London’s Crisis Care Programme Marilyn Plant, Crisis Care Subgroup Co-chair, GP - Richmond. Emma Whicher, Crisis Care Subgroup Co-chair, London Strategic Clinical Network Clinical Lead, Medical Director at South West London St George’s Mental Health Trust. 1

The Case for Change ‘Police and LAS waited five hours with a suicidal lady detained under s136 before being able to access a HBPoS. During this time the female who was extremely distressed and cold had no access to drink or toilet facilities.’ MET Police 2015 ‘The room where I waited was so depressing. It was bare with just a chair and a mattress against the wall. The door was left open and everyone stared as they went by’. ‘It is nonsensical that most mental health services operate Monday to Friday, nine to five. This is about the needs of staff who work in services, not people who use them. The use of S136 has increased by 9% since 2013/14 Only 27% of Londoners felt they received help in a timely way 2

Policy Drivers, Reviews and Publications Powerful policy drivers, reviews and publications in the past few years have clarified the need to improve mental health crisis services: 3

The London Crisis Care Programme London CCGs have come together through the Healthy London Partnership Programme and are committed to addressing crisis care… Mental Health Crisis Care in Emergency Departments Increasing transparency and alignment across the crisis care system S136 Pathway & Health Based Places of Safety

The London Crisis Care Programme Mental Health Crisis Care in Emergency Departments 5 London’s Mental Health Crisis Commissioning standards were published in 2014; The standards set out the care Londoners suffering mental health crisis should expect to receive. Healthy London Partnership Programme has committed to: Supporting the system to further implement the Mental Health Crisis Commissioning Standards, particularly the Emergency Department standards; More detailed guidance is being developed which is not covered by the standards, this will focus on the varying roles and responsibilities of staff groups in EDs; Supporting the ‘enabler’ programmes focussed on workforce and interoperability as well as national initiatives to improve the overall standard of care for mental health crisis patients in ED.

The London Crisis Care Programme The Health Based Place of Safety specification is being developed which will outline the minimum standard of care a London HBPoS should offer; This is being developed using evidence from a range of publications as well as expert knowledge and experiences from across London’s crisis care system. Patient experience and expectations Expert advice and guidance 6 S136 Pathway & Health Based Places of Safety (HBPoS) Relevant research and literature

Direction going forward The crisis care system will need to consider how the HBPoS specification is met across London 7 What needs to occur locally, regionally through the UEC networks and at a London level to ensure the specification is consistently met across London? Key drivers to make system changes: Workforce capacity and capability Working relationships across the system Payments and funding mechanisms Commitment from all key partners System interoperability