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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 problems1
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 discriminationBME 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 27th 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 1,0002 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
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 190
10
20
30
40
50
60
86 6 5
25
16
29
28
33
7
55
37
19
46
36
17
37
46
Total Incidents by Week (27 Jun - 10 Nov)
Week 1 JunWeeks 2 - 5 JulWeeks 6 - 9 AugWeeks 10 - 13SepWeeks 14 - 17OctWeeks 18 - 19Nov
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 1st
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
Team manager; 1 MH Practitioner; 2
Admin; 1
Team manager; 1
MH Practitioner; 12
Support Time Recovery Worker; 5
Admin; 4
30th September201431st March 2014
Dorset Criminal Justice Liaison & Diversion Team
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:
7 am to 8.30 pm, 7 days a week
Bournemouth Magistrates’ Court: 8.00 am – 4.00 pm Monday to Friday8.30 am – 12.30 pm Saturday
Weymouth Magistrates’ Court: 8.00 am – 4 pm Monday to Friday
Voluntary Attendance: 7 am – 8.30 pm, 7 days a week
Street Triage: 7 pm to 8.30 am Friday, Saturday and Sunday
Adult Custody and Court Contact Apr-Oct 2014
APR MAY JUN JUL AUG SEP OCT0
50
100
150
200
250
300
350
93
74
130
102
149
9382
2
318
152
264233
Adult AssessmentsAdult Screenings
Youth Contact Apr-Oct 2014
APR MAY JUN JUL AUG SEP OCT0
5
10
15
20
25
30
35
40
12
6
12
5
173235
26 26
Youth Assessments Youth Screenings
Improving the quality of life of people with mental health problems and reducing impact
Not applicable, no need identified
Need already met
No appropriate service available locally
Other
Referral/action indicated but refused by client
Advice given
Referral made to primary care service
Referral to secondary care service
Referral for assessment for detention under the MHA
Did not meet threshold for referral
Informed current care provider (no active referral)
Admitted to hospital directly
Referral made to other agency
0 50 100 150 200 250
203
125
1
17
13
95
22
11
26
13
59
11
9
Interventions to Meet Mental Health Need Apr - Oct
Intervention to Meet Mental Health Need Apr-Oct 2014
Intervention to address Physical Health Need
Intervention to address Learning Disability Need
Intervention to address S&C Difficulty
Intervention to address Alcohol Misuse
Intervention to address Substance Misuse
Intervention to address Accommodation Need
Intervention to address Financial Need
0 50 100 150 200 250 300
76
41
20
240
176
123
64
Intervention to Address Other NeedsApr-Oct 2014
Future Landscape
Too many providers are failing to monitor their service effectively, making it difficult to assess whether provision of health-based places of safety is meeting the needs of their localities. Too many commissioners are 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, 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 2014)
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
