1. The S136 Pathway: I ndividuals detained under the Mental Health Act Dan Thorpe, Chief Inspector, Mental Health Lead, Metropolitan Police Service Suzanne McMillan, Head of Inpatient Care, West London Mental Health Trust 1

2. 2 We are well rehearsed with issues across the S136 pathway… The whole experience of going to ED, waiting in a crowded public area for hours, feeling that no one was taking me seriously, was an awful experience. London section 136 use – 10 year projection ‘Officer detained female under s136 at 14:30 and were refused entry to HBPoS as it was full. Staff refused to find alternative leaving officers to try and locate a HBPoS themselves. None found and after 7 hours wait they were finally able to access HBPoS. The family who were with the female keeping her calm were disgusted with the treatment they experienced from the NHS’ ‘It took 16 hours for officers to access a HBPoS with a 15 year old suicidal female they had detained under s136’ ‘Police left waiting 13 hours in ED with a 35 year old suicidal male detained under s136 as no bed spaces’. ‘We have transformed care in London for those who have a stroke or a heart attack and now need to do the same for those in mental health crisis’ 54% of London’s s136 patients are conveyed by the Police to a Health Based Place of Safety without support from LAS.

3. Some recent initiatives to address these issues London Trusts are looking to improve the pathway at a local level: Across London, Trusts are working with the Police and other key partners to improve their S136 processes locally. Some recent initiatives include: South London and Maudsley Mental Health Trust (SLaM) An integrated s136 suite is being built, consolidating all HBPoS sites into one bespoke site; Operational policies are in development, SLaM are working alongside the London crisis care programme to ‘pilot’ the new HBPoS specifications (see slide 4); Evaluation processes are in place to assess whether services and processes have improved due to the HBPoS specification; New HBPoS site due to open April 2016. 3 West London Mental Health Trust A new two person s136 suite is currently being built at Lakeside Mental Health Unit, Hounslow. This will ensure that there are four dedicated ‘stand-alone’ HBPoS provided across three West London boroughs. New practice guidelines have been developed with the MET Police and AMPHs to ensure that all persons detained can enter into a HBPoS and have a physiological and psychological assessment within one hour of arrival.

4. Some recent initiatives to address these issues Development of HBPoS specification which will outline the minimum standard of care Londoner’s should receive from a Health Based Place of Safety; Specification document will detail appropriate staffing models, transfers between sites, the roles and responsibilities of clinical staff, Police and LAS and the mental health act assessment process; Crisis care subgroup has been established to lead this work with extensive engagement across the system, the subgroup includes representatives from across the s136 pathway including Police and LAS; The specification document is in development, many areas of the pathway need to be refined with relevant stakeholders and pan-London decisions made on certain areas of the pathway e.g. intoxicated patients London CCGs have come together through the Healthy London Partnership Programme and are committed to addressing crisis care… 4 Health Based Place of Safety Specification

5. 5 Service Transformation in other parts of England Leeds ‘Crisis Assessment Service’ (CAS) CAS encompasses different crisis care services to improve access to appropriate mental health services, includes street triage, single point of access, HBPoS and the crisis assessment unit (CAU); CAU is a similar model to the PDU above, assessment rooms and overnight facilities are provided to give the opportunity for further assessment of people allowing time and space to explore their difficulties in more depth; The CAS service is co-located on one site providing different mental health service options for patients and key stakeholders (e.g. Police); Leeds is comparable to each UEC network in London, could something similar be done in each of the networks? Birmingham Psychiatric Decisions Unit (PDU) The PDU was developed to provide an alternative pathway for patients accessing emergency departments and other services, such as the police and ambulance services; PDU is an ambulant assessment area which provides a calming environment for the assessment and development of treatment plans for more complex service users who are in crisis and are accessing emergency services; The unit has strong links with street triage which supports service users accessing the PDU when they require a safe environment for urgent assessment; The number of inpatient bed days saved due to referrals to the PDU was 6,900 days; Between March and August 2014, the Street Triage team brought 297 patients directly to ED. In the same time frame in 2015, Street Triage decreased the number of patients going to Emergency Departments by 39% through the use of PDU.

6. What can London do to improve the S136 pathway? What would these changes look like and is there a preferred model going forward? What would provide maximum benefit for the patient? How are other crisis services linked into S136 pathway changes? 6 Individual Trusts and Boroughs Urgent & Emergency Care Networks Pan-London What needs to occur at each level to make improvements to London’s crisis care pathway: What approach is needed across the crisis care system to ensure the HBPoS specification is consistently met across London?

7. 7 Once we have defined what good looks like for patients we need to enable the system to deliver the new model of care: What can London do to improve the S136 pathway? How can we do this? What commitment is needed to take this forward? What will this mean for our workforce? What does it mean for payments and contracting? How we do get agencies working better together to implement the new model of care? What interoperability requirements are needed to implement the model? Are there other areas of good practice that we can learn from? What work programmes are underway already to support this?