycle form Sep 2015 to May 2016 (reconfigure CRHT and Assessment Teams) Start development of Service Specification and policies and procedure's. End JAN Work streams across the Pathways established. Demand and capacity complete Identify suitable estates Identify IT requirements Staff recruitment 3 months implementation Estates and IT in place Single point of Access NWL Urgent Care Access Standards Achieved 3 CCGs to review commission of AMPH and EDT services to develop interfaces with the new model from April 2016 Communication and Engagement Presentation to CCG Urgent Care BC in wider Transformation Context Staff and Stakeholder Engagement for 6 months. This will have an impact on all our services to reconfigure External Communication, Carers/SU/GP s/police/ambulance Launch Transformation HR support with transformation in line with Organization Development Policy Consultation with Local Authority employees in line with their Organizational Development Policy KEY Milestone Key Meetings Task /Activity Task Deadline Dependency Transition Hotspot Key risk to successful Implementation External Dependency Interdependency flow 10

11 Annex A Urgent Access and Care Implementation Plan West London Mental Health NHS Trust Urgent Access and Care Implementation Plan Timescales Action Lead Timescale Business Plan submitted to CCGs WLMHT begin consultation with all Service Users and Staff on proposal Mobilisation of reconfiguration Demand and capacity modelling Staff Recruitment Paul Meechan WLMHT AD Local Services Helene Fager Director WLMHT Communications HR WLMHT Dr Murray Morrison WLMHT Clinical Director Local Services and Sonya Clinch Service Manager Farinaz Mazhari appoint - Specialist Informatics Lead HR WLMHT HR Local Authority August 2015 Staff and Service user - August 2015 Formal Staff WLMHT and LA - September 2015 September 2015 through to April 2016 September 2015 to January 2016 January 2016 for 3 months See Urgent Care Implementation Plan for a more detailed Timeline of key milestones and decision points. Please note any delay in decision or key milestones achieved will alter the timeline of the projects. Official Launch Review and Evaluation Murray Morrison Clinical Director Urgent Care Sonya Clinch Service Manager April 2016 October

12 Annex B Risk Log - Urgent Access and Care Business Case Risk Log: Urgent Access and Care Business Case Risk No RK 1 Risk All parts of the system need to be able to collaborate effectively to ensure that patients can flow through the system; the consequences of poor relationships are likely to result in reduced performance. Likelihood (1-5) Impact (1-5) Score Owner Mitigation Live Y/N? WLMHT Implementation of the new model of care will Y be monitored at local partnership groups and learning will be shared across all CCG areas at the Like Minded Strategic Implementation and Evaluation Board The model of commissioning should be less transactional and focus more on outcomes and challenging providers to develop solutions. There is a Transformation board that meets monthly, where partners across the system meet to continue to discuss these issues. The Board has reformed and now has Executive Director Leadership from the Trust and CCGs. RK 2 There is a need for integrated development of the work streams that will need involvement from GP s and the Local authority the consequences of this is that we develop a SPA that do not meet the Expected or agreed outcomes CCG The GP leads for the CCG have agreed to sign up to a communication plan, in addition they are updated through the transformation board. 12

13 Annex B Risk Log - Urgent Access and Care Business Case Risk No RK 3 RK 4 RK 5 Risk Improving performance requires a whole system approach to patient flow, matching capacity and demand and removing some of the visible and hidden backlogs along the patient system Provider fails to deliver the new model of care effectively There will be a need for the Social Workers employed by the local authority including the AHMPs to work within the new model of for the SPA, there is a risk that the Local Authority may not buy in to the new model of care and withdraw their teams Likelihood (1-5) Impact (1-5) Score Owner Mitigation Live Y/N? WLMHT Implementation of the urgent care model is the Y first step in a wider service redesign of the whole system of care including community services currently managing routine care and specialist services WLMHT The project will be managed as a joint project collaboratively between the CCG and the Trust with issues and delays flagged early and monitored through existing contract monitoring arrangements CCG Local Authority Representatives and Joint Commissioners attend the Transformation board. They will also be a requirement to communicate more broadly with the over view and scrutiny committees across the 3 boroughs so that the impact of the changes is fully understood by council members and their constituents. Y Y 13

