report of the bradford district care nhs foundation trust

Report of the Bradford District Care NHS Foundation Trust and the Interim Strategic Director, Adult and Community Services to the meeting of the Health and Social Care Overview & Scrutiny Committee to be held on 4 February 2016

AK Subject: Update Report: First Response Service, Crisis Care Concordat, Improving Access to Psychological Therapies (IAPT) Community Mental Heath Teams (CMHT) Chaplaincy Summary statement: At its meeting of 5 February 2015 the Health and Social Care Overview and Scrutiny Committee requested an update report on the Mental Health crisis care concordat, mental health First Response service, Improved Access to Psychological Services and Community Mental Health services. The Committee also requested an update on progress around chaplaincy services within Bradford District Care NHS Foundation Trust. The report has been written by Bradford District Care NHS Foundation Trust and Bradford Council Mental Health services and will be presented by them jointly.

Nicola Lees Deputy Chief Executive Bradford District Care NHS FT Bernard Lanigan Interim Strategic Director Adult and Community Services

Portfolio: Health and Social Care

Report Contacts: Mark Trewin / Debra Gilderdale Phone: (01274) 431526 / 228300 E-mail: [email protected] / [email protected]

Report to the Health and Social Care Overview & Scrutiny Committee Glossary of terms used in the report: MHA Mental Health Act 1983 A and E Accident and Emergency Department CMHT Community Mental Health Team IAPT Improved Access to Psychological Therapies CCC Crisis Care Concordat VCS Voluntary & Community Sector MIND The mental health charity DoH Department of Health BDCFT Bradford District Care NHS Foundation Trust S136 An order of the mental health act used by police YAS Yorkshire Ambulance Service

Report to the Health and Social Care Overview & Scrutiny Committee

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1. Summary At its meeting of 5 February 2015 the Health and Social Care Overview and Scrutiny Committee requested an update report on the Mental Health crisis care concordat, mental health First Response service, Improved Access to Psychological Services and Community Mental Health services. The Committee also requested an update on progress around chaplaincy services within Bradford District Care NHS Foundation Trust. The report has been written by Bradford District Care NHS Foundation Trust and Bradford Council Mental Health services and will be presented by them jointly. 2. Background Bradford District Care Trust has been serving people with mental health problems and adults with learning disabilities across urban and rural Bradford, Airedale, Wharfedale and Craven since April 2002. On 1 April 2011, the majority of Bradford and Airedale’s Community health services transferred to the Trust as part of the national Transforming Community Services initiative. In 2014/2015, the Trust’s income will be over £130m. The Trust employs 2,800 staff who provide a range of urgent and non-urgent inpatient, Community and social care services from over 50 sites. The Trust has an overall rating of ‘good’ from the Care Quality Commission. The Trust operates mental health services in partnership with Bradford Council and the services are integrated together. 3. Report issues The Crisis Care Concordat – Bradford and Airedale The Crisis Care Concordat (CCC) was launched in 2014 by Norman Lamb, Minister of State for Care and Support, following a declaration by a number of national agencies to work together to improve crisis services for people with a mental health problem. The main targets for the CCC are:

• Commissioning to provide more effective and responsive crisis services • Access to earlier intervention support and planning to avoid crisis • Urgent and emergency access to services when required • Good quality treatment and care when a person is in crisis • Services to support recovery and staying well • A better quality of response for people detained under s136 MHA 1983 • No young people under 18 held in police cells • A major reduction in the number of adults held in police cells • Parity of esteem between physical and mental health (This refers to the idea that

mental health should be given the same importance as physical health issues)

Bradford and Airedale have been operating a very successful CCC implementation group throughout 2015. This is a multi-agency meeting including all local NHS partners, the Local Authority Adult and Children’s services, Public Health, the Police, VCS partners, all local CCGs, Yorkshire Ambulance, Housing, Drug and Alcohol services and Criminal Justice. In our Report to the Health and Social Care Overview and Scrutiny Committee in early 2015 we identified that we would develop a ‘whole systems’ approach to achieve the following aims in our local action plan, which was updated in October 2015:


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• Improve the response to people experiencing mental health crisis, especially out of

hours • Reduced delays to Mental Health Act assessments, especially out of hours and in

A and E. • Improve the health based place of safety, especially out of hours • Reduce the number of people being held in the police cells as a place of safety,

especially children • Divert people from police custody, A and E or the use of the mental health act,

especially out of hours • Reduce the number of people detained under s136 of the MHA 1983

Bradford CCC partnership is a successful transformation project. It has been widely praised for the developments and joint working achieved. Bradford has been identified as a good practice site by National MIND. We have been identified as a site of good practice for Crisis services and health and social care integration by the Minister for Health and Social Care, the chief Social Worker, the NHS Clinical Lead for Mental Health and the DoH lead for Social Care and Partnerships. We have been visited by many other agencies and areas from around the country. We have been asked to speak to the national Crisis Care Concordat conference and Health and Care conference 2016. Acute Care Mental Health

We have reorganised the Bradford mental health services dedicated to people presenting in mental health crisis. The service operates a ‘stepped approach’ to care, providing the least restrictive treatment required.

Operated by Bradford District Care Foundation Trust (BDCFT) and delivered in partnership with Bradford Council Adult Services Department, our support for people in crisis is designed and delivered as part of the multi-agency Crisis Care Concordat Implementation group (Feb 2014).

BDCFT is working with local partners to develop a modern evidence based crisis model for mental health that provides easy access 24/7. Health and social care mental health services intervene earlier to prevent escalation and direct people to a broad range of appropriate provision; including social, private and third sector.

First Response

First Response Service (FRS) is the gateway to urgent mental health and social services. People self-refer via telephone and are asked about their needs and risk by a psychological therapist (tele-coach). Callers are provided with brief and immediate support to manage their crisis. Tele coach staff also provide support and advice to other agencies, in particular GPs and Police.

