Bedfordshire and Luton Mental Health Street Triage Operational Policy 1
1. Introduction Mental Health Street Triage (MHST) is a collaborative service between mental health professionals (MHPs) paramedics and police officers. It is governed by the Bedfordshire Mental Health Crisis Care Concordat for better outcomes for people in mental health crisis. The MHST team will work together to ensure that the most appropriate outcome is achieved for people experiencing mental health crisis. They will do this by assessing the individual and offering professional advice on the spot, accessing relevant health information, and liaising with other services to identify the most appropriate pathway to best support the individual. MHST is a county-wide service. Bedfordshire is a small county covered by three unitary authorities: Bedford Borough, Central Bedfordshire, and Luton Borough. There are two NHS Clinical Commissioning Groups responsible for Luton and Bedfordshire and the county benefits from two main Hospitals at Bedford and Luton, each having a Section 136 Suite and dedicated mental health wards. East London Foundation Trust (ELFT) provides our county-wide mental health services. East of England Ambulance Service Trust (EEAST) provides the ambulance response for the county and is also responsible for the entire eastern region. Bedfordshire Police is responsible for county-wide policing services and have two Custody Suites based at Luton and Kempston. MHST has been funded for a 12 month pilot period and will run from May 2016 to April 2017 and will be subject to an evaluation which will inform decisions about future sustainable funding. The pilot has been funded by Luton and Bedfordshire CCGs, EEAST, Bedfordshire Police and Bedfordshire Police and Crime Commissioner. Effective partnership working identifies key areas where information sharing and openness between the organisations involved needs to clarified regarding actions and expectations that will placed upon the partner organisations. The primacy for the lead organisation should be the following, Physical Health EEAST Mental Health ELFT Criminal BP It should be noted that although primacy identifies the lead organisation, the concept of partnership and shared working should support the ethos of openness, transparency across the organisations involved in the MHST pilot. The lead person identified below from the each organisation should be the initial point of contact should a untoward incident, patient safety, dangerous occurrence, complaint, or serious incident be identified by one or all of the organisations undertaking the MHST pilot. Bedfordshire Police Chief Inspector Jaki Whittred Mental Health and Public Protection Bedfordshire Police HQ, Woburn Road, Kempston, MK43 9AX Email: jacqueline.whittred@bedfordshire.pnn.police.uk East London Foundation NHS Trust Gail Dearing Associate Director of Social Care Charter House Alma Street 3 rd Floor Luton Bedfordshire LU1 2PJ 2
Email: gail.dearing@elft.nhs.uk East of England Ambulance Service NHS Trust Tracy Nicholls Head of Clinical Quality Bedford Locality Office Hammond Road Bedford Bedfordshire MK41 0RG Tracy.Nicholls@eastamb.nhs.uk 2. Aims and objectives of the pilot The aim of the pilot is to test the effectiveness of MHST in improving the response, the patient experience and the outcomes when responding to mental health crisis calls for assistance. The specific objectives of the pilot are as follows: Improve the experience and outcomes for people in mental health crisis Research and provide information and data on the full picture of mental health related incidents within the pilot area Reduce the number of detentions under S136 by identifying suitable, appropriate, less restrictive alternatives Reduce the amount of time emergency services are spending managing mental health situations in public or private locations Reduce inappropriate admissions to Emergency Departments Improve training, awareness, confidence and joint working relationships between professionals involved in mental health crisis service Improve efficiency across the police, ambulance, local authority and NHS providers Inform future commissioning including healthcare in custody, provision of health based places of safety and transportation for persons experiencing mental ill health This pilot has been designed to safeguard vulnerable people experiencing mental health crisis and to provide the most appropriate service according to individual needs. By working in partnership and having the right professionals working together at the point of triage and decision making, we will be better able to deliver the right outcome for the individual. 3. Service definition MHST functions with MHPs, paramedics and police officers working together 7 days per week between the hours of 1500 to 0100. This coverage has been determined from mental health crisis demand data evidencing that this is the peak period for mental health crisis demand in Bedfordshire. The MHST team may deploy to any mental health crisis incident within Bedfordshire and Luton and will also provide advice by telephone to professionals in the county who are presented with an incident involving a person experiencing a mental health crisis. It is intended that this will particularly benefit police officers, ambulance service personnel and Approved Mental Health Professionals (AMHPs) that require support or advice from the MHST team. It is the responsibility of ELFT, EEAST and Bedfordshire Police to ensure that they provide appropriately trained professionals to resource MHST during the core operating periods and throughout the duration of the pilot. This includes provisions for covering periods of annual leave and short notice abstractions due to illness. MHST will work together as a team and will deploy to incidents together. It is vital that they have access to a vehicle capable of responding to an immediate incident and the appropriately qualified drivers to respond safely. 3