14 Annex C Examples of how the new pathway might look for patients Scenario Pathway via new SPA Improvement on current pathway A 25year old male attends a GP surgery at 10am on Monday morning. He is new to the area and states that he is hearing voices. He also appears intoxicated and admits to drinking a litre bottle of vodka prior to attending the appointment. GP can call SPA and speak to clinician or consultant. SPA may request details of last address and how long patient had lived in the area. SPA team staff will then try to find out more information if he was known to services previously. GP makes single call to SPA and provides patient history for SPA assessment team to process referral CRHT undertake assessment and will either manage within CRHT refer to D&A services. Based on the information provided referral will be sent to the appropriate Crisis & Response team who would arrange for assessment to be completed that day GP receives details of assessment and treatment plan via contractually agreed discharge process A request is received from a GP for a Mental Health Act assessment on Wednesday at 11am A 28year old female visits her GP surgery at 10am on Tuesday morning. She has a history of depression and is known to Mental Health services. She is expressing suicidal ideation Referral will be received by SPA If patient not known to services SPA will contact GP for further information/history. AMHP from the Crisis & response team will organize MHAA assessment with staff from the Crisis & Response team and appropriate medical attendance. AMPH will liaise with ambulance/police (as appropriate) if they are required to support an admission. If warrant required the process could be delayed whilst obtaining warrant In-patient bed found and secured if assessment results in admission Ensure bed is available in MHU GP can directly contact SPA team and assessment can be arranged on the day. SPA Team will organize involvement of the appropriate Crisis & Response team. GP is contacted to fully understand the request for MHA. AMPH takes responsibility for coordinating the MHA. GP is not involved with discussions with emergency services. GP does not experience hand offs GP makes single call to SPA and provides patient history for SPA assessment team to process referral Patient assessed and allocated to appropriate team for management of suicidal risk. Once risk is minimised patient will be supported to community and voluntary support services. 14

15 Annex C Examples of how the new pathway might look for patients Scenario Pathway via new SPA Improvement on current pathway A 25year old male attends Accident & Emergency at 3am. He is new to A&E will contact SPA- referral directed to appropriate Crisis & Response Team. Assessment completed within the hour. Pathway from A&E to SPA is straightforward the area and states that he is SPA will ascertain registered GP SPA will identify registered GP and hearing voices If patient requires admission the unit coordinator will need to be contacted from the Mental health unit and bed secured. arrange assessment. If admission required and patient in If patient is not from the area then the Unit coordinator will need to discuss transfer with bed manager from where patient is from. The transfer of this patient could take up to several hours especially as it is 3 am and we would not have transport available on site either even if out of area agreed to accept. If patient is deemed appropriate for admission but not from local area and remains in A&E for longer than 4 hours then we will admit to local bed as per policy. area admission takes place. If patient from out of area, the team will liaise with responsible area and arrange transfer ( if safe to transfer, if not the patient will be kept within local MH services until it is safe to transfer ) Patient assessed and treated, risk of If patient does not require admission then treatment plan can be made at point of assessment. harm to self and others managed. Referral on to appropriate service can be made from there. Timescale for admission should be from 1-2 hours, patient only experiencing one assessment. Only delay maybe if patient was A request is received from a GP for a Mental Health Act assessment on Saturday at 3pm not from the area. If referral is received on the Saturday this will be received into the SPA. SPA, will the send referral to appropriate Crisis & Response Team. The AMHP in Crisis & response team will organize relevant services including section 12 doctors, police and ambulance. Admission arranged if appropriate Timescale for assessment should only be 1-2 hours. SPA accept referral and refer to CRHT for MHA AMPH co-ordinates MHA Patient admitted if MHA deems appropriate 15

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