The First Response helpline has made a significant difference to management of crisis care, in particular for police officers. They report feeling supported to make informed decisions involving mental health crisis. In particular, the sharing of accountability where there is apparent risk of harm to self/others. This has enabled police officers to make decisions that are effective in the overall treatment plan of an individual. For some people in regular contact with mental health services, a consistent approach to crisis between agencies can help reduce negative patterns and aid to recovery. Availability of a tele-coach also allows a police officer ‘at the scene’ to access advice in real time. The Police


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as a result resort much less frequently to using their powers under 136 and the person in crisis gets speedy, appropriate help.

For those people at greatest risk and in need of more intensive support, the First Response service provides face-to-face mental health assessment with a First Responder. First Responders are nurses, social workers and advanced nurse practitioners (nurses that can prescribe medication). They visit the person in crisis wherever they are situated including A&E departments, police stations and GP surgeries; they aim to be with a person within 1 hour of their call. This is our local model of Street Triage; it’s timely, responsive and ensures people are signposted correctly at the beginning of their crisis pathway. First Responders also support the Police and Ambulance services when making decisions about applying the Mental Health Act. People are sign posted to the most appropriate and least restrictive support; including health, social care and third sector provision.

This approach and re-organisation has been operational for a 12 month period and had impacted significantly in a number of areas, we have relied for a number of years on Out of Area beds, through this transformation for 11 months we have not required any out of area beds for people with acute care in patient’s needs and have successfully cared and treated people locally. We have seen a reduction in people presenting in A&E across Bradford and Airedale, reduction in people in crisis being held in custody suites and being supported faster in the community. There have been 53,500 calls into the First Response Service since February 2014.

The has been national recognition for the achievements of the First Response service, and have recently being awarded the prestigious Nursing Times Award.

First Response is also the route into The Sanctuary, which is run by Mind in Bradford as a safe haven from 6pm to 1am, easing pressure on A&E.

Operated by MIND in Bradford, (the mental health charity) works in partnership with the First Response Service. The Sanctuary offers a safe place for people in crisis 7 days per week between 6pm and 1am. First Responders provide a gate keeping function to ensure that places are used effectively, as an alternative to admission. They can provide specialist support if needed.

The Sanctuary provides a calm, safe space for adults experiencing acute mental distress. It provides practical and emotional support and may be used as an alternative to admission to statutory services if appropriate.

The Local Authority supports Sanctuary staff with housing and other support if needed - but most people return to their home.

The Sanctuary accepts:

• People experiencing anxiety/panic attacks • Those with suicidal thoughts who don’t feel ‘safe’ but don’t want to end their lives • Those who have self-harmed but don’t require medical attention • Those who are disassociating (but not psychotic or on drugs) • Those who are intensely depressed • People hearing voices who know that the voices are not real • Those experiencing Post Traumatic Stress Disorder (PTSD) • People at a point where they feel they can’t cope


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Police Hub (Control Room)

Additional as part of the First Response service mental health workers are embedded within the police control room. West Yorkshire Police, BDCFT and CBMDC have developed a joint information sharing protocol allowing staff to make better informed decisions. Mental health professionals have electronic access to RIO health record and are easily able to identify where mental health may be a factor as incidents arise.

Our intention is to extend this provision to 24/7 in partnership with our colleagues at Bradford Council and the Police and Crime Commissioner.

We have also reorganised our criminal justice diversion services to be part of the wider service to the police and to increase the number of people being diverted from the police station.

We are redeveloping our Appropriate Adult service so that vulnerable people in police custody are given the support they need under the Police and Criminal Evidence Act.

IAPT Aire Wharfe Craven, Bradford City, Bradford District CCGs and BDCFT are working around the redesign of the IAPT Services, during 2015, significant engagement work took place with the three CCGs and local VCS to develop the model:

• Bring all psychological therapy providers under one umbrella o Lead provider with niche providers supporting & flexing services as required

by need & demand o Niche providers retain unique offer but within consistent & controlled

environment o One system for recording treatment / support & outcomes

• Clinically led – pathway & provider dictated by what’s in the best interests of the

client

• Multi-access points but primarily through BDCFT One Call & GP referral

• Consistent training & communication

• Dedicated resource to manage quality of delivery & effective communication

• Dedicated resource for hard to reach groups The Bradford Improving Access to Psychological Therapies (IAPT) Service is delivered across the district through four discreet teams with staffing of 105.45 whole time equivalent, 117 head count. The service operates a ‘stepped care model’, covering ‘low intensity therapy’, appropriate for people with mild anxiety and depression; ‘high intensity therapy’, appropriate for people with moderate anxiety and depression. The service operates to nationally mandated KPI’s, the most significant being numbers entering therapy, recovery rate and waiting times.


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Standard referral process is via GP either electronically or by fax. Around 1000 routine referrals per month are received and processed by triage staff within the First Response Service. Since January 2015 the IAPT service has introduced self-referral via telephone, in line with national guidance. An increasing number of referrals are being received via this route, currently around 300 per month. Community Mental Health Services There are four community mental health teams that are aligned with the CCG and council localities. In addition there is an early intervention service that is co-located within the CMHTs and CMHT staff operate the Assertive Outreach team function. The teams are based within Bradford Care NHS Foundation Trust and are operated by the Trust. All of these teams are multi-disciplinary and jointly staffed and managed by BDCFT and Bradford Council. They include Community Psychiatric Nurses, Mental Health Social Workers, Consultant Psychiatrists, Therapists and Clinical Psychologists, Support workers, Service User Development Workers and Occupational Therapists. We have a partnership agreement and a joint operational policy agreed across BDCFT and the Council. Each CMHT has a Social Care and NHS manager and there is an NHS and LA service manager overseeing the teams. The teams work to the Care Programme Approach guidance on assessment, reviewing and care planning and also deliver the Care Act responsibility of the Council for people with a mental health issue. CMHTs work to a recovery and prevention model and they also work very closely with the Crisis Service and Acute Care services. We are currently reviewing the service to strengthen the recovery and early intervention aspect of their work. Summary of MH crisis Improvements achieved across agencies in 2015:

