South Gloucestershire Mental Health Crisis Care Concordat – Action Plan v 2.4
Appendix 1
The Mental Health Crisis Care Concordat
- The Mental Health Crisis Care Concordatis a national agreement between services and agencies involved in the care and support of people in crisis. It sets out how organisations will work together better to make sure that people get the help they need when they are having a mental health crisis.
- Access to support before crisis point – making sure people with mental health problems can get help 24 hours a day and that when they ask for help, they are taken seriously.
- Urgent and emergency access to crisis care – making sure that a mental health crisis is treated with the same urgency as a physical health emergency.
- Quality of treatment and care when in crisis – making sure that people are treated with dignity and respect, in a therapeutic environment.
- Recovery and staying well – preventing future crises by making sure people are referred to appropriate services.
Click here to access the Crisis Care Concordat.
All references and guidance can be found here: Mental Health Crisis Care Concordat
The South Gloucestershire Mental Health Crisis Care Concordat action plan is a multi-agency plan. The plan sets out key actions to improve support to people presenting in mental health crisis in any setting in the community or in health, social care or criminal justice services. It is anticipated that the plan will change and develop over time. If you have any comments or additions please send them to:
RAG rating GREEN = achieved AMBER = in progress/ongoingRED = no progress
A1.Early Intervention – protecting people whose circumstances make them vulnerable
Theme: Access to support before crisis
Ref / Focus / Outcomes / Lead By / TimescalesA1.1.1 / Communications campaign around mental health and associated services – making every contact count. / New mental health web content for South Gloucestershire Council (SGC) and South Gloucestershire Clinical Commissioning Group (CCG)
New SGC web content live December 2015 – It will now be road tested by a range of partners and updated again after feedback.
Links with updated website on CCG website. / SGC
CCG / September 2015 – web pages in place
A1.1.2 / Communications campaign – via The Care Forum and South Gloucestershire Mental Health Partnership
- increased referrals to early interventions services all ages
- annual communications plan agreed by Mental Health Partnership
- publicise self-referral options for people who use services
Update: Annual communications plan in place but for SGC only. After last year’s events there was a clear and measurable increase in web traffic and referrals. CCG to agree plan for 16/17 / 1. SGC Dept of Public Health
MH Programme Lead
2. CCG – Communications
3. The Care Forum / September 2015
A1.1.3 / Mental Health Awareness Week Information Campaign in South Glos.
Campaign took place May 2015 evaluation available 159 people engaged with and 39 signposted to interventions. / Mental Health Partnership / May 2015
A1.1.4 / Time to Talk e-campaign on SGC website.
Content was added / SGC / September 2015
A1.1.5 / Projects linked to Everybody’s Business Grants
25 grants awarded to a range of interventions working with different at risk communities across South Gloucestershire. Evaluation report due May 2016 / SGC Public Health / May 2015
A1.1.6 / To understand demand created by Mental Ill Health on the Constabulary and ensure that where appropriate our partners are informed of trends and possible service delivery concerns. / 1)Current demand analysis shows a base level of approximately 5%. As our ability to identify this more clearly increases this is expected to rise;
2)This data will allow targeting, evidence based engagement with relevant partners to better serve our communities;
Analysis of the CQC data allows us and partner agencies to predict problem and growth areas for mental ill health, which we can compare with our own system analysis and feedback to partners to ensure adequate care is put in place, i.e. older population demographics, increased dementia risk, leading to increased service demand through missing persons, etc. / Avon & Somerset Constabulary / Multi-agency group meeting 29/1/16
Ref / Focus / Outcomes / Lead By / Timescales
A1.2.1 / People in crisis presenting at North Bristol Trust / For Southmead Emergency Department to be aware of South Glos services and provision. / NBT
CCG / April 2015
A1.2.2 / To improve partnership working with the psychiatric liaison team and services in the community. 23.11.15 – AWP Service Manager (RS)working closely with NBT Service Manager (JB) to understand repeat attendees and to ensure more robust crisis and contingency plans.
JB and RS analysing specific cases where delays may have occurred and understand issues. / Psychiatric Liaison team – NBT
AWP / ongoing
A1.2.3 / AWP and NBT to discuss trainee rotation induction and identify what AWP input would be useful. 23.11.15 – JB providing training to trainees and AWP Intensive Support Team will also provide training / AWP
NBT / ongoing
A1.3.1 / People presenting with Drug & Alcohol problems, who are admitted or in the ED at NBT. / South Glos AWP will work jointly with the South West Clinical Network to include local mental health information in111. / AWP joint bid
SGL Work-force Dev. Group / September 2015
A1.3.2 / Proactive cross promotion of services i.e. Mental Health & drug and alcohol / To ensure patients with drug and alcohol problems receive appropriate community services.
