MENTAL HEALTH TRIAGE

Welcome and Introductions Stan Sadler Operational Manager Criminal Justice Liaison and Diversion Service Dorset Healthcare University Foundation Trust

Personal Perspective

An overwhelming privilege to present to the Independent Custody Visiting Association National Conference Setting the scene for supporting vulnerable people Illustration of service expansion - street triage services in combination with liaison and diversion Discuss the future landscape of service provision

Supporting vulnerable people who encounter the police: A strategic guide for police forces and their partners (Home office 2014) It is estimated that over 20% of police time is spent responding to people with mental health problems 1 In some circumstances this will be necessary and unavoidable; the police are often the first point of call for people in distress, crisis and emergency. However, in cases where a person has committed no offence and is principally in need of a medical intervention or the support of health and social care services, it is not likely to be in their interests to find themselves being dealt with by police officers; nor is it in the interests of the police or public, to have police officers taken away from their core front line duties unnecessarily.

1 Findings from an Independent Commission on Mental Health and Policing in London (May 2013)

Setting the Scene for Mental Health

No health without mental health

(2011, DOH) provided a strategy and implementation framework addressing:

More people will have good mental health More people with mental health problems will recover More people with mental health problems will have good physical health More people will have a positive experience of care and support Fewer people will suffer avoidable harm Fewer people will experience stigma and discrimination BME communities are 40% more likely than white Britons to access mental health services via a criminal justice system gateway (Bradley, 2009)

Setting the Scene for Mental Health

Department of Health published

Closing the Gap: Priorities for essential change in mental health

and set out immediate ambitions (February 2014, DOH)

“No-one experiencing a mental health crisis should ever be turned away from services” “We will introduce a national liaison and diversion service so that the mental health needs of offenders will be identified sooner and appropriate support provided”

No-one experiencing a mental health crisis should ever be turned away from services

“far too many examples of public services failing to respond effectively to people experiencing a mental health crisis”

The

Mental Health Crisis Care Concordat

provides a shared agreement made by over 20 national organisations about how to respond to people in mental health crisis - joining up service responses to people who are suffering from mental health crisis

Crisis Care Concordat

In 2012-13 police made nearly 22,000 detentions under section 136 of the Mental Health Act Two thirds (14053) of these people were taken to hospital for a psychiatric assessment But a third of these people (7,761) were taken to police cells, often because the NHS could not respond quickly enough

“Even allowing for pressures on NHS resources – we must all accept that this proportion is too high”

Street triage – a new approach to effective and co ordinated crisis response

The Department of Health is piloting street triage as a way of helping people experiencing a mental health crisis get the help they need faster This involves trained mental health professionals working with police officers, as a first-line response – either directly on the street or through a dedicated phone line If the police are called to an incident where a person is

suicidal or self harming

, creating a disturbance or upsetting others,

but has not committed a crime

, they can ask the mental health professional to conduct a rapid needs assessment and direct the individual to the most appropriate source of help

National context to street triage

Investment and support for the concept of street triage has made it possible in many areas of the country to implement new schemes. Some have received direct funding from the Department of Health to participate in the evaluative pilot, with some other NHS areas funding them directly through partnership agreements Approaches throughout the country reveal

differences in operational design and application

; a situation likely to lead to wide variation in outcome and experience

Dorset Mental Health Street Triage

A local task and finish group met in January 2014, which included representation from health services, local authorities and the police. It was tasked with the initiation of Dorset’s Mental Health Street Triage Scheme, and had been supported by Martyn Underhill, Dorset’s Police and Crime Commissioner Dorset HealthCare was invited to participate in the initial 1 year evaluative pilot; a reflection upon embedded CJLDS in custody within Dorset Police and built on existing integration with respective health and local authorities during a period of significant service expansion Street triage commenced 27 th June 2014 and now operates every Friday, Saturday and Sunday between 7pm – 8.30am.

Dorset’s approach

Dorset has a resident population of approximately 750,000 people and covers an area of over 1,000 2 miles. It is serviced by 15 Police Stations and 1200 Police Officers The multiagency group reviewed literature illustrating various national operational delivery models and considered Dorset’s population dispersal and geography in combination with our project resource Our current approach deploys a mental health practitioner within the force wide police control room and supports immediate access to information highlighting health vulnerabilities and risk – information that is relayed to police controllers to assist front-line officers in policing incidents An additional health professional is available to respond to community face-to-face incidents in the event of an acute presentation; incidents requiring consideration of S136. At other times the professional is located in police custody in support of phone triage and custodial presentations

Street Triage Total Incidents since 27th June 2014 = 439

Total Incidents by Week (27 Jun - 10 Nov)

60 50 40 Week 1 Weeks 2 - 5 Jun Jul Weeks 6 - 9 Aug Weeks 10 - 13 Sep Weeks 14 - 17 Oct Weeks 18 - 19 Nov 30 20 10 8 6 0 1 2 55 46 37 36 37 29 33 28 19 16 17 6 3 4 5 5 2 6 5 7 7 8 9 10 11 12 13 14 15 16 17 18 19 46

Introduction of a national liaison and diversion service

A Liaison and Diversion service is … • a service that identifies a person with one or more mental health, learning disability and substance misuse vulnerabilities who come into contact with the justice system • a service that assesses and refers that identified individual to an appropriate treatment or support service • a service that is commissioned by NHS England

