OFFICIAL SENSITIVE:Draft V3 Consultation Version
WELSH GOVERNMENT
Mental Health Crisis Care Concordat
Improving outcomes for people experiencing or at risk of mental health crisis in Wales
Issued in Partnership with:
(Insert Logos of 4 x Police areas; PCCs; BTP; RCofPsy; RCofGPs; ; Wales Ambulance Service NHS Trust; LGA; Others?)
Mental Health Crisis Care Concordat: the joint statement
Partners from the Police, NHS,Local Authority and Third sector are committing to work together to improve the system of care and support for people in crisis due to a mental health condition and who present a significant risk to themselves and/or the wider public.
As partners we agree to work together and intervene early if possible to reduce the likelihood of people becoming at risk because of a mental health condition deteriorating to crisis point.
We further agree to work together to improve the coordination and delivery of care and support, so that people experiencing or at risk of crisis due to a mental health condition are kept safe. They will be helped to find the most appropriate support needed, whatever situation in which that need arose and whichever service they turn to. We will endeavour to ensure that this engagement is promptly conducted without recourse to unnecessary or disproportionate placement within the criminal justice system; for example within police custody.
We agree to work together toward delivering this commitment across Wales.
Partners to the Concordat:
- The Chief Police Officer Group, Wales
- The Welsh Ambulance Service NHS Trust
- Police and Crime Commissioners
- Aneurin Bevan University Health Board
- Abertawe Bro Morgannwg University Health Board
- Betsi Cadwalder University Health Board
- Cwm Taf University Health Board
- Cardiff and Vale University Health Board
- Hywel Dda Local Health Board
- Powys Teaching Health Board
- The Royal College of Psychiatrist
- The Royal College of GPs
- The Royal College of Nursing
- Third Sector: Wales Alliance for Mental Health
- Public Health Wales
- The National Offender Management Service- Wales
- The College of Policing
- The Home Office
- The Department of Work and Pensions
- Welsh Local Government Association
- The Youth Justice Board-Wales
- The Welsh Government
- Healthcare Inspectorate Wales
Contents
Acknowledgements
- The Purpose of the Concordat: a statement of vision
- Aim, purpose and scope: the case for improvement
- Local Partners who plan and commission services
- Four core principles and expected outcomes
- Access to support before crisis point
- Urgent and emergency access to crisis care
- Quality of treatment and care when in crisis
- Recovery and staying well
- Delivery through governance
Annex 1: Requirements under Section 136 Mental Health Act 1983
Annex 2: Definition: Acute Mental Health Crisis
Annex 3: Shared Goals and Proposed actions
Acknowledgements
A record of thanks is extended to everyone who has contributed to the production of the Crisis in Care Concordat - Wales. Of particular importance is to acknowledge the work ofMIND UK who prepared the English Concordat in February 2014. Its work, the structure and content of that document has helped inform the basis of a Welsh Concordat.
The particular support of Welsh Local Health Boards and Ambulance Trust, the Chief Police Officer group, Police and Crime Commissioners, the Royal Colleges and the third sector has been valued and welcomed.
Sincere thanks, also, is extended to the many voices of those who have suffered mental health crisis that have helped shape this document and the particular help offered by Hafal-Cymru in this regard.
Points of Collective Commitment by Partners
-All partners to improve their response to people inmental health crisis: the response needs to be based on a multi-agencyintervention
-Partners will work to reduce the use of section 136 of the Mental Health Act and will aspire to cease to use police custody suites as a place of safety except inexceptional circumstances such as significant violence
-Access to mentalhealth professional advice at the point of crisis, available 24 hours each and every day
-Police vehicles are rarely used to convey people in crisis save for the most violent of individuals;
-The use of any restraint will accord with best practice including College of Policing and other guidelines
-NHS Transport should ideally be commissioned transport and convey people to hospital who are in mental health crisis, but police have a legal duty to accompany that transportation and set out operational plans to do so
-Adherence to the Mental Health Act ‘Code of Practice’ guidance in relation to section 136 must be followed
-Partners should agree where assessment of intoxicated individuals in crisis can safely take place.
-Health and local authority partners to ensure adequate provision of facilities for section 136 assessments for both adults and young people
-When a young person under 18is detained under section 136 in a police station, a serious untoward incident will be recorded allied with an agreement by partners to undertake an immediate case review to determine whether this could have been avoided and learn from that incident.
