Enhanced Crisis Resolution and Home Treatment Dr Gill Doody, Consultant Psychiatrist Ruth Gadd, Service manager CRHT

What do we do E-CRHT forms part of a wider portfolio of crisis services which includes Rapid Response Liaison Psychiatry (ED) working across the wards and Emergency Department of QMC, 136 suites to support those individuals detained/ sectioned by the police; Crisis House providing short-term support to those experiencing a mental health crisis who require respite and peer support; and the Street Triage Team, promoting partnership working between mental health services and the police. E-CRHT provides assessment and intervention to people identified as being in a mental health crisis to such an extent that they are admission vulnerable.

Service provision Provide mental health crisis intervention and home treatment, 24/7, 365 days a year. See people in their own home or at hospital site CRHT are the gatekeepers of all admissions to hospital.

Who are we Consultant psychiatrists Team leader – Nurse Clinical psychologist Nurse prescriber’s Crisis care practitioners Health care assistants – support workers

Activity data – April 2017 – February 2018 2,865 referrals – Of these 1079 were internal referrals and 1796 external referrals Gender mix around 50/50 Low BME referrals Carried out 21,312 contacts so far this year

Nottingham City Crisis Care Gill Doody - 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.

The future – CRHT Core fidelity The MH five year forward states all CCG’s should be working with providers to develop a plan to meet Core fidelity standards by 2020

CRHT Core fidelity in Nottinghamshire The Crisis concordat has identified the need to review the current crisis provision and establish a baseline for current provision. Teams have completed a self assessment and a paper has been written outlining the gaps using the core fidelity methodology. Proposal to develop an interim model over next 2 years whilst working to core fidelity It is recognised that successful implementation of core fidelity standards is dependant on a range of factors across the system such as access to social care, alternative accommodation and other community services. It is also noted that high levels of depravation across Nottinghamshire will need to be considered when exploring resources.