The Committee also requested an update on progress around chaplaincy services within Bradford District Care NHS Foundation Trust.

Report of the Bradford District Care NHS Foundation Trust and the Interim Strategic Director, Adult and Community Services to the meeting of the Health and Social Care Overview & Scrutiny Committee to be held on 4 ruary AK Subject: Update Report: First Response Service, Crisis Care Concordat, Improving Access to Psychological Therapies (IAPT) Community Mental Heath Teams (CMHT) Chaplaincy Summary statement: At its meeting of 5 ruary the Health and Social Care Overview and Scrutiny Committee requested an update report on the Mental Health crisis care concordat, mental health First Response service, Improved Access to Psychological Services and Community Mental Health services. The Committee also requested an update on progress around chaplaincy services within Bradford District Care NHS Foundation Trust. The report has been written by Bradford District Care NHS Foundation Trust and Bradford Council Mental Health services and will be presented by them jointly. Nicola Lees Deputy Chief Executive Bradford District Care NHS FT Portfolio: Health and Social Care Bernard Lanigan Interim Strategic Director Adult and Community Services Report Contacts: Mark Trewin / Debra Gilderdale Phone: (01274) 431526 / 228300 E-mail: mark.trewin@bradford.gov.uk / debra.gilderdale@bdct.nhs.uk

Report to the Health and Social Care Overview & Scrutiny Committee Glossary of terms used in the report: MHA Mental Health Act 1983 A and E Accident and Emergency Department CMHT Community Mental Health Team IAPT Improved Access to Psychological Therapies CCC Crisis Care Concordat VCS Voluntary & Community Sector MIND The mental health charity DoH Department of Health Bradford District Care NHS Foundation Trust S136 An order of the mental health act used by police YAS Yorkshire Ambulance Service

Report to the Health and Social Care Overview & Scrutiny Committee 1. Summary At its meeting of 5 ruary the Health and Social Care Overview and Scrutiny Committee requested an update report on the Mental Health crisis care concordat, mental health First Response service, Improved Access to Psychological Services and Community Mental Health services. The Committee also requested an update on progress around chaplaincy services within Bradford District Care NHS Foundation Trust. The report has been written by Bradford District Care NHS Foundation Trust and Bradford Council Mental Health services and will be presented by them jointly. 2. Background Bradford District Care Trust has been serving people with mental health problems and adults with learning disabilities across urban and rural Bradford, Airedale, Wharfedale and Craven since April 2002. On 1 April 2011, the majority of Bradford and Airedale s Community health services transferred to the Trust as part of the national Transforming Community Services initiative. In 2014/, the Trust s income will be over 130m. The Trust employs 2,800 staff who provide a range of urgent and non-urgent inpatient, Community and social care services from over 50 sites. The Trust has an overall rating of good from the Care Quality Commission. The Trust operates mental health services in partnership with Bradford Council and the services are integrated together. 3. Report issues The Crisis Care Concordat Bradford and Airedale The Crisis Care Concordat (CCC) was launched in 2014 by Norman Lamb, Minister of State for Care and Support, following a declaration by a number of national agencies to work together to improve crisis services for people with a mental health problem. The main targets for the CCC are: Commissioning to provide more effective and responsive crisis services Access to earlier intervention support and planning to avoid crisis Urgent and emergency access to services when required Good quality treatment and care when a person is in crisis Services to support recovery and staying well A better quality of response for people detained under s136 MHA 1983 No young people under 18 held in police cells A major reduction in the number of adults held in police cells Parity of esteem between physical and mental health (This refers to the idea that mental health should be given the same importance as physical health issues) Bradford and Airedale have been operating a very successful CCC implementation group throughout. This is a multi-agency meeting including all local NHS partners, the Local Authority Adult and Children s services, Public Health, the Police, VCS partners, all local s, Yorkshire Ambulance, Housing, Drug and Alcohol services and Criminal Justice. In our Report to the Health and Social Care Overview and Scrutiny Committee in early we identified that we would develop a whole systems approach to achieve the following aims in our local action plan, which was updated in October : 2