All services to be aware of drug and alcohol pathway -24/7
Confirmation of alcohol liaison service developments
Joint work being developed between DAAT and Mental Health Partnership. DAAT representation at MH Partnership and MH Workforce development group.
Update: Healthwatch held a Substance misuse and mental health session for dual diagnosis service users to gather their views on how services can be improved.
Update: / SGC Public Health (Dual Diagnosis Lead) AWP
Developing Health and Independence/ PHE
NBT / May 2015
A1.3.3 / Mental Health attendance at monthly D&A panel
-Improve case awareness
-Improve treatment pathway
Update: Monthly MAP – multi-agency planning meeting. AWP specialist drug and alcohol services attend. To explore if AWP Community Services could bring specific cases for discussion. / May 2015
A1.4.1 / Improving Access to Psychological Therapies services (IAPT) / Increase uptake of IAPT services by adults aged over 65 years
Increase update of IAPT services by people from BME communities
Increase uptake of IAPT services for people with Autism
Increase uptake of IAPT services for people with a learning disability
Increase uptake of IAPT services for people with sensory impairments
Update: Recovery outcomes have improved for the South Glos IAPT service. / CCG
IAPT providers
Sirona Care and Health CLDT / October 2015
Ref / Focus / Outcomes / Lead By / Timescales
A1.4.2 / Analysis of presenting needs of IAPT service users through mental health cluster data and ICD 10 codes.
Improved understanding of patient cohort to inform future service planning. / CCG
IAPT providers / May 2015
A1.4.3 / Healthwatch South Gloucestershire has a representative attending and feeding into the IAPT re-commissioning programme board and feeding back to keep Healthwatch informed.
Healthwatch has been commissioned to run focus groups to hear from identified communities who have experienced low mood, anxiety, bereavement, postnatal depression or stress a report will completed in March 2016.
First consultation groups have taken place including work with new mums, substance misusers and isolated older people. / Healthwatch
CCG
SGC – public health / Due to report March 2016
A1.5.1 / People with a learning disability with mental ill health / Audit against new version of green light toolkit / CCG
AWP
Sirona Care and Health / May 2015 – Date to be confirmed for early 2016.
A1.5.2 / Sirona Care and Health provide 2 LD Liaison nurses at NBT who provide Monday – Friday 9-5. There is demand for 7 day a week provision.
Analysis of demand for 7 day a week service.
Update: This is now scheduled for Q3 2016/17. The service is exploring provision for 16-18 year olds currently. / Sirona Care & Health
NBT / September 2015
A1.6.1 / Appropriate and proportionate responses to individuals in mental health crisis / Implementation of the joint Avon & Somerset Constabulary and Mental Health supervision group. Open to other agencies.
23.11.15 - Update supervision group going well. Now exploring AWP attendance at training days – 03.12.15.
AWP exploring with CCG possibility of control room triage. / AWP
Avon & Somerset Constabulary / October 2014
A1.6.2 / Continue commissioning of the Primary Care Liaison Service – providing early assessment and support for people in mental distress. / CCG
AWP / Ongoing
A1.6.3 / Appropriate adult service – SGC will commission appropriate adult service from April 2015 as part of the Better Care Fund. Supervision and training for volunteers will be part of this service.
Update: new provider Brandon Trust commissioned with the Police. / SGC / October 2015
A1.6.4 / What services are available to support NBT with patients who are on wards and become disturbed and violent requiring police assistance?
For May agenda. / Multi-agency discussion / Ongoing
A1.7.1 / Strategic planning for vulnerable groups. / South Gloucestershire Mental Health Needs Assessment to identify local priority groups experiencing the biggest mental health inequalities.
Needs assessment signed off by Health and Wellbeing Board summer 2015 recommendations are now being formed into a local MH Action Plan which has identified local priority groups. / Public Health – SGC (MH Programme Lead) / May 2015
A1.7.2 / South Gloucestershire Mental Health Strategy to outline local approach to supporting priority groups who experience the biggest mental health inequalities.
This has not yet been done aim to complete by April 2016 / SGC Public Health (MH Programme Lead) / September 2015
B1.Urgent and emergency access to crisis care
Ref / Focus / Outcomes / Lead By / TimescalesB1 / People in crisis are vulnerable and must be kept safe, have their needs met appropriately and be helped to achieve recovery / Support for people in crisis should be based in the community whenever possible. / Key principle for all stakeholders / ongoing
B1.1 / People presenting with self-harm in the Emergency Department / Audit of ED presentation for the mental health needs assessment. Data available for the psychiatric liaison team 9am-5pm. Analysis of out of hours data to be investigated.
