Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
Derbyshire and Derby Crisis Care Concordat plan
IntroductionThis crisis plan is for the County of Derbyshire and the City of Derby. It has been drawn up by a multiagency task group following our public signing of the principles of the Declaration at a Mental Health Summit which was attended by a wide range of organisations in June 2014. We have also just released direction of travel strategies for mental health for both the City and County. We are undertaking a major transformation of mental health services, we have an ambition to reduce inequity and to move to Parity of Esteem and there are 5 year plans of the two units of planning areas (North and South). The Care Act 2014 places a number of responsibilities on the two local authorities which will strengthen and improve access to information, advice and advocacy, support for wellbeing, support for carers and provide support for prisoners for the first time which will have a bearing on our work in the crisis concordat. We are also in process of developing a Mental Health Offender Health and Social Care Plan.
There is a suicide prevention group led by Public Health and we have supported Derbyshire Health Care Foundation Trust (DHcFT) to run a suicide prevention plan for people who use their services. We are members of a regional suicide prevention network.There is a separate children’s suicide prevention strategy also being produced. The suicide prevention work is clearly relevant to the crisis concordat plan but the detail and planning is managed through this separate arrangement for both adults and children.
This plan sits within this wider Strategic partnership context and is a high level plan focusing on areas of joint delivery or commissioning. Beneath it we have more detailed plans from the Derbyshire Constabulary, Derbyshire County Council and Derby City Council, the four Clinical Commissioning Groups (CCG’s) and our mental health provider Derbyshire Healthcare NHS Foundation Trust. Other organisational level plans are also in development. This plan will be updated on the national site on at least a yearly basis but we intend to provide more regular progress reports of the concordat plan through both Derbyshire and Derby City Health and Well Being Boards, through the Criminal Justice Board and our Joint Commissioning Boards For Mental Health And Learning Disabilities. Partner organisations will also track progress on their own plan through their existing arrangements. We intend to continue with the Crisis Concordat planning sub group for a further 12 months to enable us to tackle some specific actions of a cross system nature but our intention is to embed this work into our respective planning systems within that period.
To support on going improvements in operational coordination we have renewed a multiagency professional group that’s specifically coordinates actions and intelligence concerning the use of section 136 of the Mental Health Act. This group will have the ability to resolve problems or to report them up to commissioners for resolution. Children’s commissioners are developing plans for integrated service delivery .They will be developing specific plans to address challenging behaviour, self-harm and crisis responses all of which were identified as a serious concern at our Mental Health Summit. These plans will be updated into the concordat action during 2015.
This plan is focused on those areas specific to the concordat but the actions may be part of wider plan delivery. We have followed the broad pattern of suggested headings from the national template but have rearranged some headings to be more consistent with our wider strategies.
This version is uploaded to support the engagement about the plan. We wish to hear comments and suggestions for improvements and areas of work we should concentrate on. This plan with comments and changes received will be presented to our Clinical Commissioning Boards, Council members Health and Well being Boards, Derbyshire Police Authority and provider organisation Boards by March 2015 for ratification and agreement by all the stakeholders.
The closing date for comments is the 31 January
Please send your comments with Crisis Concordat Plan engagement in the strap line to the concordat team, care of .
Service receiver views are also being collated by Derbyshire Voice and we appreciate your views stories and suggestions being sent to them at:
Email:
Address: Unicorn Business Park, Wellington Street, Ripley, Derbyshire, DE5 3EH
Thank You.
- Commissioning- Prevention, community resilience,asset based support, community/self help approaches.Recovery and enablement - Our aspirations.
Neighbourhood delivery of services is a key concept in our wider transformational strategies. We have agreed to develop asset based approaches. As part of supporting people with long term conditions of which Mental Health will often be one, we know that we can do more to enable self-management, social inclusion, and community asset support. We are aware that people with Mental Healthproblems do not always know where to get help at an early stage and also that stigma of mental illness and ignorance about it are real obstacles in people accessing support in their ordinary communities. The Care Act 2014 responsibilities will also be driving change to the way services are commissioned and delivered in 2015. Financial pressure, and benefit changes have a significant impact on health. Homelessness and poverty are at the root of many crisis situations; our actions to support these areas will be included in Public Health and in our wider commissioning and Mental Healthplans, therefore they do not appear in this crisis concordat plan.