Report to the Health and Social Care Overview & Scrutiny Committee Improve the response to people experiencing mental health crisis, especially out of hours Reduced delays to Mental Health Act assessments, especially out of hours and in A and E. Improve the health based place of safety, especially out of hours Reduce the number of people being held in the police cells as a place of safety, especially children Divert people from police custody, A and E or the use of the mental health act, especially out of hours Reduce the number of people detained under s136 of the MHA 1983 Bradford CCC partnership is a successful transformation project. It has been widely praised for the developments and joint working achieved. Bradford has been identified as a good practice site by National MIND. We have been identified as a site of good practice for Crisis services and health and social care integration by the Minister for Health and Social Care, the chief Social Worker, the NHS Clinical Lead for Mental Health and the DoH lead for Social Care and Partnerships. We have been visited by many other agencies and areas from around the country. We have been asked to speak to the national Crisis Care Concordat conference and Health and Care conference. Acute Care Mental Health We have reorganised the Bradford mental health services dedicated to people presenting in mental health crisis. The service operates a stepped approach to care, providing the least restrictive treatment required. Operated by Bradford District Care Foundation Trust () and delivered in partnership with Bradford Council Adult Services Department, our support for people in crisis is designed and delivered as part of the multi-agency Crisis Care Concordat Implementation group ( 2014). is working with local partners to develop a modern evidence based crisis model for mental health that provides easy access 24/7. Health and social care mental health services intervene earlier to prevent escalation and direct people to a broad range of appropriate provision; including social, private and third sector. First Response First Response Service (FRS) is the gateway to urgent mental health and social services. People self-refer via telephone and are asked about their needs and risk by a psychological therapist (tele-coach). Callers are provided with brief and immediate support to manage their crisis. Tele coach staff also provide support and advice to other agencies, in particular GPs and Police. The First Response helpline has made a significant difference to management of crisis care, in particular for police officers. They report feeling supported to make informed decisions involving mental health crisis. In particular, the sharing of accountability where there is apparent risk of harm to self/others. This has enabled police officers to make decisions that are effective in the overall treatment plan of an individual. For some people in regular contact with mental health services, a consistent approach to crisis between agencies can help reduce negative patterns and aid to recovery. Availability of a telecoach also allows a police officer at the scene to access advice in real time. The Police 3

Report to the Health and Social Care Overview & Scrutiny Committee as a result resort much less frequently to using their powers under 136 and the person in crisis gets speedy, appropriate help. For those people at greatest risk and in need of more intensive support, the First Response service provides face-to-face mental health assessment with a First Responder. First Responders are nurses, social workers and advanced nurse practitioners (nurses that can prescribe medication). They visit the person in crisis wherever they are situated including A&E departments, police stations and GP surgeries; they aim to be with a person within 1 hour of their call. This is our local model of Street Triage; it s timely, responsive and ensures people are signposted correctly at the beginning of their crisis pathway. First Responders also support the Police and Ambulance services when making decisions about applying the Mental Health Act. People are sign posted to the most appropriate and least restrictive support; including health, social care and third sector provision. This approach and re-organisation has been operational for a 12 month period and had impacted significantly in a number of areas, we have relied for a number of years on Out of Area beds, through this transformation for 11 months we have not required any out of area beds for people with acute care in patient s needs and have successfully cared and treated people locally. We have seen a reduction in people presenting in A&E across Bradford and Airedale, reduction in people in crisis being held in custody suites and being supported faster in the community. There have been 53,500 calls into the First Response Service since ruary 2014. The has been national recognition for the achievements of the First Response service, and have recently being awarded the prestigious Nursing Times Award. First Response is also the route into The Sanctuary, which is run by Mind in Bradford as a safe haven from 6pm to 1am, easing pressure on A&E. Operated by MIND in Bradford, (the mental health charity) works in partnership with the First Response Service. The Sanctuary offers a safe place for people in crisis 7 days per week between 6pm and 1am. First Responders provide a gate keeping function to ensure that places are used effectively, as an alternative to admission. They can provide specialist support if needed. The Sanctuary provides a calm, safe space for adults experiencing acute mental distress. It provides practical and emotional support and may be used as an alternative to admission to statutory services if appropriate. The Local Authority supports Sanctuary staff with housing and other support if needed - but most people return to their home. The Sanctuary accepts: People experiencing anxiety/panic attacks Those with suicidal thoughts who don t feel safe but don t want to end their lives Those who have self-harmed but don t require medical attention Those who are disassociating (but not psychotic or on drugs) Those who are intensely depressed People hearing voices who know that the voices are not real Those experiencing Post Traumatic Stress Disorder (PTSD) People at a point where they feel they can t cope 4

Report to the Health and Social Care Overview & Scrutiny Committee Police Hub (Control Room) Additional as part of the First Response service mental health workers are embedded within the police control room. West Yorkshire Police, and CBMDC have developed a joint information sharing protocol allowing staff to make better informed decisions. Mental health professionals have electronic access to RIO health record and are easily able to identify where mental health may be a factor as incidents arise. Our intention is to extend this provision to 24/7 in partnership with our colleagues at Bradford Council and the Police and Crime Commissioner. We have also reorganised our criminal justice diversion services to be part of the wider service to the police and to increase the number of people being diverted from the police station. We are redeveloping our Appropriate Adult service so that vulnerable people in police custody are given the support they need under the Police and Criminal Evidence Act. IAPT Aire Wharfe Craven, Bradford City, Bradford District s and are working around the redesign of the IAPT Services, during, significant engagement work took place with the three s and local VCS to develop the model: Bring all psychological therapy providers under one umbrella o Lead provider with niche providers supporting & flexing services as required by need & demand o Niche providers retain unique offer but within consistent & controlled environment o One system for recording treatment / support & outcomes Clinically led pathway & provider dictated by what s in the best interests of the client Multi-access points but primarily through One Call & GP referral Consistent training & communication Dedicated resource to manage quality of delivery & effective communication Dedicated resource for hard to reach groups The Bradford Improving Access to Psychological Therapies (IAPT) Service is delivered across the district through four discreet teams with staffing of 105.45 whole time equivalent, 117 head count. The service operates a stepped care model, covering low intensity therapy, appropriate for people with mild anxiety and depression; high intensity therapy, appropriate for people with moderate anxiety and depression. The service operates to nationally mandated KPI s, the most significant being numbers entering therapy, recovery rate and waiting times. 5

