Evening Seminar

Commissioning Street Triage ServicesKate FlemingHome Office Safeguarding & Vulnerable People Unitand

Mark SmithHead of Suicide Prevention & Mental Health, British Transport Police

29 September, 2014

Mental Health “Street” Triage Academy for Justice Commissioning Seminar

Presented by: Kate FlemingDate: 29 September 2014

Background

• One in four adults experiences at least one diagnosable mental health problem in any one year

• At 22.8%, mental ill health is the largest disease burden within the UK. Bigger than cardiovascular disease or cancer. Yet mental health services receive 11% of funding

• Parity of esteem

• Estimated 20% of police time spent on mental health – police as “gateway service”

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Some of the work being done in this area…• Joint Department of Health and Home Office review of the

operation of Sections 135 and 136 of the Mental Health Act

• Police custody healthcare transfer

• Mental Health Crisis Care Concordat

• Training – work with the College of Police

• Policing and Mental Health Summit – products and policy options

• Data toolkit

…and Triage4

What is mental health triage?

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MODELS:

Control room/ advice line

Control room/ advice line and mobile capability

Mobile mental health professional

Mobile mental health professional and police officer

Mobile mental health professional and police officer and paramedic

AIM: to improve the experience, outcomes and access into health services for individuals at the point of crisis.

Mental health triage refers to a service where mental health professionals support and provide advice to police officers responding to incidents, either in person or via telephone, where there is a mental health issue.

Early results

• Improved partnership working and communication between agencies• Greater understanding of mental health issues• Improved confidence in dealing with persons suffering with mental

health issues• Faster response to deal with those suffering from mental health issues

or at crisis point• Time taken to deal with S136 detentions has been reduced• Reduction in detentions under S136 of the Mental Health Act• Of those detained under S136 of the Mental Health Act, the transfer

rate to further admission under the act is high (80%)• Local success has led for demand to extend the scheme• Incidents diverted from A+E• Fewer repeat calls

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Examples

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1. Report from mother that daughter suffering from mental health episode ,was banging on the door of the house trying to get in. Extensive history with services and showing signs of a having a psychotic episode.

Street triage team deployed and following face to face assessment identified that patient was currently under home treatment but beginning to disengage. Urgent referral to her team undertaken and she was seen later that day.

2. Midwife contacts police with concerns over 35 week pregnant female suffering from mental health issues threatening to harm unborn baby.

Police officer contacts the triage team, who immediately attend to undertake a mental health assessment.

3. Reports received of a male claiming he wished to commit suicide, and attempts to jump in front of moving tram.

Following advice from the triage advice line, the police officer detained the individual under Section136 of the Mental Health Act. Nurse on the triage line was able to support arrangements for the individual to be taken to a health based place of safety.

Experiences of triage

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“An officer and a mental health team member visited me at home… they were helpful and friendly. They made me feel at ease.”

Service User

“Nobody has a bad word to say about it. I was sceptical at first but it’s unbelievable the amount of time it’s saved. We have to keep it. ”

Response Officer, Street Triage

“It’s definitely the way forward.”

Street Triage Nurse

“They come out to see you; it isn’t just a telephone call. It has really helped because they have given me information that other places I have been to haven’t. I am no longer lost and I am finally going to get the help that I have been longing for”

Service User

The Future

Standard core specification Future commissioning options

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…sustainability

Street Triage Scheme

in partnership with NHS England

Mark SmithHead of Suicide prevention and Mental health

Background

BTP National Force• Divisional Command Structure (A, B, C, D)

– A - FHQ – B - East Anglia, the South coast and London,

including London Underground and Docklands Light Railway

– C - Pennines, Midlands, South West and Wales– D - Scotland

• Railway Network, Tube and Trams

C Division

Analysis – incidents

TFL244

12.9%

• Suicides & Injurious Attempts

• 2009 – 2014 (fiscal yrs)

• Total 1891 incidents

Analysis - residence

Suicides & Injurious Attempts

01/04/13 to 31/07/2014

Background….