1. Establishment of multi-agency 24 hr First Response Team 2. Zero out of area beds required for people with acute in patient needs 3. Redesign of multi-disciplinary intensive Home Treatment team and A and E Liaison

team 4. Integration of Approved Mental Health professionals and improved relationship with

Emergency Duty Team & First Response 5. Employment of Housing Worker to aid discharge from hospital 6. Establishment of The Sanctuary project within Mind in Bradford 7. Establishment of Criminal Justice Liaison service in the police cells and

development of joint working across Criminal Justice agencies 8. Establishment of the Police Hub project within Trafalgar House to improve support

for vulnerable people 9. Improved relationship and joint working with the police 10. Reduction in number of MH service users held in cells 11. No children held in cells 12. Reduction in the number of S136 detentions 13. No out of area or private sector acute inpatient placements since March 14. Reduction in the number of MH service users going to A and E. Reduction in A and

E breaches and need for MHA assessments in A and E 15. Support for Frequent Attendees to the police, MH and A and E. 16. Increased number of physical health checks within CMHT


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Summary of the next stage of developments in 2016:

1. Development of the Mental Health Urgent Care Vanguard within the Crisis Care Concordat

2. Development of Children & Young Peoples crisis pathway and safe space 3. Development of a 24hr A and E liaison service and community Safe Space for

people with MH problems 4. Development of a Suicide Prevention and reduction project 5. Development of a 24 hr AMHP service within First Response 6. Development of recovery based prevention and early intervention in Community

Mental Health teams 7. Development of improved conveyance systems with YAS. 8. Development of a place of safety for people under the influence of alcohol. 9. Development of crisis planning and advanced statements. 10. Development of parity of esteem with physical health

What do we still need to get right?

1. Some young people are still being sent away from home for treatment 2. Pressure for female acute beds 3. There is sometimes still a delay when an out of hours MHA assessment is required

in the acute hospital 4. The number of detentions under the MHA is less but still increasing partly due to

the effects of the Cheshire West judgement on deprivation 5. Pressures on CMHTs 6. Multi-agency approach to suicide reduction

Chaplaincy BDCFT decided to conduct a review of its Chaplaincy provision to look at addressing the gap that exists in this provision. The review has been undertaken by Operations and Equalities and Diversity jointly. As part of the review the contact was made with other trusts to see the type of models these trusts had, as well as looking at local and national guidance around spiritual and pastoral care. Previous reviews conducted highlighted similar issues to what was being noticed which was:

• Gaps in spiritual & pastoral care across Lynfield Mount Hospital & Airedale Centre for Mental Health

• The need to use information BDCFT have around people’s faith needs and look to provide support and provision around this

• Lack of clear leadership around Chaplaincy services • No partnership working • Spiritual & Pastoral care not used as part of the overall recovery plan for patients. • No training for staff around patients spiritual & pastoral needs


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The proposal that has been presented to BDCFT Executive Management team is to bring a model where a Chaplaincy Liaison Officer who would be employed to bridge the gaps in service provision as highlighted above. 4. Options Not applicable. 5. Contribution to corporate priorities The Council is a signatory to the MIND Mental Health Challenge for Local Authorities. These developments help us meet some of the responsibilities of this agreement. 6. Recommendations That the Health and Social Care Overview and Scrutiny Committee: i) Notes the reported position for:

- Crisis Care Concordat - First Response Service - IAPT - CMHT - Chaplaincy Service

ii) Notes the extent and scale of the partnership and integrated working 7. Background documents

None 8. Not for publication documents

None 9. Appendices 9.1 Crisis Care Concordat Action Plan

Bradford and Airedale Mental Health Crisis Care Concordat Action Plan October 30th 2015

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Crisis Care Concordat Multi Agency Action Plan for

Bradford, Airedale & Craven Version 2: Updated October 30th 2015

This document is the overarching Crisis Care Concordat Action Plan designed to provide a framework for the improvement and development of mental health services for people in crisis in our area in 2015-16. This action plan outlines the operational and commissioning priorities that have been recommended by the Crisis Care Concordat working group. This plan identifies "the

actions required of commissioners and providers to ensure that those experiencing mental health crisis are properly supported" (NHS forward plan 2015-16).


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This action plan has been developed by the Crisis Care Concordat working group:


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Our joint commitment to improve Crisis Response Services in Bradford, Airedale and Craven:

We agree to work together across Bradford and Airedale and Craven (and, where our boundaries or services overlap, with our partners in North Yorkshire, Lancashire, Kirklees and Leeds) to improve the access to services,

response from services, care and support of people experiencing a mental health crisis.

We will work together to prevent crisis through effective crisis planning and early intervention.

We will explore how we can commission mental health services to be based on recovery, wellbeing and resilience.

We will jointly commission and design services so that they are well planned and appropriate to the needs of our population, with appropriate alternatives to acute or emergency care available when needed.

We will provide consistent, timely and appropriate support regardless of the agency that comes into contact with the person in crisis and whatever time of the day or night they require our support.

We will work, plan and reflect together so that people in crisis receive an integrated, seamless service without organisational boundaries and difficulties getting in the way. We will develop a multi agency crisis care pathway

that links all of the agencies that are signatories to this document


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We will ensure that young people under 18 never have to go into police custody and we will work to ensure that vulnerable adults are only detained in custody when absolutely necessary

We will work to achieve parity of esteem between the physical and mental health needs of our service users and that they will have access to the NHS and social care services that they require

Note: Bradford and Airedale has adopted an integrated whole systems approach in which CCC developments are linked and developed together across all organisations who are part of this implementation group. All RAG assessments are as of October 30th 2015. Areas are rated Green when the CCC group feels that the original outcomes and priorities have been largely met. Further developments in these areas may be highlighted elsewhere in the action plan.

