1. Primary Care Liaison and Suicide Awareness

2. Primary Care Mental Health Liaison Practitioner PCMHLP - who are we/what do we do? All qualified Mental Health Practitioners (Occupational Therapists, Registered Mental Health Nurses) recruited from frontline posts We are in CCG funded posts developing collaborative working between secondary mental health services and primary care. Acknowledgement of poor physical health of mental health service users, “no mental health without physical health?”. SMI mortality rates at pre war levels. Requires us to be passionate and determined in our approach to the role. We are aiming to be fully embedded into primary care culture.

3. Role of the PCMHLP New ‘Collaborative Working’ CQUIN for better communication, collaboration and sharing of information Improve physical health monitoring and access to care for service users with severe and enduring physical health problems Checking SMI registers and sharing information Support collaborative working between GPs and CMHT acting as a link Target difficult to engage service users with health problems and support them in accessing treatment

4. Role of the PCMHLP Support integrated care team in meeting the needs of service users who have complex physical and mental health needs. MDT consists of GPs, district nurses, practice nurses, health trainers, pharmacists, alcohol and mental health workers. Support CMHT members in increasing their understanding of and addressing the physical health needs of service users Support primary care clinicians in understanding mental health needs in acknowledgement of “parity of care” Helping primary care staff in finding the right referral for their service users needs Supporting successful discharge of service users back to primary care Training

5. Suicide Awareness Training Suicide recognised as a hidden problem If suicide rates were applied to different health scenarios then there would probably be national outrage Estimated that 75% of suicides are known to primary care and not secondary services Mental health GP leads in Liverpool identified suicide awareness as a training need Suicide awareness sessions written and developed by Dr Reeves approved by Liverpool CCG Designed to be 30 minutes long so they can be incorporated into practice meetings

6. Key messages in suicide awareness training Provide information on prevalence of suicide Promote understanding of what groups are vulnerable to suicide Key groups that need collaboration between services i.e. service users recently discharged from hospital Recognises higher rate of suicide in men but stressed that hopelessness, distress and entrapment are risk indicators in all groups Emphasise importance of compassionate, person centred communication Stressed the importance of asking questions to establish suicidal ideation and/or intent along with protective factors and having a suicide plan Explored different responses to different levels of risk

7. Suicide Awareness Training Designed to be inclusive to all staff at GP practices including reception/admin staff Provides an opportunity for clinicians to explore different referral pathways to Mersey Care/ A&E according to level of risk Explored scenarios and gave opportunity for role play We are flexible with the duration of the session to promote further discussion if this is possible Aim for all practices to have training delivered by end of March 2015, currently on schedule for this to happen

8. Our experience of delivering Suicide Awareness Training Difficult to access time in practice meetings. We had to compete with statutory training and fitting in with previously scheduled external training. Very often led to bigger discussions around mental health and how to communicate with Mersey Care. Highlighted the need for better communication between services. Developed better clinical links with GPs and other primary care practitioners Fits in with our role as primary care staff able to contact us for advice over concerns GP concerns about new presentation of risk including people not known to Mersey Care led to the collaborative development of Primary Care Safety Plans

9. Developing primary care safety plans Directly arising from suicide awareness sessions GPs wanted accessible easy to use plans for use with service users who might be at risk Could be used for people who might never see secondary care or IAPT services Could be useful for when someone is offered a routine appointment and the GP is concerned about what might happen in the interim period. Fits in with new Mersey Care approach to perfect care in suicide prevention Deliberately doesn’t mention a diagnosis or even the word suicide. We wanted the clinician to be able to judge the conversation and the terminology they want to use Currently being trialled in an informal pilot in a limited group

14. Evaluation and future role of PCMHLP Positive feedback from all participating practices Has led to better clinical engagement with GPs PCMHLP will have more clinical role at practices and will lead team of support staff Further training in different subjects More innovative and collaborative developments such as the primary care safety plan Any questions?