Data analysis to be included in mental health needs assessment
Review of data by Suicide and Self Harm prevention steering group
NBT Psychiatric Liaison service to attend Suicide and self harm steering group
Data in needs assessment and linked actions overseen by the treatment and rehabilitation group.
Analysis of young people (under 19 years) attending ED for Mental Health and Self-harm in the young people’s needs assessment. / NBT & Public Health / May 2015
B1.2 / People in secondary mental health services who suffer relapse / Increase in the number of people with a crisis and contingency plan.
Baseline AWP data April 2014-Jan 2015 Psychotic crisis 64.5%
Severe Psychotic depression 57.4%
Update 23.11.15 – people on CPA with Crisis and Contingency Plans now at 98.9%. / AWP / CCG / Monthly Monitoring
B1.3 / People with a learning difficulty who relapse / Audit of individuals who have a crisis and contingency plan. / Sirona / CCG / Monthly Monitoring in place
B1.4 / Review of acute and psychiatric intensive care bed capacity / Acute bed capacity planning for short and medium term for South Gloucestershire residents. Business case agreed for additional investment in psychiatric intensive care unit capacity (PICU) for 15/16. 23.11.15 – Commissioned bed increased by CCG x2 Adults of Working Age and 1.5 PICU. / CCG
AWP / March 2015
B1.5 / S136 detentions when individuals are intoxicated / Review of current audit of individuals who were intoxicated at time of detention and outcomes for those individuals. 23.11.15 -S136 quarterly reports provided by Mark Bunker, QD, Bristol (AWP) and circulated to CCGs. / AWP / Avon & Somerset Constabulary
Mental Health Partnership / May 2015
B2.Equal Access
Ref / Focus / Outcomes / Lead By / TimescalesB2.1 / People with sensory loss / Awareness raising, recording of physical disabilities including information about support for people with sensory loss in new mental health communications. Accessibility of information and interpretation.
23.11.15 – AWP provide interpretation services and information leaflets and access to specialist deaf services. / Primary Care
Sirona
AWP / September 2015
B2.3 / Audit of people from BME communities accessing secondary mental health services / Audit of caseload and inpatient caseload data compared to prevalence in the wider community. Analysis to be included in the mental health needs assessment to inform the mental health strategy. / AWP
CCG
SGC Public Health / Needs assessment completed. Mental Health Strategy scheduled April 2016
B2.4 / People with cognitive impairment or who lack capacity / Commission appropriate adult service. Funding transfer for appropriate adult service via the Better Care Fund from April 2015. / SGC
Avon & Somerset Constabulary
Brandon Trust
B2.5 / Support to vulnerable adults who are sub threshold of statutory services / Co-commissioning project on community provision – Joint commissioning group reporting to Mental Health Partnership
25 grants given out to boost capacity. Another grant round running for 2016/17 / SGC + Joint commissioning
Group / April 2015
B2.6 / English as a second language / Accessibility of information and interpretation. / All Services / Ongoing
B2.7 / Gypsy and Traveller Community / The traveller liaison unit at Patchway Library and Avon & Somerset Constabulary residents meetings. / Multi-agency / Ongoing
B2.8 / Mental Health & Primary Care / Exploring provision from the community hubs in priority neighbourhoodsand increase joint working with primary care and social care where space available. This links to the information campaign.
23.11.15 – AWP attending GP Cluster 6 Steering Group and hopeful to secure rooms for Talking Therapies and PCLS co location.
AWP attending GP Cluster Multi-Disciplinary Meeting s. / AWP
IAPT
Sirona
Primary Care / March 2015
B3. Access and new models of working for children and young people
Ref / Focus / Outcomes / Lead By / TimescalesB3.1 / Earlier access to mental health support for children and young people /
- Have earlier access to CAMHS – re-look at criteria
- Have a 247 Service, i.e. text / email / phone / Facebook
- Access more help from School Nurses
- Give CYP access to Websites, posters, events & school lessons
- Friendlier access to GPs
- More counselling in schools
- More mental health and Drug Alcohol organisations in schools
Waiting list initiative in place until March 2016. CCG submitting business case to maintain capacity.
Children’s Mental Health Needs Assessment draft out for consultation.