Report to the Health and Social Care Overview & Scrutiny Committee Standard referral process is via GP either electronically or by fax. Around 1000 routine referrals per month are received and processed by triage staff within the First Response Service. Since January the IAPT service has introduced self-referral via telephone, in line with national guidance. An increasing number of referrals are being received via this route, currently around 300 per month. Community Mental Health Services There are four community mental health teams that are aligned with the and council localities. In addition there is an early intervention service that is co-located within the CMHTs and CMHT staff operate the Assertive Outreach team function. The teams are based within Bradford Care NHS Foundation Trust and are operated by the Trust. All of these teams are multi-disciplinary and jointly staffed and managed by and Bradford Council. They include Community Psychiatric Nurses, Mental Health Social Workers, Consultant Psychiatrists, Therapists and Clinical Psychologists, Support workers, Service User Development Workers and Occupational Therapists. We have a partnership agreement and a joint operational policy agreed across and the Council. Each CMHT has a Social Care and NHS manager and there is an NHS and service manager overseeing the teams. The teams work to the Care Programme Approach guidance on assessment, reviewing and care planning and also deliver the Care Act responsibility of the Council for people with a mental health issue. CMHTs work to a recovery and prevention model and they also work very closely with the Crisis Service and Acute Care services. We are currently reviewing the service to strengthen the recovery and early intervention aspect of their work. Summary of MH crisis Improvements achieved across agencies in : 1. Establishment of multi-agency 24 hr First Response Team 2. Zero out of area beds required for people with acute in patient needs 3. Redesign of multi-disciplinary intensive Home Treatment team and A and E Liaison team 4. Integration of Approved Mental Health professionals and improved relationship with Emergency Duty Team & First Response 5. Employment of Housing Worker to aid discharge from hospital 6. Establishment of The Sanctuary project within Mind in Bradford 7. Establishment of Criminal Justice Liaison service in the police cells and development of joint working across Criminal Justice agencies 8. Establishment of the Police Hub project within Trafalgar House to improve support for vulnerable people 9. Improved relationship and joint working with the police 10. Reduction in number of MH service users held in cells 11. No children held in cells 12. Reduction in the number of S136 detentions 13. No out of area or private sector acute inpatient placements since March 14. Reduction in the number of MH service users going to A and E. Reduction in A and E breaches and need for MHA assessments in A and E 15. Support for Frequent Attendees to the police, MH and A and E. 16. Increased number of physical health checks within CMHT 6

Report to the Health and Social Care Overview & Scrutiny Committee Summary of the next stage of developments in : 1. Development of the Mental Health Urgent Care Vanguard within the Crisis Care Concordat 2. Development of Children & Young Peoples crisis pathway and safe space 3. Development of a 24hr A and E liaison service and community Safe Space for people with MH problems 4. Development of a Suicide Prevention and reduction project 5. Development of a 24 hr AMHP service within First Response 6. Development of recovery based prevention and early intervention in Community Mental Health teams 7. Development of improved conveyance systems with YAS. 8. Development of a place of safety for people under the influence of alcohol. 9. Development of crisis planning and advanced statements. 10. Development of parity of esteem with physical health What do we still need to get right? 1. Some young people are still being sent away from home for treatment 2. Pressure for female acute beds 3. There is sometimes still a delay when an out of hours MHA assessment is required in the acute hospital 4. The number of detentions under the MHA is less but still increasing partly due to the effects of the Cheshire West judgement on deprivation 5. Pressures on CMHTs 6. Multi-agency approach to suicide reduction Chaplaincy decided to conduct a review of its Chaplaincy provision to look at addressing the gap that exists in this provision. The review has been undertaken by Operations and Equalities and Diversity jointly. As part of the review the contact was made with other trusts to see the type of models these trusts had, as well as looking at local and national guidance around spiritual and pastoral care. Previous reviews conducted highlighted similar issues to what was being noticed which was: Gaps in spiritual & pastoral care across Lynfield Mount Hospital & Airedale Centre for Mental Health The need to use information have around people s faith needs and look to provide support and provision around this Lack of clear leadership around Chaplaincy services No partnership working Spiritual & Pastoral care not used as part of the overall recovery plan for patients. No training for staff around patients spiritual & pastoral needs 7

Report to the Health and Social Care Overview & Scrutiny Committee The proposal that has been presented to Executive Management team is to bring a model where a Chaplaincy Liaison Officer who would be employed to bridge the gaps in service provision as highlighted above. 4. Options Not applicable. 5. Contribution to corporate priorities The Council is a signatory to the MIND Mental Health Challenge for Local Authorities. These developments help us meet some of the responsibilities of this agreement. 6. Recommendations That the Health and Social Care Overview and Scrutiny Committee: i) Notes the reported position for: - Crisis Care Concordat - First Response Service - IAPT - CMHT - Chaplaincy Service ii) Notes the extent and scale of the partnership and integrated working 7. Background documents None 8. Not for publication documents None 9. Appendices 9.1 Crisis Care Concordat Action Plan 8