1. Commissioning and development to ensure earlier intervention and more responsive crisis services

No. Recommendation and required outcome

Action needed to achieve this Lead Agency

RAG 10/15

Commissioning Priorities - Matching local need with a suitable range of Services 1 Development of the Crisis Care

Concordat Set up CCC multi agency implementation working group that answers

to the Health and Well being Board

Develop and sign up to the West Yorkshire CCC Declaration

Develop commissioning priorities to improve crisis care

Develop and sign up to the CCC Action plan that identifies how these priorities will be achieved (reviewed Oct 2015)

Link to the UEC Vanguard bid and develop a governance sub group

that reviews how these action plans are being developed

CCC Working Group

Sept 2014 Dec 2014

Mar 2015

Mar 2015 Oct 2015


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Jan 2016

2 Develop Commissioning Arrangements to achieve aims of the CCC

To develop a joint, integrated commissioning plan for 2016-17 based on a renewed local needs assessment. Decisions about the development and implementation of crisis care, recovery and community services can be prioritised and Jointly commissioned across all relevant agencies. Be clear about all of the money coming in to the local CCG or LA for crisis care, Urgent Emergency Care Vanguard, local places of safety; Children and YP Mental Health etc. All relevant commissioning plans to be linked to this Action Plan, The CCC National Actions progress plan, NHS 5 Year Plan for mental health and the Local Health and Wellbeing board and Integrated Commissioning plans. Commissioning guidance to be developed with the following considered:

Commissioning jointly with partners such as NHS, LA, Police and Housing

Children and young people’s crisis recovery pathway Developing visionary thinking on crisis care and recovery Commissioning for positive and proactive care to reduce restrictive

interventions Commissioning for effective integration of recovery into primary care Exploring new and innovative services for early intervention before

crisis Developing and looking after the workforce to prevent burnout Population-based preventive approaches such as embedding

parenting skills training in schools.

UEC GROUP CCC working group

Jan 2016

Jan 2016

Jan 2016

3 Ensure commissioned services are subject to equality impact assessments and meet all Equality

Implement MIND guidance on commissioning BME crisis services Consult and engage with BME groups through Sharing Voices and

other BME providers when commissioning and developing services

CCC working group led by sharing

Mar 2016


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Act principles To deliver to specific crisis planning pathways for BME communities and other groups such as LGBT communities

Ensure staff delivering crisis care take BME, cultural, spiritual and faith based needs into account

Empower people from BME and other groups by providing appropriate information, access to advocacy and community development services

Explore the development and strengthening of specific services for BME communities and link CCC to wider community

Research impact and outcome of crisis on BME individuals and families Develop culturally competent crisis plans and services for all

vulnerable groups Ensure inclusion of gender and LGBT based perspectives to crisis care

Voices and the BME staff group

4 Develop joint arrangements with North Yorkshire

Attend NY CCC partnership and MH development forums Invite NY & Craven police and MH colleagues to attend local CCC working group

CCG LA Police CCC group

Jan 2015 Oct 2015

5 Commission research into the needs of MH service users in crisis This is ongoing but

Reason for and outcome of s136 interventions Reason for and outcome of A & E presentation The needs of MH service users in Police custody The needs of people assessed under the MHA 1983 Feed back from Advocacy and user development/support groups MH Crisis – support and intervention requirements of each different community and ethnic groups and appropriate data collection

Police BDCFT CCG BRI AGH MIND SV

August 2015 Mar 2016

6 Safeguarding for people in crisis Link the CCC action plan to the Children and Adult Safeguarding boards

LA CCG

June 2015

7 Build links and good practice across CCCs, health and social care systems in our region

Apply for the regional Urgent Care Vanguard and ensure that it has a strong Mental Health aspect to the bid and has regional NHS & social care involvement. (see separate planning section).

BDCFT LA CCG CCC working group

August 2015

A. Access to Earlier intervention, support and planning to reduce Mental Health crisis


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Making sure people with mental health problems can get help 24 hours a day and that when they ask for help, they are taken seriously. 1 Develop co-ordinated multi agency

Crisis Prevention plans specific to the early intervention, recovery and support needs of people in crisis Update Oct 2015: A community recovery and care planning transformation plan is currently being developed by BDCFT and the LA.

CMHTs to identify all people at risk of MH crisis and develop multi agency crisis prevention and risk minimisation plans for each of them

Care Programme Approach Crisis and Contingency plans to be improved, relevant, available, easy to find and in date.

Ensure CPA Audit identifies use of Crisis & Contingency plans Training & support to be provided to relevant agencies on how to

complete use and interpret Risk and crisis plans. Look at examples of good practice in other areas Involve Service user development. VCS and advocacy colleagues in

these developments

BDCFT LA CCG Police SV MIND

March 2016

2 Develop use of Advanced Statement or Directives with service users and their families to improve crisis planning

All Service users with a history or a predicted risk of crisis care presentation should be supported to have an Advanced Statement that identifies how they wish to be treated due to lack of capacity or crisis. Action plan to achieve this to be developed. A very effective format already exists within the integrated LA/BDCT mental health services but needs to be used much more and more widely available. RIO database to be updated to support this as part of ongoing RIO development. Training on this issue to be part of the CPA and Police training

BDCFT LA

Dec 2015

Dec 2015

July 2015

3 Explore the commissioning and development of a recovery, prevention and early intervention based approach within CMHT’s and

Community and voluntary mental health organisations are key to preventing Crisis. Support the recovery and intervention model that empowers CMHT workers to be able to take action that divert people from crisis and to access services that support this. Link to existing CMHT transformation programme

LA BDCFT CCG MIND SV

March 2016


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Primary Care MH services – using innovative approaches to build on existing practice Update Oct 2015: BDCT, CCGs and LA now working on developing a new CMHT transformation model based on best practice in recovery, early intervention and personalised care.

and First Response Service (FRS). Explore the commissioning of community MH services that will focus on wellbeing with an emphasis on nurturing people’s resilience and capability, mapping their networks of support, the community assets and supporting people to help themselves (e.g. Parachute model) Develop use of the WRAP (Wellness Recovery Action Plans) for service users in Adult MH, CAMHS and community development groups who need a supportive recovery approach building on existing practice.

