A caring approach from street triage nurses for people in mental health crisis
A scheme that prevents people who are having a mental health crisis being detained in police custody has received national recognition at the Nursing Standard Nurse Awards.
Jane Murphy (pictured) and her team have helped reduce the number of patients being sectioned under the Mental Health Act. Picture credit: John Hoolihan
Nurse Jane Murphy has been shortlisted in the Mental Health category for her work leading Operation Emblem, which sees a nurse accompany officers to call outs when a person may have mental health problems. The Mental Health award is sponsored by South London and Maudsley NHS Foundation Trust and London South Bank University
Jane, who works for the Warrington and Halton Assessment Team at 5 Boroughs Partnership NHS Foundation Trust, will find out if she has won the accolade at a ceremony in the Savoy Hotel, London, on May 1. One of the 14 category winners will also be crowned UK Nurse of the Year 2015.
Trust chief nurse and executive director of operational clinical services Gail Briers says: ‘We’re delighted that Jane has been shortlisted for this prestigious award. It is thanks to her dedication and excellent collaborative work with Cheshire Police that the street triage service has delivered some outstanding results.
‘Since the project began, we have seen an 89% reduction in people being arrested under section 136 Mental Health Act or being taken unnecessarily to hospital for treatment.’
Under section 136 (S136) of the Mental Health Act 1983, the police can take people in crisis in a public place to a ‘place of safety’ for their own and others’ protection and for a medical assessment. This should be a health setting in all but exceptional circumstances.
‘Police officers regularly attend call-outs out-of-hours, yet they have limited mental health training and often make decisions based more upon resource demand and risk aversion rather than a robust assessment of individual needs,’ explains Jane. ‘Health services were not providing a fantastic 24/7 service for mental health and that’s why people call 999.
‘Police cells have been widely criticised as a place for people in mental health crisis so we had to ask ourselves why they were going through this trauma through S136s.
‘And these arrests are disclosable under advanced disclosure and barring service checks - having potentially life-changing implications for the individual.’
There was also evidence of many individuals being repeatedly arrested as the police had no framework of contact with mental health services. And police officers were spending a significant amount of their time dealing with people in crisis.
The answer was a street triage scheme in which a nurse supports police officers on emergency call outs when a person might have mental health issues. Jane says patients are benefitting from the immediate joint response as they are quickly put on the right pathway rather than being detained as a precaution.
‘If a mental health nurse is at the scene, they are able to co-ordinate the least restrictive but most appropriate treatment and follow-up through better co-ordination with health colleagues - avoiding lengthy and potentially distressing waits at A&E or Section 136 suites, or police cells,’ says Jane.
The task and finish group shared data from the previous year to identify when demand would be greatest – until 2am, seven days a week.
A four-month pilot was launched in December 2013 with a team of two dedicated Cheshire Police officers and two dedicated community psychiatric nurses working four days a week.
Importantly, the nurse has mobile access to information such as a patient’s care plan if they are known to mental health services that can help them make the right decision about the appropriate pathway for the patient.
Working with a nurse has also given officers a better understanding of mental issues. ‘It’s an education for the police,’ says Jane. ‘They are gaining an additional insight into people’s needs and support requirements in the long-term.’
In the pilot’s first week, it prevented 15 S136 detentions – followed by impressive results that earned it dedicated funding in May 2014, which allowed it to operate everyday between 8pm and 2am.
In the 11 months to March this year, the street triage team attended 734 incidents during 278 shifts. The team intervened at 89 incidents where officers were considering using a S136 and advised arresting only 10 - an 89% reduction.
Jane credits the training programme and consequent increased awareness among police officers for a 69% reduction in S136 use when the Operation Emblem team is not on duty.
Inspector Kate Woods, who leads on the street triage scheme for Cheshire Police, praised the partnership working, adding that the team is helping improve the lives of some of the most vulnerable people living in Warrington and Halton.
‘They have reduced the prevalence of section 136 arrests by 90% making significant financial savings, reducing the time officers are dealing with incidents and, most importantly, giving a better more tailored and appropriate response to vulnerable people in crisis. Great credit should go to Jane and all those involved for their innovation and commitment to this excellent scheme.’
The partnership working has reaped considerable benefits, but working with other agencies has not been without challenges.
‘In the early days, we had to overcome police officer’s perceptions on how nurses could change their working methods,’ says Jane. ‘It was about working differently and learning from eachother. And service users were used to calling the police as they knew they would get an immediate response, so we had to persuade them to call my team.’
A formal evaluation of the first 12 months of the service began this year and Cheshire Police have committed to undertake their own separate evaluation. Despite those audits not being completed, it is saving enough money – police estimate that in Warrington an S136 was costing £1,600 – for funding to be secured.
However, that is not Jane’s motivation. ‘It has improved patient care enormously,’ she says. The husband of one mental health patient agrees. He explains: ‘My wife was in crisis but spoke to the mental health nurse and agreed to go to hospital voluntarily for an assessment. Had the police officer gone on his own, his uniform would have been frightening. Having the nurse there too showed my wife it was more of a caring approach - not about locking her away.
‘She was discharged after a 10-day informal admission with a full care plan in place including medication to help her manage her stress. The street triage team calmed a really difficult situation down. They knew what they were doing and got my wife the right help without her needing to go through a traumatic section.’
Jane has plans to build on this improved patient experience and take the scheme a step further by moving nurses into police control rooms. ‘Hopefully a mental health nurse will become first attender to people in mental health crisis,’ she adds. ‘Nurses should be the 24 hour response to ensure patients get the right care at the right time.’