Crisis Care Concordat Action Plan October 30th Crisis Care Concordat Multi Agency Action Plan for Bradford, Airedale & Craven Version 2: Updated October 30 th This document is the overarching Crisis Care Concordat Action Plan designed to provide a framework for the improvement and development of mental health services for people in crisis in our area in -16. This action plan outlines the operational and commissioning priorities that have been recommended by the Crisis Care Concordat working group. This plan identifies "the actions required of commissioners and providers to ensure that those experiencing mental health crisis are properly supported" (NHS forward plan -16). 1

Crisis Care Concordat Action Plan October 30th This action plan has been developed by the Crisis Care Concordat working group: 2

Crisis Care Concordat Action Plan October 30th Our joint commitment to improve Crisis Response Services in Bradford, Airedale and Craven: We agree to work together across Bradford and Airedale and Craven (and, where our boundaries or services overlap, with our partners in North Yorkshire, Lancashire, Kirklees and Leeds) to improve the access to services, response from services, care and support of people experiencing a mental health crisis. We will work together to prevent crisis through effective crisis planning and early intervention. We will explore how we can commission mental health services to be based on recovery, wellbeing and resilience. We will jointly commission and design services so that they are well planned and appropriate to the needs of our population, with appropriate alternatives to acute or emergency care available when needed. We will provide consistent, timely and appropriate support regardless of the agency that comes into contact with the person in crisis and whatever time of the day or night they require our support. We will work, plan and reflect together so that people in crisis receive an integrated, seamless service without organisational boundaries and difficulties getting in the way. We will develop a multi agency crisis care pathway that links all of the agencies that are signatories to this document 3

Crisis Care Concordat Action Plan October 30th We will ensure that young people under 18 never have to go into police custody and we will work to ensure that vulnerable adults are only detained in custody when absolutely necessary We will work to achieve parity of esteem between the physical and mental health needs of our service users and that they will have access to the NHS and social care services that they require Note: Bradford and Airedale has adopted an integrated whole systems approach in which CCC developments are linked and developed together across all organisations who are part of this implementation group. All RAG assessments are as of October 30 th. Areas are rated Green when the CCC group feels that the original outcomes and priorities have been largely met. Further developments in these areas may be highlighted elsewhere in the action plan. 1. Commissioning and development to ensure earlier intervention and more responsive crisis services No. Recommendation and required outcome Action needed to achieve this Commissioning Priorities - Matching local need with a suitable range of Services 1 Development of the Crisis Care Set up CCC multi agency implementation working group that answers Concordat to the Health and Well being Board Develop and sign up to the West Yorkshire CCC Declaration Lead Agency CCC Working Group RAG 10/15 Sept 2014 Dec 2014 Develop commissioning priorities to improve crisis care Develop and sign up to the CCC Action plan that identifies how these priorities will be achieved (reviewed Oct ) Link to the UEC Vanguard bid and develop a governance sub group that reviews how these action plans are being developed Mar Mar Oct 4

Crisis Care Concordat Action Plan October 30th Jan 2 Develop Commissioning Arrangements to achieve aims of the CCC To develop a joint, integrated commissioning plan for -17 based on a renewed local needs assessment. Decisions about the development and implementation of crisis care, recovery and community services can be prioritised and Jointly commissioned across all relevant agencies. Be clear about all of the money coming in to the local or for crisis care, Urgent Emergency Care Vanguard, local places of safety; Children and YP Mental Health etc. All relevant commissioning plans to be linked to this Action Plan, The CCC National Actions progress plan, NHS 5 Year Plan for mental health and the Local Health and Wellbeing board and Integrated Commissioning plans. UEC GROUP CCC working group Jan Jan Commissioning guidance to be developed with the following considered: Commissioning jointly with partners such as NHS,, Police and Housing Children and young people s crisis recovery pathway Developing visionary thinking on crisis care and recovery Commissioning for positive and proactive care to reduce restrictive interventions Commissioning for effective integration of recovery into primary care Exploring new and innovative services for early intervention before crisis Developing and looking after the workforce to prevent burnout Population-based preventive approaches such as embedding parenting skills training in schools. Jan 3 Ensure commissioned services are subject to equality impact assessments and meet all Equality Implement MIND guidance on commissioning BME crisis services Consult and engage with BME groups through Sharing Voices and other BME providers when commissioning and developing services CCC working group led by sharing Mar 5

