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

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

3. 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

4. Nottingham City Crisis Care
Ben Lomas
Consultant Psychiatrist
Nottingham eCRHT

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

6. 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

7. 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

9. Reasons for referral

10. 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.

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

12. 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.

13. 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

14. 24 hours - criminals 72 hours - patients
A place of safety
24 hours - criminals
72 hours - patients

15. 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

16. 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

17. 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

18. 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

19. Proud winners of PCC excellence in partnership award 2015!