March 2016

July 2015

4 Develop links to the crisis care pathway in Primary care services

Develop a clear protocol for Primary Care professionals on how to assess risk, respond to MH crisis and refer service users at risk of crisis to FRS etc Develop the availability of GPs for MHA assessments and support the identification and support of carers in Primary Care Use the protected time for GP Training and support. www.ttcprimarycare.org.uk gives an example of this work.

BDCFT CCG LA CCC working group

April 2016

April 2016

April 2016

5 Explore the development and commissioning of best practice crisis prevention services that divert people from crisis before it develops. These are examples of commissioning ideas we may explore locally. See the Mental Health Crisis Commissioning guide for London for more

A. Planned respite such as Shared Lives Host Families scheme: Now developed in MH and starting to be used to avoid crisis B. Urgent respite such as the Hertfordshire Host families scheme: We are exploring the development and commissioning of this idea. C. Specialist recovery led residential care is now being used to avoid acute care and reduce crisis through offering a safe space D. Flexible supported accommodation that can prevent/respond to crisis has now been developed and further developments are under housing below

CCC working group and local integrated C’missioning

May 2015 Part of UECV

May 2015

April 2015


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examples of good practice E. Community based Crisis support such as the Sanctuary/safe space models: Sanctuary project now developed and supporting people every day. F. Flexible support service for people in crisis that can offer indepth support in service users homes is now available as part of IHTT and being developed as part of the LA housing tender.

May 2015

May 2015

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Telephone advice and support for people in crisis or at risk of crisis available 24 hrs a day

Review the commissioning and availability of telephone support services Develop a telephone triage and support service as part of First Response team within mental health services to people in crisis and organisations supporting them e.g. Police, Care Homes, A+E etc Link Samaritans and Guideline into the Crisis Care pathway and to the First Response telephone triage service and create a link to EDT

MIND CCG LA BDCFT

March 2015

7 Identify people who may be at specific risk of crisis and plan for their care and support Updated Oct 2015: Frequent Attender support project now set up across all agencies

Develop a list of the people who most regularly present to agencies in crisis and develop multi agency plans as to how we will respond and support them Review how people who have presented as suicidal or self harmed or been in crisis are followed up and supported to avoid crisis happening again. Link to suicide prevention group led by Public Health Ensure that the specialist First Response crisis service accepts self referral

BDCT PH Police LA

June 2012

August 2015

Feb 2015

8 Develop a multi agency Crisis Care Pathway Updated Sept 2015: CCC working group set up to develop this pathway

The pathway will provide guidance towards positive decision making and integrated working and will set out how agencies should communicate with and support each other when responding to people in crisis This should adopt a holistic approach to crisis care management including and integrating all areas and agencies that influence crisis including physical and mental health, economic factors, culture, housing, relationships, employment and benefits.

CCC working group

Feb 2016


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The CCC will set up a working group with representatives that will develop this pathway in 2015 across all age groups and specific needs.

9 Explore the specific needs and implications of MH crisis on BME communities

Work with local groups to identify the causes of MH crisis in BME communities and Develop specific strategies and services to meet the need of BME communities and develop specific ways to support crisis in these communities

CCG LA & BDCFT SV MIND Police

Jan 2016

10 Explore the use of digital and Tele support systems to reduce future crisis and support recovery

Explore local development of online support tools such as the Big White Wall app and online support service (www.bigwhitewall.com) Explore the use of Tele Care to support people in crisis and follow people following crisis support in partnership with local Vanguard.

BDCFT LA

July 2016

Jan 2016

11 Support the role of 3rd sector organisations in recovery/support

Link to a range of relevant 3rd sector/vol sector MH support providers into the action plan for the CCC, the crisis care pathway and prevention strategies

CCC group 3rd/volSector

Dec 2016

B. Urgent and emergency access to crisis care when required Making sure that a mental health crisis is treated with the same urgency as a physical health emergency.

1 Develop a 24hr integrated response service for people in MH crisis.

First Response (FRS) team to be developed. A partnership between CCGs/BDCT/LA/PH and the PCC. 24 hour telephone support and triage plus professional response to people in crisis and assessment or diversion for people in contact with the police. Links to all other crisis and out of hours response services. Includes self referral from users and carers.

BDCT LA PH PCC Public Health

Feb 2015

2 Develop police triage and support service within the FRS team

Public Health, PCC, LA and NHS to work together to build response and diversion service into FRS team for people who come to the attention of the police or are in police custody. Link to development of street triage. Base police/court liaison workers in the custody area and develop links with other agencies working in police custody such as Drug Intervention teams

BDCT Police Pub Health LA

Feb 2015

Aug 2015

3 Ensure speedy access to AMHP service out of hours especially in

Redesign existing AMHP resources so that key hours in evening and early morning are covered with a duty AMHP.