-Mental Health Act Monitoring groups within health boards will review every section 136 detention within police custody to determine its appropriateness
-Partner agencies will share relevant, need to know information in the interests of patient and public safety. The collection of data such as 136 detentions is reported accurately
-A campaign to further promote the use of and access to the Mental Health CALL 24 hour helpline will be launched
-Partners and the Third sector should be supported to widen their ambition in developing ‘new’ places of safety
- Monitoring delivery of the agreements set out within this Concordat will bereviewedby local Mental Health and Criminal Justice Partnership Boards.
- The Purpose of the Concordat:
OFFICIAL SENSITIVE:Draft V3 Consultation Version
This concordat sets out how partners can work together to deliver a quality response when people with acute mental health problems, need help. It is under-pinned by the Welsh Governments absolute commitment to mental health policy, set out within both its strategy and supported through its code of practice.
Mental ill health is a challenge for anyone who encounters it: the person in crisis, for family and friends and for the services which respond.
Whatever the presenting concern – whether suicidal behaviour, wandering and distress by someone with dementia,extreme anxiety, psychotic episodes or behaviour which seems out of control and likely to cause harm to the person or others – an appropriate and supportive response is crucial.
People in mental health crisis situations should receive help from public services when they need them. The police, social services, ambulance staff, mental health nurses and doctors, Approved Mental Health professionals – all provide a response when severe crisis arise. These services save lives and prevent harm.
This Concordat is a shared agreement, endorsed by the senior leaders from the organisations most heavily involved in responding to mental health crisis. It covers what needs to happen when people in mental health crisis require help – in terms of policy making, investment in services, in anticipating and preventing mental health crisis, and in making sure effective emergency response systems operate in localities when a serious crisis occurs. It makes specific and repeated reference to section 136 of the Mental Health Act 1983 and the obligations placed on relevant partners to discharge their responsibilities accordingly. (Annex 1 refers).
The Concordat is structured around:
- Accessing support before crisis
- Urgent and emergency access to crisis care, whilst using the least restrictive options
- The right quality of treatment and care, including talking therapy
- Recovery and relapse prevention
In every locality across Wales, partnerships of health, criminal justice and local authorities alreadycommit to local mental health crisis within published section 136 plans. These set out required actions that will help deliver the aspirations of this Concordat.Theywill provide common purpose and refresh understanding of the roles and responsibilities of each service.
OFFICIAL SENSITIVE:Draft V3 Consultation Version
- Aim, Purpose and Scope
OFFICIAL SENSITIVE:Draft V3 Consultation Version
This Concordat is a joint statement which describes what people who experience an acute mental health crisis andwho mayhave contact with the police should expect from other public services who respond to their needs.
The Concordat establishes key principles of good practice which services and partners should use to enhance standards and strengthen working arrangements.It includes the voice of service users who have needed these services in the past and were able to share their experiences.
The Concordat requires partners across local health boards to prepare refreshedaction plans designed to bring together the commitments made by partners to help deliver its objectives.
Local Mental Health and Criminal Justice Partnership Boards are well placed to oversee and monitor progress on the delivery of these actions plans. Critically, they can hold partners to account for discharging their responsibilities.
Best practice and organisational learning can be shared at a yearly seminar, designed to maintain focus on this area of service. It should bring together Academic research and practitioner experiences to help improve outcomes.
What Needs To Happen? Whilst the Concordat sets out a national agreement of principles, their adoption and application can only be delivered by buildingon existing local, area wide arrangements.
The ambition is for Local Health Boards, WAST,Police and Local Authorities allied with other partners to agree a collective statement of intent, issued and regulated through area Mental Health and Criminal Justice Partnership Boards. This should include:
- A local declaration, agreed by key agencies which establishes a commitment for partners to work together to improve the experience of people inacute mental health crisis in their area
- A published section 136 action plan setting out improvements to be made over an agreed timescale
- A clear stated outcome within the plan to materially reduce the use of police stations as places of safety and the overall number of section 136 detentions
- A commitment to enhance and refresh mental health sensitivity training of key operational staff
- Evidence of responsive local governance, the development of extra places of safety if required and inclusion of the third sector as a key partner
Scope and Context:This Concordat focuses on people who experience acute mental health crisis (Annex 2 provides a definition). It spans health, social care, criminal justice systems and can extend to areas of work and pensions. It is not age specific. Whilst it’s main focus is on responding to acute need, it does include a clear reference to prevention and intervention.
It builds on existing arrangements and fully endorses current policy and practice guidance, issued through the Welsh Government.
The role of NHS-Wales: The Welsh Government has set out its vision in how it intends to improve and develop all aspects of mental health policy and practice. Its Together for Mental Health strategy[1] places an emphasis on partners adopting preventative measures whilst being responsive to individual crisis. Policy implementation guidance in relation to mental health criminal justice liaison services; mental health services for prisoners and veterans; children and young people requiring mental health services within the youth justice system – has been published and all flow from this strategy.