Outside the hours of 15.00-01.00 the response to a mental health crisis will follow the usual processes as determined by local policy and procedure. This will ensure that we continue to respond to people experiencing a mental health crisis during the hours when MHST is not in operation. 4. Philosophy of care The MHST team will work in partnership to provide mental health triage and advice in order to best support people in mental health crisis. MHST seeks to provide an inclusive service to ensure that people who come into contact with emergency services, and are considered to be experiencing mental ill health, receive a high quality, professional and effective range of appropriate interventions. The service delivery will include liaison, prevention and ultimately if needed, equitable access to mental health services across the Trust. MHST service aims to reduce the unnecessary use of Section 136 detentions and inappropriate referrals to EDs by working in a flexible, mobile and timely manner with all agencies in the locality. They will also make appropriate referrals into other services to ensure that the right level of care, support and intervention is accessed and received. 5. Service values The service will provide a rapid response to meeting the mental health needs of people who present or come to the attention of emergency services. Each person will be treated as a unique individual with dignity and respect, whilst promoting a non-discriminatory service to all. The service will ensure that the care provided will be culturally sensitive and recognition of those cultural differences will not exclude anyone from the service. Each partner organisation forming MHST are committed and accountable to their own robust ethical standards and MHST will work together to uphold these high standards. 6. Referral criteria The service will be open to anyone in Bedfordshire and Luton coming into contact with police (usually outside of custody) and ambulance and who are considered to be suffering from a mental disorder and in need of crisis intervention. Incidents that are assessed as high priority, requiring an immediate response, will be prioritised by the team. The MHST team will be a valuable source of advice and this is a key role of the service. If the police, paramedics and AMHPs have concerns about the mental health of an individual, they can access advice and guidance from the team via their dedicated mobile telephone number or by contacting their email address. The type of advice professionals may request from the MHST will be varied and will be assessed on a case by case basis. However, this could include advice and support regarding a repeat victim of crime or anti-social behaviour, about a vulnerable adult, about a repeat caller, or about supporting a S135 warrant execution. The key factor will be that the person you are seeking advice about is believed to have a mental health issue which may be at the root of the situation. 7. Referral process MHST professionals will book on and off duty by telephoning Bedfordshire Police Force Control Room on 2218 (internal police extension) or police officers will book on and off duty via STORM using call signs PN20 or PN21. The call sign for the MHST Sergeant is PN10 and it is the responsibility of the sergeant to book on and off duty. The police and ambulance control rooms will be able to contact MHST on the dedicated mobile telephone number 07867527714 to request support and deployment. Contact can also be made from control rooms via police and paramedic radio call-signs. The team can also be contacted via their dedicated email address: MentalHealthTriageTeam@Bedfordshire.pnn.Police.uk 4
It should be acknowledged that the MHST team can be deployed by both police and ambulance control rooms. It will be the responsibility of the police officer and paramedic to ensure that their respective control rooms are informed of deployments from partner control rooms. This includes responsibility for updating their respective control rooms on arrival and on resuming. MHST will be expected to proactively monitor incoming incidents and to self-deploy. It will be their responsibility to update the respective control rooms. However, it is also the responsibility of the force control room to bring relevant incidents to the attention of MHST, recognising that they will not be able to monitor all incoming incidents. There will be occasions when numerous deployable incidents occur simultaneously. On such occasions the MHST team will advise on which incident they will deploy to, depending on where they believe they can have most impact. In such circumstances it will be the responsibility of the relevant control room to ensure that all outstanding mental health incidents are resourced by appropriately qualified professionals as per policy. MHST will not be deployable to any other, non-mental health incident except in exceptional emergency situations. This might include MHST being in the close vicinity of a report of a cardiac arrest or a crime in action. These incidents must be risk assessed on a case by case basis prior to deployment to ensure that partners are not put at risk as a result of the deployment. Partners will be expected to take a mature and collaborative approach to MHST deployments, recognising that we do not have authority to direct each other s resources. 8. Triage Process On deployment to an incident (including the provision of telephone advice) the professionals are expected to research their respective information systems to access relevant information about the subject. It is expected that the MHP will check RiO and ELFT electronic patient record keeping system, to gain a better understanding of relevant health history. The paramedic and police officer will also be expected to research any relevant known history of the subject to enable the MHST team to assess whether the person is known to services or poses a risk of harm to themselves or others. MHST are empowered to share information about individuals as per the Information Sharing Agreements between EEAST, ELFT and Bedfordshire Police. If the need for a face-to-face triage assessment is identified the MHST will aim to arrive in accordance with the emergency service response times. It is acknowledged that there may be times when attending the incident within the required time frame cannot be met. This could be because the team are deployed to another incident or the team are situated at the opposite end of the county. It is vital that other emergency response resources are deployed if an immediate response is required and the MHST are unable to respond in an immediate capacity. Before the MHST are deployed a risk assessment must be carried out to ensure that it is safe for the team to engage. This will be particularly relevant for the paramedics and the MHPs who will not have access to personal protective equipment or the level of control and restraint training as the police officers. 9. Triage assessment and referral On arrival and providing it is safe to do so, the paramedic will assess and treat any medical injury or condition that requires prioritisation. The paramedic will also inform decision making regarding the necessity to obtain further medical attention or treatment, including the need to transfer the patient to hospital. The paramedic will be required to complete and file treatment notes, according to EEAST policy. 5