BDCFT LA

Dec 2016


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police station and A & E

Explore options for on call AMHP service for out of hours assessments Agree timescales for AMHP assessments

4 Develop Links between crisis services and the Emergency Duty Service

EDT currently has an on call worker dealing with Local Authority emergencies out of hours. They have bank of AMHPs that can be called out to assess people at weekends. This service is integrated with the Crisis Care Pathway and linked to FRS/IHTT so that there is support and planning between EDT and other out of hours services and a more co-ordinated response to MHA assessments.

LA BDCFT

May 2015

5 Agree standards for availability and attendance of s12 doctors at MHA assessments

Ensure Consultants and s12 doctors can be available when mental health or MH act assessments are required. Free up time to enable them to attend assessments in line with working pattern of FRS AMHP service and EDT

BDCFT LA

Jan 2016

6 Improve Link between crisis services and the AMHP service

Duty day time AMHPs to be integrated with the 24 hour crisis FRS team. Develop a clear communication pathway with the EDT service and access to 24 hr AMHP availability across both services. Major development of AMHP service to reduce problems and stresses and ensure a speedy response to MHA assessments

BDCFT LA

March 2015 May 2015 Sept 2015

7 Develop the Psychiatric Liaison and AMHP response service in A+E Update: PLS now integrated with FR service. Social care role now permanent. Psychiatric Liasion A and E developments now linked to urgent care vanguard section (below).

Expand the PLN service to cover as many A+E hours as possible and link to the crisis care pathway and FRS, EDT and IHT teams. Integrate Social Care/AMHPs into this service through employment of social care staff in the PLN team and via the Integrated Hubs and hospital social work teams. Agree minimum standards for assessment and decisions in A&E and explore a specific assessment area in A and E in line with recent recommendations. Develop frequent attendee project with police, LA and NHS

LA BDCFT CCG CCC working group Urgent Care Vanguard group

Feb 2015 March 2015

Part of UECV

July 2015

8 Develop the Intensive Home Treatment service to provide

Redesign the IHTT so it is separate to the crisis function and can support people to divert from acute care or facilitate early discharge from Hospital or

BDCFT LA

Feb 2015


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intensive support to people in crisis and avoid admission

offer intensive support into peoples homes to reduce crisis. Link to Crisis Care pathway and joint management with FRS and PLN. Increase coverage of this service to 24 hr and link to AMHP service.

9 Link the MIND Guideline telephone support service to the Crisis Care Pathway

Referral/signposting process between this agency and the FRS triage system will enable better response to people in crisis. Guideline may need to refer people they are concerned about to FRS triage.

MIND SV BDCFT LA

April 2015

10 Explore the establishment of a safe place or sanctuary for people in crisis in partnership with Mind/ Sharing Voices

Support Mind/Sharing Voices and other agencies to set up a safe place for MH service users in crisis to receive therapeutic or practical support as an expansion of their current service. Extend hours into late evening. Link to professional support from the FRS and IHTT health and social care staff.

MIND SV CCG LA BDCFT

May 2015

11 Ensure appropriate access to local MH acute care beds when needed Update: No Out of Area bed placements for 8 months

Improved Links with social housing and joint commissioning of step down accommodation to support move on from hospital

Link Bed Manager to IHTT and FRS teams FRS, AMHP and IHT teams to work together to divert people from

acute care and facilitate early discharge Implement strategies to reduce bed occupancy and improve discharge Link to frequent attender programmes Use sanctuary and specific Residential care providers to provide

support for people who do not need Acute Care bed

LA CCG BDCFT

April 2015

12 Develop joint working with NHS 111 and police call centres Link to UECV project

Explore the basing of health and social care mental health professionals with the emergency services 111 call centre. This is now part of regional UECV. MH staff in Trafalgar house Hub to co-ordinate responses to MH service users to reduce the number of people presenting in crisis and improve response

Police LA PH BDCFT

May 2015

July 2015

13 Crisis response for a range of other support areas in addition to adult mental health

Identify specific needs of people with developmental disorders; Learning Disability – now covered by police hub and FRS Older People – now part of the CCC group – Sept 2015 Physical Health - Parity of esteem part of the CCC group Children and Young people – Now part of the CCC Vanguard group

CCG LA BDCFT

March 2016


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C. Quality of Treatment and Care when a person is in crisis Making sure that people are treated with dignity and respect, in a therapeutic environment.

1 Ensure that the Crisis Care Pathway identifies how people should be supported in crisis

All agencies involved in crisis care to agree minimum standards of response and service delivery to people in crisis in line with this action plan and the crisis care pathway

CCC working group

Dec 2015

2 Improved response to people missing from acute care or MH services

Develop the joint missing person policy for vulnerable people in MH crisis missing from services. To identify the role and responsibilities of both police and MH services

Police BDCFT LA

Mar 2016

3 Develop services for people with MH issues who present to A+E Update Sept 2015: This will be part of the Urgent Care Vanguard status for 2016-18

Explore the development of a dedicated area in A + E departments for the assessment and support of vulnerable people Development of an integrated A & E Liaison service Development of the A and E housing and support pathway

CCGs BRI AGH LA Horton Housing & Bevan hse

UECV plan May 2015

Feb 2016

4 Age appropriate care pathways for young people in crisis Develop a Children and Young People Crisis service in A and E and as part of EDT/FRS/Childrens social care ad part of the UEC Vanguard.

Develop an integrated crisis pathway for children and young people that ensures age appropriate services for young people in MH crisis through the ‘Future in Mind’ Transformation project. Develop one SPOA for C&YP and integrate into FRS Develop an age appropriate place of safety or sanctuary for C&YP in education or other placements No children held in the police cells under any circumstances – No children with MH problems held in cells so far in 2015

LA childrens services LA Adult MH CCGs BDCFT

Nov 2016

Nov 2016

Nov 2016

2015

5 Improve Access to an Appropriate Adult for vulnerable people in police custody

Explore the setting up of a volunteer service across health & social care to respond to the PACE requirements for people in custody Update Oct 2015: LA Access team and some volunteers trained

Police LA BDCFT 3rd Sector

Feb 2016


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6 Speedy access to appropriate medication support when required

Development of the ANP role in FRS and IHTT to provide urgent prescribing when needed to reduce crisis.

