London’s Mental Health Crisis Care Summit: 25 th February 2016 Session Three: Discussion session - Moving forward to implement the vision in London 1 The last session asked delegates to sit in their UEC network region and discuss their vision for crisis care in the next 1, 2 and 5 years and what actions and support is required to achieve this. Delegates were asked to think about the following questions: What changes will you aim to achieve in the next one, two and five years? What is needed to achieve these changes? What enablers already exist and what further support is required? Changes to occur over 1, 2 and 5 years Increased focus on prevention Increased community provision and alternatives to admission and ED Increased use of non-clinical models e.g. crisis houses, crisis cafes, better use of third sector support Ensuring a 24 hour service Whole system approach with integrated systems and joined up commissioning Pan-London approach to bed management Requirements to support system change: Increased mental health commissioning capacity and capability Ensuring local engagement and co-design with service users Partnership working with local authorities particularly around issues such as housing Robust data and evidence base Ensuring workforce has the right skills (training for existing and future staff) Clear policies Information sharing and supporting technology Common themes from the session are summarised below and some feedback specific to each of the network discussions is captured on the following slides. This information can be used by the Networks when developing the urgent and emergency care element of their sustainability and transformation (STP) plans going forward.

2-5 years: What should we aim to achieve? A wider system approach to change looking at a joint pan-London approach to acute bed management. What do we need to do to achieve this? Before any plans are agreed South West London are keen to ensure that plans and underpinning assumptions are rigorously and independently tested. To do this a capacity and demand modelling exercise has recently taken place to provide an independent analysis and assessment of the potential for change in key aspects of the capacity, organisation and delivery of acute adult mental health services. South West London (SWL): Moving forward to implement the vision in London years: What should we aim to achieve? Increased community provision to address crisis care Increased partnership working across Acute and MH Trusts as well as increased partnership working with local authority and the third sector Clear urgent care mental health pathway understood by patients and staff Croydon Richmond Wandsworth Kingston Merton Sutton What do we need to do to achieve this? South West London are looking at a range of options to improve the urgent care pathway for mental health patients, the different service models being scoped include: A Psychiatric Decision Unit (PDU) – considering the feasibility of a place where those in a mental health crisis can be taken (either self-referral or by the Police or LAS) for further assessment and treatment. This provides an alternative for the Police rather than taking the individual to ED or sectioning under 136. South West London are looking at the benefits of both the Birmingham and Leeds models. The benefit of crisis cafes have also been looked at to introduce a non-clinical alternative for mental health crisis patients, the crisis café in Aldershot is a model that SWL are learning from and looking to adapt for the SWL population, this includes the potential of a 24 hour service rather than 6pm-12pm. UEC Network Group Discussion and feedback

2-5 years: What should we aim to achieve? Increased integration between health and Local Authority e.g. Psychiatric liaison teams to include social care, enabling a more holistic approach to care. A whole system strategy for mental health which results in a joined up approach across services, enabling seamless pathways and care to be wrapped around the individual. What do we need to do to achieve this? A strong evidence base to inform service redesign. Partnership working and co-funding between CCGs and Local Authorities A tiered approach to mental health care, focussing on prevention, early intervention and an appropriate urgent response when required. Consideration should be given to commissioning fewer more specialised units: -Potentially a specialist hub and spoke model for responding to children and young people in crisis, helping to ensure that their specific needs can be adequately met at any time of day. -Potentially centralising the provision of health based places of safety across North Central London to provide one unit with improved capability and capacity. UEC Network Group Discussion and feedback North Central London (NCL): Moving forward to implement the vision in London years: What should we aim to achieve? Ensure that the right data is collected regularly and used to better understand existing service provision, demand and service gaps to make a case for change in the way crisis services are provided and inform local plans. Commissioners across NCL should consider jointly commissioning psychiatric liaison services in EDs across the network’s footprint to ensure a consistent service offer for mental health patients who might attend any one of the sites. This would also promote better partnership working and sharing of best practice between the liaison teams based at the different EDs. What do we need to do to achieve this? Data from EDs to understand who is presenting in mental health crisis and what alternative service provision might look like. Local engagement and co-design, ensuring there is service user input when developing new service models. Stronger mental health commissioning across the network – possibly achieved by more collaboration across CCGs and boroughs. New funding that can be pooled to focus on specific areas of innovation, enabling new approaches to be tested and evaluated properly. Engaging physical health providers around improving the experience for individuals presenting in crisis, including addressing the training needs of frontline staff in acute settings to enable them to better manage people in crisis. Barnet Enfield Haringey Camden Islington

