Enhanced Crisis Resolution and Home Treatment Dr Ben Lomas, Consultant Psychiatrist Jo Horsley, Acute Operational Manager Ruth Gadd, Service Manager eCRHT City & County South

Who are we ? Consultant psychiatrists Team leader – OT Clinical psychologist Nurse prescriber Community psychiatric nurses Health care assistants – support workers

Service provision Provide mental health crisis intervention and home treatment, 24/7, 365 days a year. Activity data – April to Nov 1,004 referrals 382 of those are new to secondary MH services 165 cases currently open to the team Carried out 8, 462 contacts so far this year

Nottingham City Crisis Care Ben Lomas Consultant Psychiatrist Nottingham eCRHT

Key points When to refer Who you’ll be talking to What they want to know about the patient What happens afterwards

When to refer The patient has a mental disorder that is leading to a high imminent risk in one or more domains*. The level of this risk is such that the patient needs to be further assessed +/- managed by a specialist mental health team as an emergency

Referral Process Must be referred over the phone Band 6 nurse, usually the shift lead, will take the call (you might be asked to discuss it with the consultant) Triages the referral, completing triage pro forma as follows

Reasons for referral

Suicide/self harm The commonest reason for referral We are aiming to work with those at high risk of serious self harm in the short term This includes those at risk of accidental death, serious self mutilation (eg self castration), permanent serious injury (severe head banging), etc. Our focus would be on intent to act, intensity of suicidal ideation, hopelessness etc.

Key info Correct contact details? Do they want to see us? What do we do if they don’t respond?

After referral Assessment with 2 staff (at least 1 Band 6 nurse/junior doctor/consultant) Assessment of risk, do they meet the threshold for CRHT, if not what support is required etc. Will be provided with short discharge summary with interventions offered and most recent medication +/- further direct correspondence from medical staff as necessary.

Nottinghamshire pilot Street Triage service Aims of service Reduce 136 detentions in police custody Divert vulnerable unwell mental health patients away from the criminal justice system Divert people away from ED Provide health triage at the point of contact – Crisis concordat 2014

24 hours - criminals 72 hours - patients A place of safety 24 hours - criminals 72 hours - patients

2014/15 370,000 recorded incidents in Nottinghamshire But its less than: Add together all of the: Rapes sexual offences Robberies Theft of/from cars House burglaries + ______________ 17,387 Mental health qualifiers Safe and well checks + __________________ 17,408

Street Triage team CPNs and Police Officers working together, information sharing, making joint decisions 2 Cars, 4pm-1am, 7 days a week directed by police control room Pilot ends March 2016

Success to date 3,870 incidents responded to 1,754 triage assessments taken place 960 referrals made – Diverting from ED and 136 suites 90% reduction of police custody 136 detentions 60% reduction in 136 detentions over all NO CHILDREN IN POLICE CELLS in Nottinghamshire since April

Health Outcomes…. Reduction in unnecessary attendance at ED Increased access to mental health professions beyond traditional working hours Improved access to appropriate health services Diversion away from criminal justice service Reduction of inappropriate 136 detentions STT have a higher rate of further MH involvement following 136 detention Reduction in unnecessary attendance at ED Increased contact with people traditionally hard to engage Improved timeliness to appropriate help and support Improved experience and satisfaction

Proud winners of PCC excellence in partnership award 2015!