BDCFT August 2015

7 Evaluation of the development of crisis services

Explore development of Mental Health triage assessment tools and training Evalution of development of FRS and attitudes of the police and other staff

BDCFT LA CCGs

August 2015

8 Develop Positive and proactive care in inpatient environments

To develop a strategy to reduce seclusion, restrictive care, chemical and physical restraint in inpatient environments

CCG BDCFT

May 2016

D. Services to support recovery and staying well following a crisis Preventing future crises by making sure people are referred to appropriate services.

1 Develop supported accommodation that keep people well and identifies crisis in advance

LA to undertake a review of Housing Related Support and Supported Living options for people with a mental health problem and develop services that can respond to the needs of people who may experience MH crisis. New service spec to be produced and tender arranged.

LA BDCFT CCG

Oct 2015

2 Develop specific housing support for people in crisis or being discharged

Integrated commissioning with housing, NHS and LA to identify to housing needs of people in MH crisis. To develop urgent access housing for people who need a step down provision from acute care or are homeless.

March 2016

3 Explore the development of services that support people to move out of secondary MH care and back to primary care Link to Review of CMHTs

Consider the development of a supportive multi agency care navigator service to support people with serious or long term mental health problems to be supported when discharged from secondary mental health services (see ‘Evolve’ service http://www.crestwf.org.uk/evolve/ ). Link with the local Wi FI complex care service

BDCFT LA WiFi

Mar 2016

4 Explore the development of services that support people recovering from a crisis to stay safe and in recovery Link to Review of CMHTs

Identification and support of people recovering from crisis or experiencing multiple MH crisis. A co-ordinated and assertive outreach approach to working with them within the crisis pathway and frequent attender scheme. Solidarity in a crisis service (www.certitide.org.uk) is a service that provides in depth support to people in recovery from a crisis

Police BDCFT LA

Mar 2016

5 Explore the development of an employment support service for people with mental health problems

Develop Multi agency individual placement service for people in secondary mental health services to move back to employment. This project is supported by the Centre for Mental Health and is being implemented by BDCT and CBMDC with 3rd Sector partners

BDCFT LA SV Cellar Trust

May 2015


15

2. Improved quality of response when people are assessed or detained under Sections

of the Mental Health Act 1983 No Recommendation and required

outcome Action needed to achieve this Lead

Agency RAG 10/15

A. Develop Appropriate Services for people detained under S136 and S135 1 Implement services that will reduce

the number of people detained under S136 by the police Ensure people who are detained under s136 are treated appropriately in a place of safety

FRS triage service will support the police to divert people to other services whenever required through a dedicated police telephone line, police hub, and immediate triage response. All s136 detainees to be taken directly to the s136 suite unless there is a risk of serious violence to facilitate recovery and speedy assessment Oct 2015 update: Services implemented but S136 numbers not falling as expected. Review underway with police about this.

BDCFT LA Police

April 2016

May 2016

2 Improve timescales and arrangements for conveyance under the Mental Health Act and for vulnerable people

Explore the introduce the use of a range of appropriate vehicles in the event of conveyance being required in a mental health emergency wider than paramedic ambulances Agree shared standards and timescales for 30 min conveyance with YAS. Link this CCC action plan with the UVC developed across west Yorkshire.

YAS CCG BDCFT

Link to UECV

Link to UECV

6 Ensure that Care Act responsibilities for Vulnerable people are part of the CCC

A clear pathway for vulnerable people in crisis – link to the LA access team and BRI teams with joint working across FRS and mental health services.

LA CCG BDCFT

Oct 2016

7 Develop parity of esteem between physical and mental health services

To ensure that physical health risks to people with MH problems such as hearth disease, diabetes, stroke etc are part of the crisis care planning and can be assessed and acted upon using the Bradford MH Physical Health assessment tool.

BDCFT CCG June 2016


16

Review conveyancing policy in line with the Association of Ambulance Chief Executives S136 guideline for transportation of people under Section 136 detention and local YAS guidance developed as part of the CCC

Mar 16

3 Develop S136 suites to meet national guidance

S136 suites can safely support people for up to 72 hours for assessment under MHA and reduce need for police custody to a minimum Ensure that S136 suites can be staffed when needed by IHTT professionals and that police can be released as soon as possible after they have delivered a person under s136 Agree a clear protocol on when police can be released – aim for immediate release with a maximum police support timescale of 1 hour

BDCFT Police

Feb 2015

Feb 2015

May 2015

4 Ensure that no young people under 18 are held in police cells under s136 Link to UEC Vanguard and CYP pathway (see below)

Ensure that S136 suites and special areas in acute wards are age appropriate and can be staffed when needed for young people Consider development of specific non health based places of safety to cater for young people in emotional and MH crisis Develop alternatives to hospital and supported accommodation for young people in crisis including needs of BME young people Ensure access to CAMHS staff expertise through 24 hour cover arrangements (duty consultant; speedit )

BDCFT LA CAMHS

Nov 2016

5 Improve experience for people detained under the MH Act

Link and develop existing policies and practical arrangements to create a multi agency ‘Standards for Mental Health Act Assessments’ that identifies the minimum expectations for service users and agencies

LA BDCFT

Feb 2016

6 Develop links with drug and alcohol services and services for people in crisis

Develop protocol and integrated services to consider the recommendation of the D&A services review integrated support services to people in crisis especially when in police custody

CCG PH BDCFT

Mar 2016


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Develop alternative places of safety for People under the influence of drugs and Alcohol ( see CCC national actions progress report)

March 2016

7 Improve the care and management of intoxicated service users

Consider using specialist places of safety for intoxicated people where they can resume capacity in a safe environment that is not the police cells or hospital. Most intoxicated S136 clients are not detained.