Providing it is safe and appropriate to do so, the MHP will carry out a mental health triage assessment and will provide referral recommendations based on that assessment. The MHP will be required to complete and file assessment notes according to ELFT policy. The police officer will be part of the triage team and will be particularly concerned with the management of the safety of the individual, the safety of any other members of public present and the safety of the professionals involved. They will also be responsible for enacting their powers under the Mental Health Act and any other relevant police powers, if this is a necessary and proportionate response to the triage assessment. The police officer will be required to complete and file records of action taken according to Bedfordshire Police policy. There will be a wide range of potential outcomes to the triage assessment and it will be for the team to consider and decide the most appropriate outcome in each individual circumstance. The potential outcomes range from no further action to a detention under S136 MHA or immediate transfer to an Emergency Department for a medical emergency. In deciding the most appropriate outcome it is vital that the MHST team consider the risk presented to or by the individual and then the most appropriate referral to best support the individual according to their needs. The MHST team will require excellent knowledge of and access to existing referral pathways to enable them to provide the most effective support possible, which will minimise the likelihood of future mental health crisis presentations. Any decisions and action taken must be legal and proportionate and should comply with guidance under the Mental Health Codes of Practice. The following is a non-exhaustive list of potential referral pathways for MHST outcomes; Child & Adolescent Mental Health Services (CAMHS) Early Intervention Team Crisis Resolution and Home Treatment Team (CRHT) Adult and Older Adult Mental Health Teams (AMHTs and OAMHTs) GP Samaritans Mind CHUMS Improving Access to Psychological Therapies (IAPT) Court Liaison and Diversion Team (CLDT) Drug and Alcohol Services S136 Detention Voluntary attendance to hospital Learning Disability Intensive Support Team If transport is required the MHST team can convey people in their vehicle provided it is safe to do so. The decision to do so should be jointly agreed by the MHST professionals. If an ambulance has been requested and is unavailable within a reasonable time this must be documented. Conveyance in a police vehicle should only be carried out in exceptional circumstances and as a result of an increased level of risk presented by the individual or if the waiting time for an ambulance is likely to exacerbate the condition of the individual. When conveying in a police vehicle, the MHP or paramedic should also travel in the vehicle, providing the level of risk to that professional can be managed. Police conveyance is to be avoided in order to reduce mental health stigma and an escalation of distress to the individual, while also recognising that a police vehicle is unlikely to be appropriately medically equipped if a deterioration of physical health occurs. The continuous management of risk is integral to good service delivery. Assessment of all presenting risks should be documented and any identified concerns communicated to all relevant parties as an 6
on-going process. Staff will consider their personal safety and the safety of their colleagues through effective communication, multi-agency liaison and by adhering to the Trust s Lone Working Policy. Consent to share relevant personal information with professionals will be sought from the person being assessed (if practicable to do so) and documented accordingly. Information will only be shared without consent if the MHST team consider it is in the best interest of the client or public to do so. Information Sharing Agreements have been agreed between EEAST, ELFT and Bedfordshire Police. Incidents will only be deemed as complete and discharged once the MHST Monitoring Form has been completed and submitted, appropriate updates have been entered on RiO (and any other relevant systems) and the police and / or ambulance control room has been updated with the outcome. Furthermore, professionals must ensure that all necessary action has been taken to safeguard people that they come into contact with, including children that may be at risk, and that safeguarding referrals are submitted as necessary. 10. Supervision The on-call clinical lead will be expected to provide advice and support to the MHP when required. Clinical and managerial supervision for the MHPs will be undertaken according to ELFT policy and carried out by an ELFT manager. The police and ambulance professionals will be supported by their respective command structure which operates 24/7. The MHST operational manager (police sergeant) will ensure that the team are operationally supported and that any risks and issues are identified and solutions sought. 11. Monitoring and evaluation This pilot is governed by the Bedfordshire Mental Health Senior Officer Group. The MHST Steering Group will meet on a monthly basis in order to consider performance and to seek solutions to any barriers. It is therefore compulsory for the MHST team to complete the MHST monitoring forms for every incident attended or advised upon. This data will be collated by a Bedfordshire Police analyst for presentation to the monthly steering group. Bedfordshire and Luton CCGs will also support the collation of relevant data from the hospitals, particularly referring to ED admissions, while EEAST will provide data regarding ambulance attendance, and ELFT will provide data regarding MHA assessments and detentions. ELFT will also manage the collation and evaluation of feedback from the people triaged by the MHST team to ensure that we consider the impact on the patient. This information will be used to present a business case in Quarter 3, seeking sustainable funding for the future of MHST in Bedfordshire. 7