1. 03 June 2016 Mental Health Crisis Plans Steve Lennox

2. 2 Broadly split into two areas of provision Provision 1 = Conveyance Patients in Crisis Section 136 & 135 Community Sections Provision 2 = Interventional Patients in Crisis Uncomplicated diagnosed patients receiving care Complicated diagnosed patients receiving care Uncomplicated undiagnosed patients Complicated undiagnosed patients Worried Well Mental Health Care

3. 3 Broadly split into two areas of provision Provision 1 = Conveyance Patients in Crisis Section 136 & 135 Community Sections Provision 2 = Interventional Patients in Crisis Uncomplicated diagnosed patients receiving care Complicated diagnosed patients receiving care Uncomplicated undiagnosed patients Complicated undiagnosed patients Worried Well Mental Health Care

4. 4 Care PathwayCountPercentage _none323444.689% Cancelled50330.73% Care Pathway - conveyed343834.985% No patient184662.677% Patient not conveyed8784212.736% Patient not conveyed - referred133021.929% Taken to A&E49836172.254% Total689731100.00% Illness/Incident Code Report PCT: Illness Code: Incident Code: All All All Date from: Date to: 01/04/2011 01/12/2011

5. 5 Care PathwayCountPercentage _none1120.928% Cancelled530.439% Care Pathway - conveyed141811.743% No patient1731.433% Patient not conveyed145912.083% Patient not conveyed - referred2742.269% Taken to A&E858671.106% Total12075100.00% Illness/Incident Code Report PCT: Illness Code: Incident Code: All All Psychiatric Date from: Date to: 01/04/2011 01/12/2011

6. 6 Illness/Incident Code Report PCT: Illness Code: Incident Code: All All Self-harm Date from: Date to: 01/04/2011 01/12/2011 Care PathwayCountPercentage _none1130.875% Cancelled180.139% Care Pathway - conveyed2602.014% No patient1160.899% Patient not conveyed164912.776% Patient not conveyed - referred540.418% Taken to A&E1069782.878% Total12907100.00%

7. 7 Care PathwayCountPercentage _none580.868% Cancelled170.254% Care Pathway - conveyed96814.482% No patient781.167% Patient not conveyed74411.131% Patient not conveyed - referred1722.573% Taken to A&E464769.524% Total6684100.00% Illness/Incident Code Report PCT: Illness Code: Incident Code: All Psychiatric problems - diagnosed Psychiatric Date from: Date to: 01/04/2011 05/12/2011

8. 8 Borough NumberA&E Barnet27565% Lambeth24661% Newham24479% Southwark20962% Ealing20878% Croydon20467% Kensington & C.8459% Richmond8167%

9. 9

10. 10 Broadly split into two areas of provision Provision 1 = Conveyance Patients in Crisis Section 136 & 135 Community Sections Provision 2 =Interventional Patients in Crisis Uncomplicated diagnosed patients receiving care Complicated diagnosed patients receiving care Uncomplicated undiagnosed patients Complicated undiagnosed patients Worried Well Mental Health Care

11. 11 Broadly split into two areas of provision Provision 1 = Conveyance Patients in Crisis Section 136 & 135 Community Sections Provision 2 =Interventional Patients in Crisis Uncomplicated diagnosed patients receiving care Complicated diagnosed patients receiving care Uncomplicated undiagnosed patients Complicated undiagnosed patients Worried Well Mental Health Care

12. 12 Mental Health Care Case Study

13. 13 Issues for 136 and Emergency Assessment Accessibility Full Short of staff Regarded as “out of area” Not seen as an emergency Mental Health Care

14. 14 Section 136 Emergency mental health care to be equivalent to emergency acute commissioning by all Treat the patient first and ask the questions afterwards Mental Health Care

15. 15 Broadly split into two areas of provision Provision 1 = Conveyance Patients in Crisis Section 136 & 135 Community Sections Provision 2 = Interventional Patients in Crisis Uncomplicated diagnosed patients receiving care Complicated diagnosed patients receiving care Uncomplicated undiagnosed patients Complicated undiagnosed patients Worried Well Mental Health Care

16. 16 Mental Health Care Case Study

17. 17 Issues for those in crisis Expertise Accessibility Difficult to know who the provider is Can not always access Professional issues Opening hours Don’t respond to crisis Few alternatives to conveyance Mental Health Care

18. 18 Kent & Medway Mental Health / Ambulance referral Pathway SECAmb Ambulance Paramedic Practitioner/paramedic/technician on scene Mental Health (MH) problem identified does not require attendance for medical/physical intervention at the emergency department (ED). Consider contacting MH team for advice / referral (see guidance notes), if unsure discuss with paramedic practitioner. Contact relevant MH Team (Duty or Crisis Team) ** for advice or to make a referral When referring the term ‘Ambulance on scene’ will identify that an urgent response is required from the mental health service MH team respond Duty worker will co-ordinate response and ensure Ambulance crew are informed of outcome within 10 minutes of end of initial contact Exchange phone numbers with Ambulance crew Ask for ambulance incident number; patient details; presenting problem/concerns; observations; contact information; and patient consent Speak with patient and carer MH team will: determine Urgency Identify most appropriate MH service to assess Agree a timescale for contact from MH services with patient/carer and ambulance crew Agree time and place for assessment. Give the patient/carer the relevant mental health team contact number Ambulance crew can leave unless otherwise indicated* Community mental health services Respond / assess within agreed timescale with AMHP if MHA required CRHTT Respond / assess as per agreed timescale with AMHP if MHA required Acute Care (as per Acute care pathway) Community Mental Health Team * If timescale cannot be achieved then patient will be taken to the nearest ED

19. 19

20. 20 Broadly split into two areas of provision Provision 1 = Conveyance Patients in Crisis Section 136 & 135 Community Sections Provision 2 = Interventional Patients in Crisis Uncomplicated diagnosed patients receiving care Complicated diagnosed patients receiving care Uncomplicated undiagnosed patients Complicated undiagnosed patients Worried Well Mental Health Care

21. 21 Looking for commissioner support for: Section 136 London Ambulance to have access to crisis teams for advice Crisis teams to accept referrals Think about next year Alcohol Frequent callers Mental Health Care