Crisis Care Concordat Action Plan October 30th Act principles To deliver to specific crisis planning pathways for BME communities and other groups such as LGBT communities 4 Develop joint arrangements with North Yorkshire Ensure staff delivering crisis care take BME, cultural, spiritual and faith based needs into account Empower people from BME and other groups by providing appropriate information, access to advocacy and community development services Explore the development and strengthening of specific services for BME communities and link CCC to wider community Research impact and outcome of crisis on BME individuals and families Develop culturally competent crisis plans and services for all vulnerable groups Ensure inclusion of gender and LGBT based perspectives to crisis care Attend NY CCC partnership and MH development forums Invite NY & Craven police and MH colleagues to attend local CCC working group Voices and the BME staff group Police CCC group Jan Oct 5 Commission research into the needs of MH service users in crisis This is ongoing but Reason for and outcome of s136 interventions Reason for and outcome of A & E presentation The needs of MH service users in Police custody The needs of people assessed under the MHA 1983 Feed back from Advocacy and user development/support groups MH Crisis support and intervention requirements of each different community and ethnic groups and appropriate data collection 6 Safeguarding for people in crisis Link the CCC action plan to the Children and Adult Safeguarding boards 7 Build links and good practice across CCCs, health and social care systems in our region Apply for the regional Urgent Care Vanguard and ensure that it has a strong Mental Health aspect to the bid and has regional NHS & social care involvement. (see separate planning section). A. Access to Earlier intervention, support and planning to reduce Mental Health crisis Police BRI AGH MIND SV CCC working group August Mar June August 6

Crisis Care Concordat Action Plan October 30th Making sure people with mental health problems can get help 24 hours a day and that when they ask for help, they are taken seriously. 1 Develop co-ordinated multi agency CMHTs to identify all people at risk of MH crisis and develop multi March Crisis Prevention plans specific to agency crisis prevention and risk minimisation plans for each of them the early intervention, recovery and Care Programme Approach Crisis and Contingency plans to be support needs of people in crisis improved, relevant, available, easy to find and in date. Police SV Ensure CPA Audit identifies use of Crisis & Contingency plans MIND Update Oct : Training & support to be provided to relevant agencies on how to A community recovery and care complete use and interpret Risk and crisis plans. planning transformation plan is Look at examples of good practice in other areas currently being developed by and the. Involve Service user development. VCS and advocacy colleagues in these developments 2 Develop use of Advanced Statement or Directives with service users and their families to improve crisis planning All Service users with a history or a predicted risk of crisis care presentation should be supported to have an Advanced Statement that identifies how they wish to be treated due to lack of capacity or crisis. Action plan to achieve this to be developed. Dec A very effective format already exists within the integrated /BDCT mental health services but needs to be used much more and more widely available. RIO database to be updated to support this as part of ongoing RIO development. Training on this issue to be part of the CPA and Police training Dec July 3 Explore the commissioning and development of a recovery, prevention and early intervention based approach within CMHT s and Community and voluntary mental health organisations are key to preventing Crisis. Support the recovery and intervention model that empowers CMHT workers to be able to take action that divert people from crisis and to access services that support this. Link to existing CMHT transformation programme MIND SV March 7

Crisis Care Concordat Action Plan October 30th Primary Care MH services using innovative approaches to build on existing practice Update Oct : BDCT, s and now working on developing a new CMHT transformation model based on best practice in recovery, early intervention and personalised care. 4 Develop links to the crisis care pathway in Primary care services and First Response Service (FRS). Explore the commissioning of community MH services that will focus on wellbeing with an emphasis on nurturing people s resilience and capability, mapping their networks of support, the community assets and supporting people to help themselves (e.g. Parachute model) Develop use of the WRAP (Wellness Recovery Action Plans) for service users in Adult MH, CAMHS and community development groups who need a supportive recovery approach building on existing practice. Develop a clear protocol for Primary Care professionals on how to assess risk, respond to MH crisis and refer service users at risk of crisis to FRS etc Develop the availability of GPs for MHA assessments and support the identification and support of carers in Primary Care CCC working group March July April April Use the protected time for GP Training and support. www.ttcprimarycare.org.uk gives an example of this work. April 5 Explore the development and commissioning of best practice crisis prevention services that divert people from crisis before it develops. A. Planned respite such as Shared Lives Host Families scheme: Now developed in MH and starting to be used to avoid crisis B. Urgent respite such as the Hertfordshire Host families scheme: We are exploring the development and commissioning of this idea. CCC working group and local integrated C missioning May Part of UECV These are examples of commissioning ideas we may explore locally. See the Mental Health Crisis Commissioning guide for London for more C. Specialist recovery led residential care is now being used to avoid acute care and reduce crisis through offering a safe space D. Flexible supported accommodation that can prevent/respond to crisis has now been developed and further developments are under housing below May April 8