Within each CCG plans are being made to deliver allcare to populations of about 30,000-60,000 in an integrated way. The plans below are to be seen in that context. Our GP leads are developing plans for enhancing primary care capabilities and these will appear in further detail in later versions of the plan. Recovery (see the definition in the concordat) and enablement is a key concept in our Mental Health strategic plans. Some of those elements that are needed to get people’s lives back on track after a crisis are often people with lived experience tell us are the same as those things that can help prevent a crisis or keep people well. We have therefore included Recovery and enablement in the same section as Prevention and not produced a separate plan for recovery after a crisis.
- Prevention, community resilience ,asset based support and community /self help approaches.
No. / Action / Timescale / Led By / Outcomes / How and where can this be monitored
Matching local need with a suitable range of services
1.1 / We will continue to develop local area coordination in Derby City and we will launch two pilot schemes alongside other approaches within the county. / 5 year plan / Derby City Council and SDCCG,
Hardwick CCG, and Derbyshire County Council / To work with people to find their own solutions on what good looks like for them. An evidence based, asset approach.
Reduced demand for statutory services
Severe crisis being avoided for some people as they obtain support within community.
Improved connections and partnerships across a community. / Derby Joint Adult Care Board
Hardwick LAC Planning group.
Bolsover Joint Planning Group.
Adult Care Board.
1.2 / Across both units of planning we will work to develop community resilience and community support to help people manage their MH and well being / 2015-20 / JCB / People supported within natural communities.
People accessing and utilising self support approaches
The communities and peoples own assets being recognized and used as a source of strength (resilience) Crisis support, and recovery / Mental Health Action plan
Joint Commissioning Boards (JCB)
1.3 / We will continue to develop Personal budgets and self-directed support approaches including personal health Budgets. / On going / Derbyshire County Council Adult Care
Derby City Council Adult Care
CCGs /
- Support people to maintain their independence, to have a life and not a service. With this support people are less likely to go into crisis
- Customers can use their personal budgets to self direct their support. This means that in times of crisis customers can use banked hours to bring in additional support.
- Support plans can include advance directives and other ways of managing fluctuations in mental health without precipitating a crisis situation.
JCB MH plan
1.4 / We will develop mental health first aid schemes to train non MH specialist community organisations.
This includes the work we are undertaking with BME communities. / April 1 –September 2015 / All 4 CCGS
JCB’s / Improved access to ordinary associations of support improved community responses to mental health problems. / MH Action Plan
JCB
1.5 / We will develop an integrated model of voluntary sector neighbourhood delivery. We will support the development of Voluntary Sector single point of access for primary care and professionals to facilitate befriending support, community resilience and access to the full range of community supports for people. / 2014 launch Service user review of Problems to be resolved.
2015 development of new model including VSPA development. / In Erewash CCG we will work on a first phase which will help us develop this elsewhere in the county
with partners and service receivers
Erewash CCG
SDVSMHF
MHAG / •Single point of access to support
within voluntary sector and
community for Primary Care.
•Improved access to community
support to help prevent crisis
escalating
•Obstacles and issues raised by
Service receivers addressed
1.6 / We will support recovery colleges and other approaches to self management. In our reviews of social inclusion services due in 2015 we will enable open access, community capacity building, peer support and recovery approaches. / 2015 / Local authority and CCG commissioners
DHcFT and voluntary sector providers. / Improved personal resilience and help to other people who can gain from lived experience.
Improved care and people enabled to “regain a life and make a contribution” / MH Plan
JCB
1.7 / Carry out a county-wide gap analysis and review of day opportunities / support services to ensure equitable geographical access to recovery and support model
Sustain and develop the steps social inclusion service in Derby / 2015-16 / DCC Adult Care working with CCGs and Derby City Council / People are able to access a choice of meaningful opportunities in their local area both to promote recovery and respond to individual crisis / MH Plan
1.8 / Improve support and involvement for carers (including young carers) by working with them to better understand their needs / DCC Adult Care &
Derby City Carers leads / Mental health carers feel more involved and supported in their caring role
1.9 / Develop and implement trauma pathway / April 2015 / JCBs
Time to Change Alliance(made up of voluntary sector service receiver and DHcFT) / People experiencing mental health crisis will receive safe, evidence based care when they need it in the most appropriate setting / Transformation Board
Contract arrangements
1.10 / We will work with our employers and our own organisations promoting healthier workplaces and sign up to the Time to Change and mindful employer initiatives / 2014-16 / JCBs
Time to Change
Alliance (made up of voluntary sector) / Improved response to people experiencing Mental Health Problems at work. Awareness of how to get help in the workplace and retention of employment. / MH Plan
1.11 / We will review how we develop, promote and sustain self-help community groups. / 2015-16 / DCC Adult Care /Hardwick CCG,NDCCG
NDVA. Locality partnership groups. /
- Increased opportunities to attend and/or develop local self-help groups and community activities
KPI
2.Improved partnership working in Derbyshire and Derby
No. / Action / Timescale / Led By / Outcomes / How can this be monitored
2.1 / We will establish a Crisis concordat group to ensure we produce a joint plan and to ensure delivery, co- sponsored by Hardwick CCG for the NHS and The office of the Police and Crime Commissioner(PCC). / July 2014 / EMAS, CCGs, DHCFT, PCC, probation,DCHS,
Derbyshire County Council Derby City Council / Bringing together information and data sources
Agreeing priorities
Producing a joint plan
Supporting joint delivery of solutions.