LA WYP BDCFT

Nov 2016

8 Faster response to S136 assessments Ensure AMHPs and Doctors are available to assess within an agreed time frame and build this into the S136 policy. Link to point 5 above.

BDCFT LA

Nov 2016

9 Review police use of places of safety under the Mental Health Act 1983 and results of local monitoring

Use the monitoring arrangements to check progress in relation to the number of people detained under s136 and use of cells and s136 suite. Oct 2015 - This is now being checked regularly

Police BDCFT

Oct 15

10 S136/135 policy to be updated Re write the S136 policy and partnership agreement to reflect the new arrangements within the CCC.

WYP LA

Jan 2016

B. Improved information and advice available to front line staff to enable better response to individuals 1 Link access to crisis plans and

advanced directives across agencies Agencies need to be able to share the Crisis Plans for certain service users through client consent or an information sharing process so that service users have a consistent support plan that can be accessed when needed Information Governance issues need to be resolved through a multi agency IG agreement linked to the existing Info sharing agreement

IG Depts of all agencies to work together

Mar 2016

C. Improved training and guidance for police officers and MH professionals 1 Provide training in MH issues for police Set up a rolling training programme on MH and MH act issues for police

colleagues. Specific training on working with vulnerable people especially MH and LD clients.

WYP BDCFT LA

August 2016

2 Support police to make better decisions about people who need MH support

Telephone support & joint decision making with police officers from FRS. Place health and Social Care staff in the police Hub.

Police LA BDCFT

August 2016

3 Training for MH professionals Police to support training on Appropriate Adult and Criminal Justice issues BDCFT LA Police

July 16

4 Training for other professionals working in Police custody

Support medical professionals working in police cell areas to make better decisions about people with mental health issues

Police BDCFT LA

July 16


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3. Suicide Prevention Plan

No Recommendation and required outcome


RAG 10/15

Develop a suicide multi agency suicide prevention plan as part of the CCC (Oct 2015 – this is currently subject to a major review within the Crisis Care Concordat group)

1 Establish a MDT suicide prevention group

Public Health to establish and chair a MDT suicide prevention group with responsibility for developing a suicide prevention action plan and monitoring its progress. We have agreed to work towards zero suicides in mental health settings and a major reduction in community suicides.

Public Health CCC imp group

June 2015

Dec 2016

2 Conduct a local Suicide Audit that explores the local risk factors

A specific action plan for reducing male suicides Use of the public health suicide prevention profile plus local data and published evidence. Respond to all recommendations in the APPG (all party parliamentary group) Children and young people self harm and suicide reduction plan. Link to CDOP

Public Health

Nov 2015

Nov

2015

Nov 2015

3 Suicide prevention conference: How to work towards zero suicides in our area

Public Health/LA and BDCFT to present findings of audit and use this forum to set up and launch the specific suicide prevention plan for our area. Specific plan to reduce suicide by joint working with Fire service and Network Rail and voluntary and community sector

Public Health CCG LA CCC team

Feb 2016

Feb 2016


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Set up local suicide training using findings of audit, local plan and best practice.

Feb 2016

Explore best practice options for suicide reduction

Review evidence and take best practice from other areas. Develop a Suicide Prevention conference

Public health BDCFT

Feb 2016

4. West Yorkshire Urgent Emergency Care Vanguard Mental Health

No Recommendation and required outcome


RAG 10/15

Main Aims of the WYUECV (note: this plan is currently still in development at Oct 2015 as part of the WY vanguard process and may change)

1 Regional Non Urgent Ambulance service to improve conveyance

To develop a more responsive conveyance system that does not require the need for paramedic ambulances and can ensure the timely conveyance of vulnerable people within guidance. This is a regional approach across West Yorkshire.

West Yorks UECV group

To be decided

2 Reduce unnecessary A and E attendance by 50% through the development of community crisis support within an integrated health and social care model.

Initially Health and social care to develop joint A and E MH liaison services to support and divert vulnerable people in A and E. As a longer term project to develop sustainable community recovery services that reduce the need for people to attend A and E. Sanctuary projects; safe haven projects and the US ‘parachute’ crisis support service are the models we are considering. Links to housing and other support agencies.


3 Health and Social Care to develop mental health in reach to inpatient wards in hospitals.

As part of the development of A and E liaison and integration with the hospital social work teams we intend to be able to provide MH professionals to inreach to the impatient wards and support staff there with expertise in mental health support.



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4. Reduce MH acute care out of area placements in the West Yorkshire region

Work across West Yorkshire to develop a model of robust admission and discharge processes that ensure there are enough acute bed spaces to reduce out of area or private sector placements to a minimum.

Effective support of people in the community to increase emotional resilience

Effective crisis planning and multi agency support with crisis management with people prone to admission or frequent reliance on crisis services

Effective Discharge management systems in partnership with social care and housing


5. Reduce s136 place of safety attendance

Stage one of this process is to ensure that effective health and non health places of safety are available and staffed. Stage two is reduce use of s136 by effective street triage, integrated police hubs


6. Reduce number of suicides in West Yorkshire

See suicide prevention plan. Review best practice suicide prevention & Design plan appropriately.


7. Crisis Care Concordat for children and Young People integrated with Children’s social care

Develop separate C&YP plan based on Future in MIND and linked to A and E liaison, specialist places of safety and recovery.


8. Improve Access to urgent Housing for vulnerable people with a MH problem

Supported accommodation; urgent housing for homeless and specialist crisis housing.


9. Improve data collection Improve baseline data tracking of access point s and activity West Yorks UECV group

report of the bradford district care nhs foundation trust

Documents