Crisis Care Concordat Action Plan October 30th examples of good practice E. Community based Crisis support such as the Sanctuary/safe space models: Sanctuary project now developed and supporting people every day. May 6 Telephone advice and support for people in crisis or at risk of crisis available 24 hrs a day F. Flexible support service for people in crisis that can offer indepth support in service users homes is now available as part of IHTT and being developed as part of the housing tender. Review the commissioning and availability of telephone support services Develop a telephone triage and support service as part of First Response team within mental health services to people in crisis and organisations supporting them e.g. Police, Care Homes, A+E etc MIND May March 7 Identify people who may be at specific risk of crisis and plan for their care and support Updated Oct : Frequent Attender support project now set up across all agencies 8 Develop a multi agency Crisis Care Pathway Updated Sept : CCC working group set up to develop this pathway Link Samaritans and Guideline into the Crisis Care pathway and to the First Response telephone triage service and create a link to EDT Develop a list of the people who most regularly present to agencies in crisis and develop multi agency plans as to how we will respond and support them Review how people who have presented as suicidal or self harmed or been in crisis are followed up and supported to avoid crisis happening again. Link to suicide prevention group led by Public Health Ensure that the specialist First Response crisis service accepts self referral The pathway will provide guidance towards positive decision making and integrated working and will set out how agencies should communicate with and support each other when responding to people in crisis This should adopt a holistic approach to crisis care management including and integrating all areas and agencies that influence crisis including physical and mental health, economic factors, culture, housing, relationships, employment and benefits. BDCT PH Police CCC working group June 2012 August 9

Crisis Care Concordat Action Plan October 30th 9 Explore the specific needs and implications of MH crisis on BME communities 10 Explore the use of digital and Tele support systems to reduce future crisis and support recovery The CCC will set up a working group with representatives that will develop this pathway in across all age groups and specific needs. Work with local groups to identify the causes of MH crisis in BME communities and Develop specific strategies and services to meet the need of BME communities and develop specific ways to support crisis in these communities Explore local development of online support tools such as the Big White Wall app and online support service (www.bigwhitewall.com) Explore the use of Tele Care to support people in crisis and follow people following crisis support in partnership with local Vanguard. & SV MIND Police Jan July Jan 11 Support the role of 3 rd sector organisations in recovery/support Link to a range of relevant 3rd sector/vol sector MH support providers into the action plan for the CCC, the crisis care pathway and prevention strategies B. Urgent and emergency access to crisis care when required Making sure that a mental health crisis is treated with the same urgency as a physical health emergency. 1 Develop a 24hr integrated response service for people in MH crisis. 2 Develop police triage and support service within the FRS team 3 Ensure speedy access to AMHP service out of hours especially in First Response (FRS) team to be developed. A partnership between s/bdct//ph and the PCC. 24 hour telephone support and triage plus professional response to people in crisis and assessment or diversion for people in contact with the police. Links to all other crisis and out of hours response services. Includes self referral from users and carers. Public Health, PCC, and NHS to work together to build response and diversion service into FRS team for people who come to the attention of the police or are in police custody. Link to development of street triage. Base police/court liaison workers in the custody area and develop links with other agencies working in police custody such as Drug Intervention teams Redesign existing AMHP resources so that key hours in evening and early morning are covered with a duty AMHP. CCC group 3 rd /volsector BDCT PH PCC Public Health BDCT Police Pub Health Dec Aug Dec 10

Crisis Care Concordat Action Plan October 30th police station and A & E Explore options for on call AMHP service for out of hours assessments Agree timescales for AMHP assessments 4 Develop Links between crisis services and the Emergency Duty Service EDT currently has an on call worker dealing with Local Authority emergencies out of hours. They have bank of AMHPs that can be called out to assess people at weekends. This service is integrated with the Crisis Care Pathway and linked to FRS/IHTT so that there is support and planning between EDT and other out of hours services and a more co-ordinated response to MHA 5 Agree standards for availability and attendance of s12 doctors at MHA assessments 6 Improve Link between crisis services and the AMHP service 7 Develop the Psychiatric Liaison and AMHP response service in A+E Update: PLS now integrated with FR service. Social care role now permanent. Psychiatric Liasion A and E developments now linked to urgent care vanguard section (below). assessments. Ensure Consultants and s12 doctors can be available when mental health or MH act assessments are required. Free up time to enable them to attend assessments in line with working pattern of FRS AMHP service and EDT Duty day time AMHPs to be integrated with the 24 hour crisis FRS team. Develop a clear communication pathway with the EDT service and access to 24 hr AMHP availability across both services. Major development of AMHP service to reduce problems and stresses and ensure a speedy response to MHA assessments Expand the PLN service to cover as many A+E hours as possible and link to the crisis care pathway and FRS, EDT and IHT teams. Integrate Social Care/AMHPs into this service through employment of social care staff in the PLN team and via the Integrated Hubs and hospital social work teams. Agree minimum standards for assessment and decisions in A&E and explore a specific assessment area in A and E in line with recent recommendations. Develop frequent attendee project with police, and NHS CCC working group Urgent Care Vanguard group May Jan March May Sept March Part of UECV July 8 Develop the Intensive Home Treatment service to provide Redesign the IHTT so it is separate to the crisis function and can support people to divert from acute care or facilitate early discharge from Hospital or 11