Dorset Criminal Justice Liaison and Diversion Service

January 2014 the service became one of ten sites chosen to participate in the 1 st wave of a national evaluative pilot providing Liaison and Diversion Services within the Criminal and Youth Justice Systems – Since October 2012 there had been an initial pathfinder pilot introduced in support of the Bradley Report (2009) A

national operating model for implementation and evaluation

was set by NHS England and became operational in April 2014

Dorset Criminal Justice Liaison & Diversion Team

31 st March 2014 30th September2014 Admin; 1 MH Practitioner; 2 Team manager; 1 Team manager; 1 MH Practitioner; 12 Admin; 4 Support Time Recovery Worker; 5

Applying Lord Bradley’s identified requirements

ASSESSMENT –

identifying and assessing people as early as possible

after entering the criminal justice system either at police custody or courts to minimise the need for further assessment whilst in prison.

LIAISON – support and advice to

those with

mental ill health or learning disability and

other agents

who may be involved in supporting the individual through the criminal justice system. DIVERSION – of individuals,

where appropriate

, out of the youth and criminal justice systems into health or other supportive agencies

The key aims of the liaison and diversion service

To improve access to healthcare and support services for vulnerable people through effective liaison with appropriate services and a reduction in health inequalities The diversion of people, where appropriate, out of the youth and criminal justice systems into health or other supported services The delivery of efficiencies within the youth and criminal justice systems The reduction of reoffending

HOURS OF OPERATION

Bournemouth & Weymouth Custody Suites: Bournemouth Magistrates’ Court: Weymouth Magistrates’ Court: Voluntary Attendance: Street Triage: 7 am to 8.30 pm, 7 days a week 8.00 am – 4.00 pm Monday to Friday 8.30 am – 12.30 pm Saturday 8.00 am – 4 pm Monday to Friday 7 am – 8.30 pm, 7 days a week 7 pm to 8.30 am Friday, Saturday and Sunday

Adult Custody and Court Contact Apr-Oct 2014

350 300 250 200 150 100 93 50 0 APR 74 MAY 130 JUN 2 102 318 149 152 93 264 82 233 Adult Assessments Adult Screenings JUL AUG SEP OCT

Youth Contact Apr-Oct 2014

15 10 5 0 40 35 30 25 20 1 APR MAY 32 12 6 2 JUN Youth Assessments JUL Youth Screenings AUG 35 5 SEP 26 17 26 OCT

Improving the quality of life of people with mental health problems and reducing impact

Intervention to Meet Mental Health Need Apr-Oct 2014

Interventions to Meet Mental Health Need Apr - Oct

Referral made to other agency

9

Admitted to hospital directly Informed current care provider (no active referral) Did not meet threshold for referral Referral for assessment for detention under the MHA Referral to secondary care service Referral made to primary care service Advice given Referral/action indicated but refused by client Other No appropriate service available locally Need already met Not applicable, no need identified

1 11 13 11 13 17 26 22 59 95 125

0 50 100 150 200

203

250

Intervention to Address Other Needs Apr-Oct 2014

Intervention to address Financial Need

64 123

Intervention to address Accommodation Need Intervention to address Substance Misuse Intervention to address Alcohol Misuse Intervention to address S&C Difficulty

20

Intervention to address Learning Disability Need

41

Intervention to address Physical Health Need 0 50

76

100 150

176

200

240

250 300

Future Landscape

Too many providers are failing to

monitor their service effectively

the needs of their localities. Too many commissioners are , making it difficult to assess whether provision of health-based places of safety is meeting

not adequately fulfilling their oversight

responsibilities in relation to people who are detained under section 136. This limits their awareness of a key issue which should inform their commissioning decisions (CQC 2014)

Extension of Liaison and Diversion will continue

– anticipate full rollout of the service specification to 100% of the population by 2017/18 (NHS England) People with mental health problems or other vulnerabilities may have a

range of complex needs

2014) , which the police alone are not fully equipped to meet. In such circumstances, it is crucial that there is early recognition of a person’s requirements and a clear process for the police to access, in conjunction with partner agencies, the right and timely support to meet these (Home Office

RELATED ARTICLES

The Bradley Report 2009 Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system HM Government - No Health Without Mental Health: A cross-government mental health outcomes strategy for people of all ages 2011 NHS England - An Operating Model for Liaison and Diversion Services across England 2013 Department of Health and Concordat signatories 2014 Mental Health Crisis Care Concordat – Improving outcomes for people experiencing mental health crisis. Social Care, Local Government and Care Partnership Directorate 2014 Closing the gap: priorities for essential change in mental health. Home Office - Supporting vulnerable people who encounter the police: A strategic guide for police forces and their partners 2014 Care Quality Commission (October 2014) - A safer place to be: Findings from our survey of health based places of safety for people detained under section 136 of the Mental Health Act

Useful links

http://www.youtube.com/watch?v=ZCTzHLXK4Oc http://www.england.nhs.uk/ourwork/commissioning/health just/liaison-and-diversion/ld-about/

Contact Details

Stan Sadler Operational Manager Criminal Justice Liaison and Diversion Service

[email protected]