The Welsh Government’sCode of Practice sets outs out duties and requirements on partners specifically in relation to responding to crisis and using powers under the Mental Health Act 1983.
This Concordat supports and compliments the Mental Health Act Code of Practice for Wales. It requires local health boards and its partners to make sure the emergency response to people in mental health crisis has parity with those with a physical condition.
The Need for Improvement: The evidence which supports the benefit of early intervention when people have a mental health problem is compelling.In its independent inquiry in 2011, Mind found that access to crisis care services varied widely across the UK.[2] The differences in staffing levels, access to places of safety other than a hospital, out-of-hours services, and care planning post discharge were stark.
The ‘Criminal Use of Police Cells’ joint thematic inspection report highlighted the issue of people in crisis being detained by police officers in police custody suites sometimes due to health services being unable to respond often due to lack of capacity.[3] Reducing the dependency on the police and their custody suites is a major priority and driver within this Concordat.
The Independent Commission on Mental Health and Policing[4] made recommendations to police forces nationally on how to prevent serious injury and deaths when officers respond to incidents with people with mental health conditions. As part of its core police business, training and greater emphasis on partnership working was also an important recommendation.
The Concordat addresses these issues by bringing together senior leaders of key organisations who respond to people in mental health crisis in a coordinated way.
OFFICIAL SENSITIVE:Draft V3 Consultation Version
- Local Partners who plan and commission services
OFFICIAL SENSITIVE:Draft V3 Consultation Version
Planning and commissioning services which are responsive to those inacute crisis and which meet local and regional needs are at the heart of effective delivery.Capacity for 24/7 cover and provision of accessible advice and support is key.Multi agency partners must be part of the commissioning cycle which informs area wide judgements and decisions.
Mental Health and Criminal Justice Partnership Boards will have an active role in shaping local crisis response planning. Board composition includes the ‘voice’ of the third sector, the service user and its crucial role in service delivery.
Across Wales, arrangements designed to respond to mental health crisis are already established. The key questions that will aid improvement should include:
- Are local partners content with existing operational protocols; are they locally responsive and effective?
- Is the principle of 24/7 – out of hour’s service provision in place and working?
- Are existing places of safety sufficient to meet reasonable demand? If not, is their a coherent local plan to enhance provision and one that includes and involves the third sector?
- Is the policy within the Mental Health Act Code of Practice for Wales - ofnot usingpolice custody unless exceptional circumstances prevail -universally recognised and being planned for?
- Are there care pathways from police custody and courts which ensure individuals with
co-existing mental health and
substance misuse problems
can access appropriate services?
- Is the planned local response to children and young people in crisis with a mental health concern universally understood and responsive?
- Are the current information systems used by different services accessible by all who require them?
Service planners and commissioners will want to ensure that they have effective local safeguarding arrangements in place to prevent or reduce the risk of significant harm to people whose circumstances make them vulnerable.Addressing these and related questions will enable local commissioners and planners to deliver the ambition within this Concordat. Effective planning and commissioning will ensure that the support offered and services reflect:
- The needs of people of all ages and differing ethnic backgrounds are reflected
- A contribution to planning by all partners
- The voice of service users and groups who represent their views are included in all planning considerations – this could include focus groups to support the service users voice
At a national level, the Welsh Government and its lead partners are able to support, inform and help shape local commissioning plans. Given the composition of mental health and criminal justice partnership boards, these are ideally placed to informplanning of crisis services and to provide oversight of arrangements.
OFFICIAL SENSITIVE:Draft V3 Consultation Version
- Four core principles and expected outcomes
OFFICIAL SENSITIVE:Draft V3 Consultation Version
This section sets out the principles and statutory guidance that all services involved with responding to and dealing with mental health crisis currently follow.It describes where improvements can be considered.
It is well understood that people seeking urgent help with mental ill health and often their friends, families, partners and work colleagues, will approach various services and agencies. They are likely to contact their GP, phone helplines-NHS Direct Wales or 111, approach voluntary groups, faith based organisations, A&E departments, social services, schools, colleges, health boards and the police.
NHS services should be able to ensure that a patient experiencing mental health crisis is assessed by a mental health professional as early in their treatment episode as possible. In the community this means that ambulance services must have the ability to seek advice from and make referrals to mental health services.
These approaches are often characterised with high degree of urgency. The complexity of the crisis is likely to be multi-layered. It is unlikely that anyone single response will be enough to resolve what are often enduring difficulties.