Community Triage NHS Greater Glasgow and Clyde Crisis Out of Hours CPN (Community Psychiatric Nurse) Service Pilot Evaluation Report
Community Triage NHS Greater Glasgow and Clyde Crisis Out of Hours CPN Service Pilot Evaluation Report The purpose of this report is to provide partners with evaluation results relating to the Community Triage NHS Greater Glasgow and Clyde Crisis Out of Hours CPN Service pilot, which commenced on 5 January 2015 across Greater Glasgow, Renfrewshire, Inverclyde and West Dunbartonshire. The pilot between Police Scotland and NHS Greater Glasgow and Clyde has developed partnership working between the police and the existing Crisis Out of Hours CPN Service provided by NHS Greater Glasgow and Clyde. The official pilot period ended on 30 June 2015, however the service is still being and will continue to be provided Background The aim of the pilot was to demonstrate that Community Triage leads to more timely intervention by Mental Health professionals when required, avoiding unnecessary detention either in a police station or hospital. This process is suitable only where there is no immediate danger or threat to life. It was anticipated that Community Triage would provide a better service for individuals as well as achieving efficiencies and improvements for the Police, Health and other services including: * Reducing the number of detentions to both hospital and custody. * Reduce the burden on both police and health staff who spend long periods of time in hospitals awaiting assessments. * Improve outcomes for those who are detained and also those who are dealt with in the community. * Improve partnership working between Police and Health services. * Improve pathways to effective Mental Health Services including follow up for those difficult to engage with, following initial contact with the police. * Reduce costs to police, health and criminal justice system. Results Contained within this report is both statistical data from incidents and qualitative feedback from police officers across the Pilot areas who used the service between January June 2015. Officers responses and other data extracted have been incorporated to give an overall view of how the service was used throughout the pilot period. A number of police officers and CPNs have taken the time to provide their perception of the service. A selection of the perception feedback has been detailed in Appendix A. Police Officers across the pilot area used the Community Triage Service NHS Greater Glasgow and Clyde Crisis Out of Hours CPN Service (CTS) on 234 occasions between January June 2015. The service operates between 2000hrs 0900hrs Monday Friday and 1700hrs 0900hrs on Saturdays, Sundays and public holidays. Each of these incidents involved one person who appeared to the officers either to be in distress or suffering from a mental health related issue. Those officers were asked the following 6 questions about the incident and the individuals they dealt with. 1
1. Was the individual found in a public or private place? As can be seen above, the majority of incidents (92%) took place in a private place. Incidents within a public place included individuals found on the street by officers, officers being called by others to assist individuals on the street and individuals who had attended personally within the non-custodial areas of police offices. The following 4 questions and answers have been detailed together as they overlap on the graphs. 2. Was a telephone consultation conducted? 3. Was there a face to face mental health consultation carried out? 4. What was the outcome of this? a. Deemed fit and well, no further action b. Detained under Section 297 Mental Health Care and Treatment (Scot) Act 2003 and taken to a place of safety. c. Was an MHO (Mental Health Officer) summoned to facilitate the removal of the individual to a Place of Safety? (Private place only) 5. Was the individual subsequently arrested for an offence? 2
When officers decided to contact CTS, 215 of the 234 (92%) individuals accepted telephone consultations with CPN s from the service. 184 (86%) were deemed to be fit and well following the telephone consultation with no further intervention required at that time. Following their telephone consultations, CPNs conducted a total of 31 (14% of the telephone consultations) face to face assessments with 31 individuals. Seven individuals declined telephone consultations and they were also afforded a face to face assessment from the CPNs. Of the 38 face to face assessments conducted by the CPNs, 29 (76%) of those individuals were assessed as being fit and well with no further intervention required at that time. The remaining 9 persons required to be admitted to hospital for full psychiatric assessment. Although police offices assisted with transport to hospital, these admissions were facilitated throughout by the CTS CPNs. 3
Of the 234 incidents attended and 234 persons assessed, 225 (96%) of those persons were found to be fit and well by the CPNs and in no need of further intervention at that time. As well as those deemed fit and well after telephone assessment (184) and face to face consultation (29); 5 persons refused to engage with either the Police or the CPNs, however were deemed fit and well, with no need for further intervention after guidance was obtained by the officers from the CPNs. On seven other occasions, officers pro-actively contacted the CPN s and took advice and direction. One of these occasions involved a malicious call about an individual, another involved an individual whose behaviour was not uncommon for himself. Four individuals were too intoxicated to be assessed and 1 other person had already been assessed that day by the CTS. As can be seen by the above graph, 6 individuals are recorded as having been arrested and/or reported for offences. It should be acknowledged that all 6 persons had been assessed by the CTS and deemed to be fit and well prior to this. Four of the six individuals were taken into police custody, the remaining 2 persons were dealt with at the locus of their offence and reported to the Procurator Fiscal. These 6 persons form only 2.5 % of the total number of persons assessed by the Community Triage Service. 6. How long did this incident take you to deal with from time of arrival until stood down? 4
