serenity PS PAUL JENNINGS Mental Health Sergeant Hampshire Constabulary HIGHLY COMMENDED – Positive Practice in Mental Health Awards 2013 OUTSTANDING – CQC Inspection 2014 PLAYING THE LONG GAME Can police adapt a ‘results’ based culture to support Personality Disorder recovery? MENTAL HEALTH PARTNERSHIP DR UMAMA KHAN Consultant Psychiatrist Isle of Wight NHS Trust

Do you know what PERSONALITY DISORDER is? Que?

THE JOURNEY HAS FINALLY BEGUN

The first Street Triage team to ‘go live’ in the UK November 2012 STREET TRIAGE

POLICE CONTROL ROOM NURSE

2013 Jun0 Jul0 Aug0 Sep1 Oct0 Nov0 Dec Jan0 Feb0 Mar0 Apr0 May0 Jun0 Jul0 Aug0 Sep0 Oct0 Nov0 Dec Jan0 Feb0 Mar Apr May Jun Jul Aug Sep Oct Nov Dec ZERO USE OF POLICE CUSTODY

POLICE DEMAND AND CALLS SHARING RISK DECISIONS & DIVERSIONS CRIMINAL JUSTICE PATIENT PROFILING TRANSPORT PLACES OF SAFETY TRAINING RESPITE SAFE HOUSE SUICIDE PREVENTION RELEASE COMMUNITY INNOVATION CULTURAL CHANGE DEATHS IN CUSTODY RECOVERY ORG CHANGE serenity RESTRAINT MENTAL HEALTH AMBULANCE A&E HOSPITAL SECURITY DRUG & ALCOHOL CCG WHO GOES? FAMILY SUPPORT RESPONSE PLANS SOCIAL CONVERSATION 3 RD SECTOR

PERSONALITY WHAT?

165 54! s136 arrests for….69 people but caused Who are THEY!!? YEAR 1 STATS…..

“Within my mental health service, I have two groups of service users with Personality Disorder. The first group makes clinical progress. The second is simply uncontrollable” A Mental Health Manager of an NHS Trust Comment made during an informal discussion at a Mental Health Crisis Care Concordat Regional Conference (Summer 2014) THEY ARE….

common characteristics of high intensity users Female Over 30 years of age History of sexual abuse or violence Diagnosis of Borderline or Anti-Social Personality Disorder Dissociative episodes (‘out of body’) Disenfranchisement (deprivation of rights or privileges) from the NHS A preference to be dealt with by police officers, not NHS Highly stigmatised people Socially isolated Downward mobility Co-morbidity (2 or more illnesses) Physical health problems Data used with kind permission of Professor Gillian Bendelow and Claire Warrington School of Applied Social Science, University of Brighton THEY ARE….

Not making any significant clinical progress Having a high impact on their NHS care co-ordinator Repeatedly being detained under s136 Mental Health Act Attending A&E for compassion and emotional rewards Requesting ambulance with malicious medical claims Putting members of the public at risk from their suicidal acts A Medium-High risk of death by ‘accidental suicide’ Behaving in disorderly ways that could end with a court order Impacting on family life THEY ARE….

People who: we need to understand and support are ‘broken’ – not ‘bad’ are victims of crime, abuse and neglect cannot be ‘quick fixed’ we cannot write a ‘tactical plan’ for need levels of patience we are not used to need to avoid court at every opportunity do not belong in prison People who need an innovative approach? THEY ARE….

RECOVERY integrated programme supporting high intensity users of public services compassionate nobody changes behaviour that works recovery focussed adaptable risk management consent and attendance clinically authorised personal responsibility mentoring honest patient reliable collectively resilient non judgemental boundaries sufficient timeholistic care and response planning positive risk taking information shared proportionate use of criminal justice transparent capacity

Jane 40’s Gena 20’s Susan 40’s Tina 60’s Wendy 40’s Mia 50’s CLINICAL PROGRESS IMPACT ON PRACTITIONER FAMILY AND FRIENDS CRISIS DEMAND RISK REDUCTION PREV OF CRIME & DIS S136 MHACT OTHER PREV PR PREV HOLD HIGHER RISKS DURING DISCH’GED PERIOD

YES! THE POLICE CAN ADAPT BUT…….. How does this change your NHS environment? How does this change your ‘clinical planning’? Who would object and why? Police as ‘clinicians’………..really? A ‘Last resort’ option or a ‘Day 1’ option? Who pays for the police officer? Q: DO SOME PERSONALITY DISORDER SERVICE USERS NEED AN INTEGRATED APPROACH?