2-5 years: What should we aim to achieve? Broader societal changes regarding mental health – increased focus on the social determinants of mental-ill health, attitudes and education to support progression towards a preventative model. Consistency of care across the network which puts an end to the postcode lottery. What do we need to do to achieve this? Involve service users at every level when developing the strategic direction and implementing service changes. More work is needed to understand why people end up in crisis, this will require a particular focus on the needs of different social/cultural groups South East London (SEL): Moving forward to implement the vision in London years: What should we aim to achieve? Recognise the contribution of the voluntary sector in crisis care and utilise this resource better. Introduce more best practice care models including crisis houses, crisis cafes and other service models providing alternatives to A&E. More effective prevention services across South East London to prevent mental health crises from occurring where possible. Training and awareness - Upskilling staff in mental health crisis and educating the general population about mental health to reduce stigma. Further inclusion of service user groups to drive the case for change and inform the direction of service redesign. What do we need to do to achieve this? Improved communication between services and across voluntary and health sector including: -Information and resource sharing -Include voluntary sector services in a comprehensive local directory of services Use technology better to improve communication across services, enabling appropriate information sharing for more holistic care. Engage more service users in co-design work. Strengthen mental health commissioning capacity locally. Better use of data to inform commissioning and the strategic approach going forward. Lambeth Bromley Bexley Greenwich Lewisham Southwark UEC Network Group Discussion and feedback

North West London (NWL): Moving forward to implement the vision in London 1-2 years: What should we aim to achieve? Address the issues of stigma and lack of parity experienced by mental health patients in emergency departments Address the gaps between services, particularly for 16/17 year olds in single point of access What do we need to do to achieve this? Move away from the medical model and preventing people from getting into crisis e.g. scoping crisis cafes across NWL Strengthen working arrangements and communication between services and sectors e.g. Acute Trusts and mental health community teams Audit of crisis plans 2-5 years: What should we aim to achieve? More focus on prevention; tackling issues downstream from S136, contingency planning to prevent repeat sectioning Improved offer for people in crisis, do something constructive, less ‘patching people up’ Extending the new single point of access to include children and young people and older people Holistic care e.g. increased provision of community services, joined up work with social care and housing. Increased access to data to ensure services designed in response to demand Police are not involved where people are known to services, unless there is good reason. What do we need to do to achieve this? Addressing the broader question of vulnerability and the impact this has on individuals’ mental health Improving the way we work together e.g. trust each others’ assessments, proper care planning, how we share, work with all partners, including the Police - creative thinking between health and social care. Better contingency planning for people known to services Move towards outcomes based commissioning, and services based around that, not bed days etc. Addressing the staffing issues (mental health nursing shortage and having a better understanding of the skill mix required from the future workforce; refer to the social work ‘Think Ahead’ model) Thinking broader than Places of Safety but places of support e.g. crisis cafes. Brent Ealing H&F Harrow Hounslow K&C Westminster Hillingdon UEC Network Group Discussion and feedback 5

North East London (NEL) : Moving forward to implement the vision in London 1-2 years: What should we aim to achieve? Understand the needs (diagnosed and undiagnosed) of our populations through the needs analysis work to be carried out in 2016/17 Share and evaluate good practice across the NEL UEC Network arising from the actions developed in response to the crisis concordant plans Review safe alternatives to / or within the ED space for people in mental health crisis Improve service user experience within the ED for people in mental health crisis Improve the skills/understanding across our UEC system for all staff coming into contact with people who have a mental healthcare need Review opportunities to integrate our urgent care system closer to home (physical/mental health needs), e.g. through a Single Point of Access, Summary Care Record What do we need to do to achieve this? Work together across NEL to share good practice and roll out schemes where positively evaluated Work up Organisational Development plans which support improving staff understanding of people with a mental health needs Focus on integrating service delivery for people with physical and mental health needs within service redesign and other relevant areas Continually review service user satisfaction rates 2-5 years: What should we aim to achieve? Continue to improve the integration within the urgent care system closer to home Continue to strive to improve integrated models of care What do we need to do to achieve this? Revision of needs analysis Continually review service user satisfaction rates and undertake impact analysis of current service provision to understand what works well Joined up planning around mental health service delivery Barking and Dagenham Hackney Havering Newham Redbridge Tower Hamlets Waltham Forest 6 UEC Network Group Discussion and feedback