1. CAMHS Emergency care pathway Alison Hemphill Acting Clinical Lead Nurse, CAMHS Urgent & Unplanned Care Dr Nina Champaneri Consultant Child & Adolescent Psychiatrist, CAMHS Home Treatment Team

2. CAMHS Parkview Tier 4 Community CAMHS James Brindley Schools CAMHS HTT Schools Early Intervention Service Other Tier 4 providers ERA CAMHS Place of safety Youth support clinical team Looked after children Substance misuse/ YOS Social Services Paediatric wards / Liaison

3. CAMHS emergency care pathway What are we doing now? CAMHS Emergency Access Points: Specialist CAMHS Access Point (SCAP) Emergency Response Assessment Team (ERA) Home Treatment Team 136 co-ordinators (place of safety)

4. SCAP “Front door” of CAMHS – run by a team of Clinical Nurse Specialists and Primary Mental Health workers Single point of access to receive and process all Community CAMHS referrals Mainly from GPs, Community Paediatricians, School Nurses, Social Workers Electronic referral form (www.lotsonyourmind.org.uk)www.lotsonyourmind.org.uk Referral advice and signposting Telephone risk screening Book into CAMHS Choice appointments Review DNA’s (for Choice)

5. ERA Team of Clinical Nurse Specialists, Senior Mental Health Practitioners and a Consultant Psychiatrist 7 day a week service weekdays 8-8pm, weekends 10-6pm Cover citywide A&E departments and paediatric wards (for 5 hospitals) Self harm/Risk/ Emergency mental state assessments 7 day follow ups Telephone risk advice Support for Paediatric ward staff Liaison with Community CAMHS, HTT, Inpatient CAMHS, 136 Suite and other agencies

6. ERA Mental health & Risk assessment Psychosocial assessment Referral & joint working with HTT and Tier 4 Follow up in the community Support for ward staff and joint care planning Family support Liaison with other professionals Psycho- education (young people, families and ward staff) Pharmacologica l intervention, & medication management Mental state monitoring Short term therapeutic intervention, tailored to individual MH needs

7. Home Treatment Drivers for change – NSF 2004, National CAMHS review 2008, Tier 4 regional strategy 2009 Increase in Tier 4 use Partnership between BCH & BSMHFT Set up in 2011 as a pilot service BCH successful in securing substantive service via competitive tender Inclusion criteria CYP is registered patient in Birmingham CYP aged 12-18 years who are known to CAMHS or Youth support Hospital Admission is being considered – Not crisis CYP need to be seen over and above the capacity of generic CAMHS CYP has a severe/complex mental health needs and is likely to respond to treatment

8. 24/7 cover 7 days a week 8am – 8pm MDT cover Nurse on-call 8pm – 8am Home visits Entire City of B’Ham covered Gateway all B’Ham referrals Seamless service Community and Tier 4 Partnership working

9. Patient journey….. The following case history illustrates the journey BCH CAMHS has taken over 3 years to develop an Emergency Care Pathway. “Jamie is a 14 year old girl who self harmed whilst out with friends on a Friday night. Her friends contacted Jamie’s parents. After a 999 call she is brought to A&E, where she presents as upset, disorientated and expresses suicidal thoughts. She lashes out at staff. The A&E staff are anxious about how to manage her safely. Jamie has a history of low mood and eating difficulties and parents have been struggling to manage her for a few weeks.“

10. Past Admitted to a paediatric ward over the weekend with parental supervision on the ward. On call Psychiatrist contacted and over the phone advice given Referral made to the CAMHS DSH rota on Monday and assessment carried out on Monday afternoon. Due to ongoing suicidality and risk a Tier 4 (inpatient) referral is made Gateway assessment carried by Tier 4 clinicians on the Thursday Admission to Tier 4 the following Monday Whilst on the Paediatric ward she is reviewed twice by different clinicians Jamie was on a Paediatric ward for 10 days. In that time she was reviewed by 4 different CAMHS clinicians who gave advice on management to the Paediatric team but was inconsistent.

11. Present On call psychiatrist contacted who reviews her in A&E Risk plan is formulated and PRN medication prescribed Admitted to a paediatric ward with clear risk plan On call Psychiatrist and Paediatric ward refer to ERA on Saturday who assess that morning – develop joint care plan with YP, family and ward staff, and reassess on Sunday Refer to HTT that weekend who carry out a gateway assessment on Monday afternoon No Tier 4 beds so Jamie was discharged to HTT with twice daily visits whilst bed is sought

12. Future Following a 999 call the ambulance and Police Street Triage Team are contacted, who liaise with the CAMHS POS co- ordinator Arrange to go out jointly to the family home to assess Jamie Paramedics treat DSH wounds Jamie brought voluntarily to the CAMHS Urgent care centre, managed by CAMHS/ AMHS Joint assessment by ERA (crisis), HTT and Psychiatrist Discharge on Saturday afternoon to HTT with twice daily visits until Tier 4 bed found

13. Any Questions? Contact details: Alison.Hemphill@bch.nhs.ukAlison.Hemphill@bch.nhs.uk 0121 333 9193 Nina.Champaneri@bch.nhs.ukNina.Champaneri@bch.nhs.uk 0121 333 8805