Crisis Care Concordat Action Plan October 30th intensive support to people in crisis and avoid admission 9 Link the MIND Guideline telephone support service to the Crisis Care Pathway 10 Explore the establishment of a safe place or sanctuary for people in crisis in partnership with Mind/ Sharing Voices offer intensive support into peoples homes to reduce crisis. Link to Crisis Care pathway and joint management with FRS and PLN. Increase coverage of this service to 24 hr and link to AMHP service. Referral/signposting process between this agency and the FRS triage system will enable better response to people in crisis. Guideline may need to refer people they are concerned about to FRS triage. Support Mind/Sharing Voices and other agencies to set up a safe place for MH service users in crisis to receive therapeutic or practical support as an expansion of their current service. Extend hours into late evening. Link to professional support from the FRS and IHTT health and social care staff. MIND SV MIND SV April May 11 Ensure appropriate access to local MH acute care beds when needed Update: No Out of Area bed placements for 8 months 12 Develop joint working with NHS 111 and police call centres Link to UECV project 13 Crisis response for a range of other support areas in addition to adult mental health Improved Links with social housing and joint commissioning of step down accommodation to support move on from hospital Link Bed Manager to IHTT and FRS teams FRS, AMHP and IHT teams to work together to divert people from acute care and facilitate early discharge Implement strategies to reduce bed occupancy and improve discharge Link to frequent attender programmes Use sanctuary and specific Residential care providers to provide support for people who do not need Acute Care bed Explore the basing of health and social care mental health professionals with the emergency services 111 call centre. This is now part of regional UECV. MH staff in Trafalgar house Hub to co-ordinate responses to MH service users to reduce the number of people presenting in crisis and improve response Identify specific needs of people with developmental disorders; Learning Disability now covered by police hub and FRS Older People now part of the CCC group Sept Physical Health - Parity of esteem part of the CCC group Children and Young people Now part of the CCC Vanguard group Police PH April May July March 12

Crisis Care Concordat Action Plan October 30th 1 Ensure that the Crisis Care Pathway identifies how people should be supported in crisis 2 Improved response to people missing from acute care or MH services 3 Develop services for people with MH issues who present to A+E Update Sept : This will be part of the Urgent Care Vanguard status for -18 4 Age appropriate care pathways for young people in crisis Develop a Children and Young People Crisis service in A and E and as part of EDT/FRS/Childrens social care ad part of the UEC Vanguard. C. Quality of Treatment and Care when a person is in crisis Making sure that people are treated with dignity and respect, in a therapeutic environment. All agencies involved in crisis care to agree minimum standards of response and service delivery to people in crisis in line with this action plan and the crisis care pathway Develop the joint missing person policy for vulnerable people in MH crisis missing from services. To identify the role and responsibilities of both police and MH services Explore the development of a dedicated area in A + E departments for the assessment and support of vulnerable people Development of an integrated A & E Liaison service Development of the A and E housing and support pathway Develop an integrated crisis pathway for children and young people that ensures age appropriate services for young people in MH crisis through the Future in Mind Transformation project. Develop one SPOA for C&YP and integrate into FRS Develop an age appropriate place of safety or sanctuary for C&YP in education or other placements No children held in the police cells under any circumstances No children with MH problems held in cells so far in CCC working group Police s BRI AGH Horton Housing & Bevan hse childrens services Adult MH s Dec Mar UECV plan May Nov Nov Nov 5 Improve Access to an Appropriate Adult for vulnerable people in police custody Explore the setting up of a volunteer service across health & social care to respond to the PACE requirements for people in custody Update Oct : Access team and some volunteers trained Police 3 rd Sector 13

Crisis Care Concordat Action Plan October 30th 6 Speedy access to appropriate medication support when required Development of the ANP role in FRS and IHTT to provide urgent prescribing when needed to reduce crisis. 7 Evaluation of the development of crisis Explore development of Mental Health triage assessment tools and training services Evalution of development of FRS and attitudes of the police and other staff 8 Develop Positive and proactive care in To develop a strategy to reduce seclusion, restrictive care, chemical and inpatient environments physical restraint in inpatient environments D. Services to support recovery and staying well following a crisis Preventing future crises by making sure people are referred to appropriate services. 1 Develop supported accommodation to undertake a review of Housing Related Support and Supported that keep people well and identifies Living options for people with a mental health problem and develop crisis in advance services that can respond to the needs of people who may experience MH 2 Develop specific housing support for people in crisis or being discharged 3 Explore the development of services that support people to move out of secondary MH care and back to primary care Link to Review of CMHTs 4 Explore the development of services that support people recovering from a crisis to stay safe and in recovery Link to Review of CMHTs 5 Explore the development of an employment support service for people with mental health problems crisis. New service spec to be produced and tender arranged. Integrated commissioning with housing, NHS and to identify to housing needs of people in MH crisis. To develop urgent access housing for people who need a step down provision from acute care or are homeless. Consider the development of a supportive multi agency care navigator service to support people with serious or long term mental health problems to be supported when discharged from secondary mental health services (see Evolve service http://www.crestwf.org.uk/evolve/ ). Link with the local Wi FI complex care service Identification and support of people recovering from crisis or experiencing multiple MH crisis. A co-ordinated and assertive outreach approach to working with them within the crisis pathway and frequent attender scheme. Solidarity in a crisis service (www.certitide.org.uk) is a service that provides in depth support to people in recovery from a crisis Develop Multi agency individual placement service for people in secondary mental health services to move back to employment. This project is supported by the Centre for Mental Health and is being implemented by BDCT and CBMDC with 3 rd Sector partners s WiFi Police SV Cellar Trust August August May Oct March Mar Mar May 14

