Devon Street Triage Pilot

Progress Report April 2014

Where we were?

  • High use of detentions made under s.136
  • High number of individuals held in police custody
  • Delays in the mental health pathway into Urgent/Crisis and Inpatient services
  • Police and mental health services often working in isolation
  • Lack of mental health awareness and expertise across front line policing
  • Risk averse culture within the police force
  • Significant time spent by officers in processing individuals with Mental Health conditions, leading to high costs and inefficiencies
  • Unclear pathways into mental health services for individuals needing support
  • Poor information sharing across agencies with lack of ‘joined up’ approaches

Where are we now?

  • Newly commissioned Street Triage pilot service Devon, Plymouth, Torbay (telephone advice and support via police ‘Control Room’ and urban ‘call out’ in Exeter and Plymouth – operational from 6th March 2014)
  • Reducing numbers of detentions made under s.136
  • Development integrated pathways
  • Timely intervention by mental health services leading to time saving for police force
  • Provision of alternatives to custody and/or mental health inpatient services
  • Information sharing and partnership working
  • Joint decision making – avoiding isolative working practice
  • Robust risk management with joint agency planning
  • Significantly improved outcomes for vulnerable individuals
  • Strengthened relations between front line services
  • Improvements in the understanding of mental health presentations by police officers
  • Significant saving in time for both the police as well as the health service
  • Crisis Care Concordat 2014

Where are we heading?

  • Even greater reduction in s.136 and improved decision making
  • A sustainable, efficient and solution focused model
  • Development of clear national business case and service specification
  • Maintaining integration, collaboration and partnership working
  • Consistently enhanced decision making
  • Embedded information sharing agreements and protocols
  • Sustained outcomes for all agencies
  • Consistent and safe risk management
  • Clear and consistent information sharing agreements
  • Cost benefit analysis to quantify efficiencies and savings
  • Building a strong set of data
  • Supporting development of a national service specification

Additional Evidence of Success:(full summary report expected end of quarter 1)

  • March 2014

Police officers in control room accessing clinical record via MHP to check risk assessment. Avoiding s.136 by negotiating crisis and risk plan, CRHT appt. Next day. Suicidal person reassured on appt time and reduced risk avoiding s.136

  • March 30th 2014

Hi there,
I just wanted to note that I had a call from a suicidal female sitting on the harbour wall in Ilfracombe tonight log 902 30/03/2014. The lady was very drowsy and very hard to get information from, Mark the street triage worker noted that I was talking to a suicidal person and came over. It made the call a lot easier when he gave me some additional questions to ask over and above the ones we do ask persons when they are suicidal.
If we could get some extra questions from them when dealing I think we would all find this very helpful.
Officers got there in time and were able to pull the female off the wall before she had a chance to do anything.
Thought I would just pass this information onto you. It is an asset to the room to have them here.
Dawn
DawnPugsley - 55380
Radio Despatch Operator
Exeter Control RoomCMCD – HeadquartersDevon and Cornwall Constabulary

  • March 2014

Sir
At the time I was assisting Inspector CUNNINGHAM on two authorized firearms incidents in Exeter but was aware of this incident and the Street Triage workers input. The Street Triage Worker was Mark RATTENBURY and he went and supported RDO PUGSLEY who was on the line to the female until Police were with her. I understand Mark assisted Dawn in prompting her with some questions to ask. I also know Mark spoke with the officers at scene and advised them that in view of her behaviour that evening she should be considered high risk of self-harm. Mark advised the officers that female should be seen by paramedics to triage the need for further assessment at A&E . I understand this happened and the female went voluntarily to the hospital with Ambulance with Police officers following.
I tried to speak tonight with the officers who attended to seek their views on the input by the Street Triage Worker and if this assisted in their decision making process but unfortunately they are now on rest days.
Robert
Sgt 16509 Robert NUNN
Section One
CM&CU East
HQ Middlemoor
Exeter

  • April 2014

Female North Devon calls 999.

She is standing on cliffs and considering jumping off onto rocks below.

999 call handler recognises that this person may have mental health issues and alerts Sergeant in control room.

MH Nurse Street Triage notified of incident andreviews clinical information.

MH Nurse identifies through viewing clinical records that person is well known to MH Services.

MH Nurse sits with 999 call handler and whilst 999 call handler on call to female -advises call handler questions to ask female to establish risk.

Female willing to be taken informally to Hospital for MH assessment.

MH Nurse contacts DPT Night Practitioner who agrees to assess female.

Female transported to Hospital by Police (I think) and is assessed by Night Practitioner.

Outcome- post assessment female discharged home.

Evidence of potential s.136 aversion

  • March 14th 2014

Urban ‘call out’ to support officers with a lady thought to be experiencing mental health problems

Patient is well known to services and was threatening to jump out of her windowat hersupportive residential accommodation. Clinical record accessed by mental health clinician who confirmed that she had previouspsychotic episodesand readher relapse indicators from her most recent care plan.

Accompanied police officers,assessed her briefly and recognisedthat a few relapse indicators were present. Clinician assessed risk and offered the lady an informal admission to psychiatric inpatient unit, to which she agreed. Crisis Resolution, Home Treatment were still in working hours sothis referral was ‘gate kept’ to provide smooth transition into service avoiding the need to duplicate assessment. Clinician liaised withGlenbourne unit and a bed wasidentified. Clinician then transported the lady with an officer and handed care over to Glenbourne unit.

Aversion of potential s.136 and subsequent formal detention order.

Significant saving in time and resource

Evidence of excellent joint working across agencies in support of risk management and access to Urgent & Inpatient care pathway

TF/140414 – NEW Devon CCG

Chair: Dr Tim Burke

Chief Officer: Rebecca Harriott

Newcourt House, Old Rydon Lane, Exeter, EX2 7JU

Tel. 01392 205205