Mental Health• 2013/14

– BTP dealt with 325 suspected suicides and 91 injury attempts. Of these 47% had a known mental health history.

– BTP prevent more people from taking their own life on the railway each year than there are victims of robbery on the railway – (631 life saving interventions)

Op Partner – B Division• 2013/14 to 2013/12

– BTP nationally saw an increase of 10% in suspected suicides

– In contrast, the main area implementing Operation Partner saw a 14% reduction in suicides

Suicidal Incidents

2013/14 compared to 2012/134227 (2738) incidents– 325 (298) suspected suicides– 91 (86) injurious attempts– 572 (313) non injury attempts– 77 (44) reconnoitring– 892 (796) threats with no attempt– 940 (630) third party reports

– 1330 (570) Para-suicide events

Life Saving Interventions2013/14

• 631 potential life saving interventions• 504 to hospital, 74 to Custody

• Local police made 279 (44%)• Rail Industry made 149 (23%)• BTP made 116 (18%)• Public Made 58 (9%)

Network Rail Period End Report for P13 2013/14

“The interventions made have also had a significant impact on the industry’s finances and performance. Had they not taken place there would have been an additional 773,000 minutes delay across the network at the cost of £91m”

Overview

Objectives:• Ensure appropriate use of S136 • To provide healthcare support to people in crisis on the rail network• Provide rapid access to information and advice in emergency situations to

officers ‘on the ground’• Prevent people returning to the network in crisis• Crisis to Care

In Addition:• Referrals & sign-posting Samaritans, Maytree, Papyrus • Support and enforcement - Acceptable Behaviour Contract (ABCs) • Suicide Prevention Hotline: 0300 123 9101 • Suicide Prevention Plans (SPPs)• Post incident follow ups MH Unit• GP letters• Awareness meetings e.g. MH focus groups

C-SPMH Team – Live 6/5/14

CPN Band 7

3 CPN band 6

2 Researchers

Coordinator

Mon-SunCore Office hours0900 – 1700 hours

Out of hours1700 – 2100 hours

Mon-FriCore Office hours0800 – 1600 hours

Police Sergeant

Identifying Vulnerability• Assessment tools (risk &

bereavement)• Custody Screening• Analysis – people & places

The Model

Managing Risk• Intervention• Diversion• Situational

solutions

Providing Care• Care Plan• Family support• Information sharing• Escalation process

Challenges

Setup• Commissioning

– NHS Birmingham Cross City CCGBirmingham

– Solihull Mental Health NHS Foundation Trust

• Resourcing / Recruitment

Current• NHS information ‘data’ sharing• S136 arrangements

Successes

• Quicker and more effective care administered through real time NHS medical record access

• BTP Staff & officers increased knowledge and understanding of Mental Health and multi-agency work in all capacities

• Reduction in S136

• Suicide Prevention Plans (SPP)

• Support and Enforcement

• Reduce persons attempting to take their own lives/returning to the railways in Crisis

Good News!!

Support & Prosecution Case – Live Incident:

Female came to notice on the tracks:• NHS found she had just seen her psychiatrist,

therefore S136 not required; care team advised to charge

• After the charge the female remarked (to her care coordinator) ‘I won’t be doing that again’

Statistics C-SPMH from 06/05/2014 to 31/08/2014

C-Division• Total incidents Recorded - 916 • Total SPP’s initiated and updated - 323 (1 took their own life)• The NHS team have undertaken 572 separate tasks

Midlands Sub Division• Total incidents recorded - 268 • Total SPP’s initiated and updated – 86

The Midlands Sub Division accounted for approximately 30% of the total recorded suicidal and Mental Health incidents, and just over a quarter (~27%) of all SPP opened or updated.

Contact

• Sue Collins: BTP Project Manager Sue.Collins@btp.pnn.police.uk

• Gareth Davies: InspectorGareth.Davies2@btp.pnn.police.uk

• Karen Barker: Sergeant Karen.Barker@btp.pnn.police.uk

• General Queries: Strategic TeamSPMH@btp.pnn.police.uk

Questions ?