Crisis Care Concordat Action Plan October 30th 6 Ensure that Care Act responsibilities for Vulnerable people are part of the CCC 7 Develop parity of esteem between physical and mental health services A clear pathway for vulnerable people in crisis link to the access team and BRI teams with joint working across FRS and mental health services. To ensure that physical health risks to people with MH problems such as hearth disease, diabetes, stroke etc are part of the crisis care planning and can be assessed and acted upon using the Bradford MH Physical Health assessment tool. Oct June 2. Improved quality of response when people are assessed or detained under Sections of the Mental Health Act 1983 No Recommendation and required outcome Action needed to achieve this Lead Agency A. Develop Appropriate Services for people detained under S136 and S135 1 Implement services that will reduce FRS triage service will support the police to divert people to other services the number of people detained under whenever required through a dedicated police telephone line, police hub, S136 by the police and immediate triage response. Police Ensure people who are detained under s136 are treated appropriately in a place of safety 2 Improve timescales and arrangements for conveyance under the Mental Health Act and for vulnerable people All s136 detainees to be taken directly to the s136 suite unless there is a risk of serious violence to facilitate recovery and speedy assessment Oct update: Services implemented but S136 numbers not falling as expected. Review underway with police about this. Explore the introduce the use of a range of appropriate vehicles in the event of conveyance being required in a mental health emergency wider than paramedic ambulances Agree shared standards and timescales for 30 min conveyance with YAS. Link this CCC action plan with the UVC developed across west Yorkshire. YAS RAG 10/15 April May Link to UECV Link to UECV 15

Crisis Care Concordat Action Plan October 30th Review conveyancing policy in line with the Association of Ambulance Chief Executives S136 guideline for transportation of people under Section 136 detention and local YAS guidance developed as part of the CCC Mar 16 3 Develop S136 suites to meet national guidance S136 suites can safely support people for up to 72 hours for assessment under MHA and reduce need for police custody to a minimum Ensure that S136 suites can be staffed when needed by IHTT professionals and that police can be released as soon as possible after they have delivered a person under s136 Police Agree a clear protocol on when police can be released aim for immediate release with a maximum police support timescale of 1 hour May 4 Ensure that no young people under 18 are held in police cells under s136 Link to UEC Vanguard and CYP pathway (see below) Ensure that S136 suites and special areas in acute wards are age appropriate and can be staffed when needed for young people Consider development of specific non health based places of safety to cater for young people in emotional and MH crisis CAMHS Nov Develop alternatives to hospital and supported accommodation for young people in crisis including needs of BME young people 5 Improve experience for people detained under the MH Act 6 Develop links with drug and alcohol services and services for people in crisis Ensure access to CAMHS staff expertise through 24 hour cover arrangements (duty consultant; speedit ) Link and develop existing policies and practical arrangements to create a multi agency Standards for Mental Health Act Assessments that identifies the minimum expectations for service users and agencies Develop protocol and integrated services to consider the recommendation of the D&A services review integrated support services to people in crisis especially when in police custody PH Mar 16

Crisis Care Concordat Action Plan October 30th Develop alternative places of safety for People under the influence of drugs and Alcohol ( see CCC national actions progress report) 7 Improve the care and management of Consider using specialist places of safety for intoxicated people where they intoxicated service users can resume capacity in a safe environment that is not the police cells or hospital. Most intoxicated S136 clients are not detained. 8 Faster response to S136 assessments Ensure AMHPs and Doctors are available to assess within an agreed time frame and build this into the S136 policy. Link to point 5 above. 9 Review police use of places of safety Use the monitoring arrangements to check progress in relation to the under the Mental Health Act 1983 and number of people detained under s136 and use of cells and s136 suite. results of local monitoring Oct - This is now being checked regularly 10 S136/135 policy to be updated Re write the S136 policy and partnership agreement to reflect the new arrangements within the CCC. 1 Link access to crisis plans and advanced directives across agencies WYP Police B. Improved information and advice available to front line staff to enable better response to individuals Agencies need to be able to share the Crisis Plans for certain service users through client consent or an information sharing process so that service users have a consistent support plan that can be accessed when needed Information Governance issues need to be resolved through a multi agency IG agreement linked to the existing Info sharing agreement C. Improved training and guidance for police officers and MH professionals 1 Provide training in MH issues for police Set up a rolling training programme on MH and MH act issues for police colleagues. Specific training on working with vulnerable people especially MH and LD clients. 2 Support police to make better Telephone support & joint decision making with police officers from FRS. decisions about people who need MH Place health and Social Care staff in the police Hub. support WYP IG Depts of all agencies to work together WYP Police 3 Training for MH professionals Police to support training on Appropriate Adult and Criminal Justice issues Police 4 Training for other professionals Support medical professionals working in police cell areas to make better Police working in Police custody decisions about people with mental health issues March Nov Nov Oct 15 Jan Mar August August July 16 July 16 17