Analysis

Mental health triage team ensures people in crisis receive appropriate care

A multidisciplinary team is aiming to improve how emergency services respond to people who are in mental health crisis

Paramedics have joined police and mental health nurses to improve how emergency services respond to those who call 999 when in mental health crisis


Derbyshire's Mental Health Triage Hub team

The Mental Health Triage Hub based at Derbyshire Constabulary’s call centre in Ripley began as a pilot in 2014. Its focus was specialist intervention when police were considering using Section 136 of the Mental Health Act, which officers can apply if they suspect a person has a mental illness and needs ‘care and control’ in a place of safety.

As part of the pilot, a mental health nurse would accompany a police officer, in an unmarked car, to incidents where a mental health issue was suspected.

The local trust, Derbyshire Healthcare NHS Foundation Trust, also placed nurses in an NHS 111 call centre to respond to mental health-related calls.

11pm-4.59am

Peak hours for admission for self-harm injuries via the emergency department 

Source: Care Quality Commission 

Triage hub

Following on from the pilot, nurses, social workers and police later joined forces to form the Mental Health Triage Hub.

In October 2018, the service was expanded to include paramedics, who can advise callers directly, offering immediate medical advice or they can head out to attend the caller using the ambulance kept on standby at the call centre.

Tim Slater
Tim Slater

Tim Slater, paramedic and general manager of the Derbyshire division of the East Midlands Ambulance Service, says it aims to prevent people being taken to emergency departments when it is unnecessary or potentially detrimental to their well-being.

‘When a patient experiencing a mental health crisis calls 999, they may need to be taken to the emergency department (ED) for further assessment,’ Mr Slater says.

‘But being in that environment can exacerbate their distress and may not be the right place for them.'

Funding

Instead of being taken to an ED, patients may be advised over the phone about booking a GP or specialist appointment, given a mental health assessment in their own home, or admitted directly to a mental health unit for treatment.

This extension of the original pilot is being funded by the Derbyshire police and crime commissioner Hardyal Dhindsa.

'Care, not custody'

Mr Dhindsa says police officers are not, nor should they be, medically trained. ‘The Mental Health Triage Hub ensures that our officers can access expert advice to help people in mental health crisis receive help more swiftly.’

He adds: ‘Being ill is not a crime and people with mental health problems need care, not custody.’

5%

of emergency department attendances in England recorded as relating to mental health problems

Source: Care Quality Commission 

The triage hub is staffed from 4pm until midnight, Monday to Friday, and from 9am to midnight at weekends. Health and social care professionals working there can access relevant records to ensure up-to-date information is shared.

The hub’s acting service manager and mental health nurse Mary Ishaq says: ‘We want there to be “no wrong door” for patients experiencing a mental health crisis, so that patients get the help they need whether they contact the ambulance service, police or mental health service.

Mental health assessment

‘Paramedics can check physical health and rule out the need to attend ED for physical issues. The mental health nurse or mental health social worker carries out an in-depth mental health assessment to determine the necessary care pathway, providing a more seamless transition in care for the service user.’

Mary Ishaq
Mary Ishaq

To date, no formal evaluation of the extended pilot has been undertaken but, says Ms Ishaq, informal feedback from the agencies involved indicates a positive impact in several areas, including:

  • Better outcomes for services users.
  • Fewer unnecessary Section 136 detentions.
  • Increased confidence in staff decision-making, with a more holistic approach to care.
  • Improved working relationships between police and partner agencies.
  • Increased use of the triage hub by police officers.

‘Overall, the pilot has had a positive impact and we hope to continue to involve the East Midlands Ambulance Service in the long term, beyond the immediate scope of the pilot,’ says Ms Ishaq.

A positive partnership

She describes how partnership working between the police, local authorities, nurses and paramedics means that patients can access the right kind of support more quickly and get the help they need.

‘We’re aiming to avoid inappropriate Section 136 detentions or unnecessary ED admissions, while providing improved access to services and out-of-hours support for people experiencing mental health crisis.’

She adds: ‘By avoiding taking patients in crisis to the ED unnecessarily, we will be doing what is best for the patient, as well as reducing pressure on hospitals and other parts of the NHS where people need urgent care.’

12%

of people in mental health crisis called an ambulance according to a Crisis Care Concordat survey

Source: McPin Foundation (2016)

Places of safety

At RCN congress in 2017, a resolution calling for EDs to no longer be considered places of safety under Section 136 was given overwhelming support.

Congress that year was addressed by Jonny Benjamin, who was prevented from taking his own life by a stranger when he planned to jump from Waterloo Bridge in London.

He described how he was then taken to an ED.

‘I was in the ED with handcuffs on, which just added to the distress,’ he said.

‘It’s certainly not the most appropriate environment. There must be better, more therapeutic areas where people can go. Police cells and emergency departments are not that.’

Experiences of mental health crisis

A report by the Care Quality Commission (CQC) published in 2015 said that 5% of all ED attendances in England relate to mental health problems.

But when the CQC asked people in mental health crisis how they felt they were treated by ED staff, fewer than four in ten gave a positive response. Experiences of specialist mental health services were only slightly more positive, while ambulance staff and police were perceived as being more caring and empathetic towards those in crisis.

More than 40% said the care they were given did not resolve their crisis or was only partially helpful, irrespective of care location or which service the respondents contacted.

‘A health and care system where more than four in ten respondents feel their crisis was not resolved raises serious questions about the fairness and safety of service responses,’ the CQC said.

‘Providers must recognise that the risks from emotional harm are just as real, and potentially life-threatening, as those from a physical injury.’

 


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