Achieving Better Access to Urgent and Community Mental Health Care Mental Health Act Assessments What Helps What hinders What should change 1
Proposed standards and pathways National standard of a 4 hour response to request for a Mental Health Act assessment for urgent and emergency care (whether from blue light services or community crisis request( not a standard for the time taken to complete an assessment) note final version of standards subject to sign off by NHSE Currently different standards in different localities which are not always well monitored or adhered to over 24 hours 7 days a week 2
Governed by 1983 MH Act and Code of Practice with regard to MCA With regard to guiding principles of COP Least restrictive option and maximising independence Empowerment and involvement Respect and Dignity Purpose and effectiveness Efficiency and equity Monitoring The Mental Health Act CCQ 2015/2016 58,400 detentions rise year on year biggest rise of 10% in this period, for first time ever more detained people than are informal, 400 under 18 detained 3
Objective of assessment is to determine whether the criteria for detention are met and if so whether an application for detention should be made Because an assessment cannot be done without considering alternative ways of providing treatment AMPHS and doctors should as far as possible in the circumstances identify and liaise with services which may potentially be able to provide alternatives to admission such as crisis and home treatment teams Local authorities responsible for ensuring sufficient AMPH are available to carry out their roles and provide a 24hour service CQC report showed difficulty with having enough to provide a 24 hour service Application should be supported by two medical recommendations ( not sect 4) 4
Section 13 places a specific duty on L/A to arrange for an AMPH to consider care of patient within their area and must make such arrangements if asked by nearest relative13(4) AMPH are the applicant in majority of cases, Doctors provide medical recommendations AMPH who are responsible for assessing the patient have overall responsibility to for co-ordinating process of assessment, being sensitive to patients age sex gender identity social cultural or ethnic background Doctors and AMPH need to apply professional judgement and reach decisions independently but in a framework of co-operation and mutual support 5
AMPHs have a particular focussed role in protecting peoples rights most often at points of crisis where they assess the least restrictive option to meet a persons needs under the law Must interview the patient in a suitable manner and satisfy himself detention in hospital is in all the circumstances the most appropriate way of providing care and medical treatment of which the patient stands in need They are responsible for arranging conveyance to hospital 6
Challenges and Good Practice Section 140 and commissioning, CCGs responsible for commissioning services to meet the needs of their areas, duty to notify L/A in their areas for reception of patients in cases of special urgency or the provision of appropriate accommodation or facilities for under 18 Increase of patients subject to section and no bed available Med Reccs signed, cannot proceed till named unit available, Out of Area placements, conveyance issues and delays, availability of sect 12 doctors 24 hour availability of AMPH loss of leadership for AMPH in some local authorities access to alternatives to admission, failure to acknowledge increasing complexity, timely access to courts for 135 warrant's Integrated Working done well with real leadership Interagency protocols with real teeth commissioners chairing interagency forums that change things, resources for the new guidelines Keeping Service users and their carers at the centre beyond interagency disputes Good practice links:nccmh positive practice site Enabling positive change, a patients journey 7
Queens speech government will reform mental health legislation and ensure mental health is prioritised in the England Nhs Now saying further reform of mental health act legislation, while working towards a new mental health act Consideration will include-: why rates of detention increasing and taking necc action to improve services, examine disproportionate number of those from particular ethnic backgrounds in particular black people detained, review CTO to see if they remain fit for purpose, consider how rights of family members to get information can be improved, ensure those with mental health problems treated fairly particularly re employment. Publish a green paper on children and young peoples mental health 8
With a four hour standard What works well two examples What hinders, two examples What are you personally going to do to improve service user and carer experience What else needs to change 9
feedback from participants What helps? There was positive feedback from health care staff about working together with the process how helpful AMPH where, professional skilled and supportive but also remember they also needed support and the opportunity to debrief Service users said what helped was being part of the training for professionals gave feedback on being part of the training for AMPH courses how that made a difference to seeing things from a user perspective In some areas the first section 12 Doctor was responsible for obtaining the second sect 12,also feedback from another area where they had a sect 12 App, so they could tell AMPH if they were available like an uber for sect 12 reducing time and stress in constantly ringing around 10
Mental health Act Assessments feedback What hinders: universal concern on lack of beds and increasingly reports of service users assessed as needing admission but paperwork could not be completed as no bed available and service user could be left at home for several days needing a bed, compared to physical health where someone has a heart attack needs treatment but is left at home this would never be tolerated why is it in mental health? Also why so many admissions? Feedback that CQC are going to be looking at this Concern in an area of inflexibility of AMPH response to street triage request to assess the service user at their temple or a venue which is right for them and asking for 136,suggestions from the audience about service users with street triage asking to attend the local AMPH forum to give feedback on how unhelpful this was Funding also needed for AMPH services if 4 hour target is to be effective 11
MH Act Assessments Feedback What else needs to change? Understanding of traumatic effects for service users involved in assessments, even if later it is recognised it was the right thing to do. They may never see that AMPH again but would benefit from talking through how they felt, needs more recognition, suggestions to contact AMPH lead request opportunity to speak to AMPH, user involvement in training also we could feedback these concerns to AMPH leads network via BASW Better information and data, AMPHs collect lots rarely asked for it, conveyance via ambulance some areas using private ambulances really helps, commissioners really getting involved in relation to 140 powers and interagency protocols. More alternatives to admissions, earlier intervention, proper systems for sect 12 doctor availability. Action not just talk re bed availability when most needed. Consistent not just episodic care, better focus on listening and responding to carer and user perspectives 12