From a pure police resourcing perspective, the above graph demonstrates that 159 (68%) of the incidents attended during the pilot, were dealt with in less than 2 hours. 198 (85%) of calls were completed within 3 or less hours. Although accurate data prior to the pilot regarding police resource time dealing with this type of incident is unavailable, it is accepted in the operational policing environment, that a conservative estimate of police resourcing would be 2 officers engaged with the incident for at least 4 hours. This data demonstrates that 225 persons did not need to go to hospital. Prior to Community Triage, it is most likely that each of them would have been taken by police officers to hospital. It s therefore estimated that 1800 police officer hours have been saved, allowing officers to return to frontline duties. Police officers have stated that regarding the lengthier timescales, this is due to the individuals taking longer to or completely refusing to engage with officers. The delays are not a result of the Community Triage Service response times. National Potential for Local Benefit Police Scotland wrote to each NHS Board (apart from NHS GG and Clyde) in December 2014, informing them about Community Triage, the anticipated business benefits and inviting them to work in partnership with Police Scotland to develop services in their areas. There has been indications of interest and some progress nationally. NHS Lothian and police colleagues in Edinburgh started a Community Triage pilot in August 2015. NHS and police colleagues in Lanarkshire, Ayrshire, Scottish Borders and Fife are all involved in partnership work looking at developing and improving services in their areas. The Distress Innovation Improving our Response event was held in partnership between NHS Scotland, Scottish Government and Police Scotland on 22nd September 2015 at the Police Scotland College, Tulliallan. Police Scotland delivered a presentation about the Community Triage service and informed the delegates about the results of the pilot. The evaluation sheets from the event were very positive and some delegates have already been in contact with Police Scotland and other speakers expressing an interest to work together. 5
Conclusion The Community Triage Pilot has demonstrated that the vast majority of related incidents, occurring out of hours are satisfactorily dealt with and concluded by a telephone consultation between the individual concerned and a CPN, thus removing the need on these occasions for the police to take them to hospital. Where further intervention is required, this was and is provided in a far more efficient manner than before. Only a very small number of persons were taken into custody. As officers awareness of and confidence in the service increased throughout the pilot, so did their use of it, and both their perception and that of the CPNs is extremely positive. The service remains in place across Greater Glasgow and Clyde. It is likely that a telephone consultation service would work equally as well in both urban and rural areas and it is suggested that services could be developed to suit the needs and demands across the different communities of Scotland both in and out of hours. 6
Police Officer and CPN Perception and Feedback Appendix A My neighbour and I found the service extremely helpful on this occasion. The triage service phoned us back within minutes and had specialist knowledge of the male in question resulting in us being able to do our job quickly and efficiently. Found the service to be quick and helpful, if we had attended the Hospital, from previous experience, we would have been in the region of 4 hrs. The actual triage part only lasted about 20-30 minutes, the rest was down to speaking with Sgts and the male involved. Excellent tool which can be used in the right circumstances. Hope it stays. The community triage service was of great use as the subject was turned away from hospital due to his level of intoxication however due to speaking to said CPN, this seemed to settle and reassure the subject Our shift had a missing person tonight (Saturday nightshift) who was high risk, he had taken an overdose the day before he went missing. At that time, he was released from hospital and arrangements were made for him to attend an outpatient clinic at a later date by appointment. He was traced in the early hours of the morning the day after he had been reported missing after extensive enquiry, and due to previous information that he had suicidal thoughts and him taking an overdose it was decided that he should be assessed. Officers contacted the service, and received a call-back within approximately 10 minutes. A CPN spoke to the male and advised the officers that they had no concerns for his welfare or mental health and that he did not need to go to hospital. The whole process took about 20 minutes, and saved the need for the officers and male to sit in A&E for what would probably have been a long time given that it was Saturday night. This service was invaluable to us, it meant that the officers were able to get back to answering calls on a busy night where we had prisoner watches, locus protection, other missing people, along with a high volume of calls to be dealt with Overall very positive experience working together, at first when pilot started there was still a bit of confusion around what officers could expect from CPN S. As pilot has progressed better understanding of each other s roles and patients attended to quicker and mostly in their own homes. Has cut down the need to see some patients in the busy A & E depts when not required. When carrying out face to face assessments CPN's have found officers to be very approachable and helpful CPN still encountering difficulties sometimes with assessing intoxicated patients on telephone and when there is no real mental health problem but do understand that the person is distressed and officers looking for guidance. Officers more accepting of these difficulties and they seem to have a better understanding of these problems. By working more closely with NHS colleagues this has definitely improved the relationship between us and our police colleagues. Police officers more accepting of the outcome of our assessments and are working closer with us to build a bit more trust between services. Much better than it was before. the officers and the male to sit in A&E for a long time given that it was Saturday night. This service was it 7