2.2 / The police will produce and monitor a detailed action plan covering areas where joint operational arrangements need improving. / November 2014 / Derbyshire Constabulary / Enabling operational issues to be progressed. Where required jointly worked on within the 136 working group and inter-professional groups or the crisis concordat group / Crisis plan reporting.
2.3 / Review the terms of reference 136 and the multi professional group / County CouncilAMHPs, Derbyshire Constabulary , EMAS and DHcFT / Ensure operational day to day problems in communication, procedure, and other barriers to joint working are removed.
Provide a Joint data set so we can see if our plans are having an impact on the use of S136
2.4 / The AMHP services will ensure attendance at quarterly regional AMHP Lead meetings / On going / DCC Adult Care / Share ideas of improving working practices
agreed cross border working arrangements for undertaking MHAAs to avoid people in crisis being passed around / between LAs
2.5 / We will update the Joint Strategic Needs
Assessment to include information to help plan and monitor the concordat actions. / 2015 / Public Health / Bringing information held separately together to enable a clearer picture of need. / JCB
Adult Care Boards
2.6 / We will review children’s commissioning arrangements to enable us to plan effective integrated care pathway. We will specifically focus on improvements to commissioning of the crisis care pathway. / November 2015 apply for enhancing Crisis Commissioning funding / CCG and Local authorities-
Children’s and Adults / Identified in data, by children and families and in the summit as a pressing need for change. / CAMHS Commissioning Group
JCB
Adult Care Board
2.7 / We will commission for specific conditions such as autism through a pathway approach so that people’s needs are more likely to be met before they reach a crisis in adult hood. / 2015-17 / People with autism are often found in offender health and criminal justice systems.
We know that about 50% of people in adult services will have had the same needs as children. We can reduce demand for adult crisis services by supporting younger people. / JCB
Better Care Board
2.8 / NHS providers will work with the police to ensure we have protocols
- to use police time more effectively
- To work together safely when the police are called to an incident on NHS premises
By December 2015 we will have some protocols agreed
By March 2016 training plans will be in place to support their implementation. / DCHS, DHcFT
DRH,CRH / There have been some very serious incidents reported nationally and recently at Sherwood Forest Hospital resulting in coroners letters to the provider. By having some clear arrangements we can reduce the risk when joint action with the police is required.
Having clearer policies in health will ensure we use police time more wisely.
Patient care will be improved. / Crisis concordat sub group
2.9 / Missing Persons Policies.
Ensure that county wide absent without leave (AWOL) policies reflect wording in the CCC.
Consistent application of a shared definition of high, medium and low risk embedded throughout the police and MH trust and independent hospitals in Derbyshire. / By June 2015 a county wide AWOL policy signed up to by police, trust and private providers / Derbyshire Constabulary and DHcFT
DCHS,
Cygnet Health Care, CambianHealth Care, Lighthouse Health Care HuntercombeHealth Care / Ensure that county wide AWOL policies reflect wording in the CCC
- Police services should establish a consistent approach to the reporting of missing/absent by health partners based upon an appropriate review of all available information
- The AWOL policy needs to reflect police practices in relation to missing persons to avoid confusion over different levels of risk
2.10 / Restraint Review all cases where police are used for restraint purposes. The number of times the police are called to perform this function is currently not understood. Further work is required to collate and review this information. / By Mar 15 all use of police restraint in a MH setting will be reviewed at an appropriate multi agency forum. / DHcFT
DCHS
Derbyshire Constabulary / Ensure that protocols clearly state that use of police to restrain patients is only used on an exceptional basis and where there is a clear and pressing ‘policing purpose’. / Crisis concordat sub group
2.11 / Develop assurance mechanisms through the crisis concordat group to review and disseminate learning from incidents to improve services. / March 2015 / Quality team Hardwick CCG and adult Safeguarding