Partnership Outreach Team pilot implemented September 2015 to support young people attending ED. / NBT
CCG / Pilot running
B3.3 / New piloted service ‘Off the Record’ which provides a counselling service to South Gloucestershire Young People aged 11-15, based in three locations within South Glos.
CCG Business case agreed to increase capacity in service – April 2015 / SGC Public Health (MH Programme Lead) / CCG / Commenced
B3.4 / Explore working with schools starting with children in Year 1 (5-6 yrs olds). To be looked at with the findings from the school mental wellbeing survey.
Audit of counselling provision across SGC schools (secondary and primary)
Improved CYP mental health content including service access information held by all key partners
Develop a local Mental Health toolkit aimed at school staff, students and parents
Anxiety in school toolkit to be launched May 2016
CYP needs assessment outlines lots of data relating to schools.
Primary schools have a much more limited offer than secondary schools. / SGC Public Health / September 2015
Ref / Focus / Outcomes / Lead By / Timescales
Tier 1 support:
- Work on a 24/7 support service for CYP, i.e. websites/text/email/phone/Facebook/posters/events and school lessons.
- ‘Core’ offer for counselling services in schools and better access and support from School Nurses.
- Specific MH training to staff working with YP (a lot of training focus in adults)
B3.2 / Increasing support for young people in crisis. / Fixed term NHS England funding secured for Bristol and South Glos for a Crisis and Assertive outreach service for young people. This will allow the current CAMHS Provider (Community Children’s Health Partnership) to explore more intensive models of support and extended hours working. The pilot will be evaluated and will inform re-commissioning plans for community children’s health services.
Partnership Outreach Team pilot started September 2015. / NBT / CCG / May 2015
B3.3 / Equal access for young people / Participation work is undertaken by Barnardos who are in partnership with NBT (CCHP). One area of their work is to provide engagement with ALL children and young people for all circumstances and backgrounds. / NBT
CCG / Completed
B3.4 / Supporting young people in crisis / Tier 1- Core ‘offer’ for counselling services to be developed for all schools.
Update: Off the Record Resilience Lab has been rolled out via six secondary schools and one FE college. Lack of offer for Primary schools / SGC maybe SGC Public Health (MH Prog. Lead) / In progress
B3.5 / Tier 2 - ‘Off the Record’ currently providing a counselling service to South Gloucestershire young people aged between 11-15 years, based in three locations within South Glos.
Update: service currently in 3 locations. CCG business case in commissioning round for consideration to extend to three places. / SG CCG / Completed but capacity issues
B3.6 / Tier 3 – The Community CAMHS service runs on a referral basis with resulting waiting times. The hospital CAMHS team is based at the Bristol children’s hospital and is available for assessments from 9am to 5pm Monday to Friday.
Update: CCG business case in Commissioning round to maintain capacity.
Transformation plan in place from 15/16 / SG CCG / Completed but capacity issues
B3.7 / Tier 3.5 - There is an on call CAMHS consultant for out of hours consultations at the children’s hospital or on the telephone should an emergency situation arise. This can be accessed by GPs, social care and other health professionals where appropriate. / Completed but capacity issues
B3.8 / The AWP 136 place of safety suite is now able to take young people (14-18) on the NBT site as an alternative to the police cell. / February 2015
B3.9 / NBT to confirm pathway for young people presenting in crisis. / NBT / May 2015
B3.10 / Tier 4 – Inpatient service commissioned by NHS England. (but there is a recognition by NHSE that the bed capacity is not sufficient for CAMHS and therefore a review is underway) / NHSE / Ongoing
B3.11 / Perinatal mental health / Perinatal mental health - there is an emerging national focus on perinatal mental health services, it is a key priority, and it features in the ‘Forward View into Action’ planning guidance for 2015/16. The Maternity and Children Strategic Clinical Network is carrying out a piece of work to develop a regional consensus as to the way forward for these services in the South West.
A questionnaire was circulated to gain a better understanding of the current provision of perinatal mental health services across the South West. From this the Network has created a vision for perinatal and infant mental health services in the South West, with suggested actions and the prioritised list of standards from the NSPCC Prevention in Mind document. This will be taken forward by the Network and the CCGs. This will be BNSSG wide for SG.
Local PND group with first meeting held November 2015 and next meeting Feb 2016. Local areas for service development gathered and the lack of data across the system identified as biggest challenge
Wehave set up a South Gloucestershire PIMH Strategy group to look at the current services and identify gaps. With further transformation funding in 2016 we can start to plan future services to fill these gaps and create a Bristol and South Gloucestershire Community PIMH service. / BNSSG system pathway
B4.All staff should have the right skills and training to respond to mental health crises appropriately