Mental Health Crisis Care 1 Supporting information Mental Health Crisis Care Contents Understanding What Londoners Expect from Mental Health Crisis Care Key themes identified through engagement ID: 596972
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Slide1
Sustainability and Transformation Plans – Mental Health Crisis Care
1
Supporting
informationSlide2
Mental Health Crisis Care
Contents:
Understanding What Londoners Expect from Mental Health Crisis
Care
Key themes identified through engagementLondoners’ Crisis Care ‘I’ Statements Crisis Care Data Analysed by NetworkNorth Central LondonNorth West LondonSouth East LondonSouth West LondonNorth East London
2Slide3
Understanding What Londoners Expect from Mental Health Crisis Care
3
With support from Mind and YoungMinds, Healthy London Partnership has undertaken an engagement process to understand what matters most to Londoners with lived experience of mental health crisis and what they expect from the capital’s crisis care system.
More than 140 service users and carers took part in an online survey, telling us about their recent experiences of crisis care, including those in emergency departments and health-based places of safety. They told us what was good and what could have been better. They also told us what is most important to them in helping to prevent a crisis, during a crisis and following a crisis.
A face-to-face service user focus group was undertaken to help develop a series of ‘I’ statements from the survey responses. The statements were then tested and refined through further online consultation. They are first person statements that say what Londoners expect from the services and agencies involved in their care. They are what people should be able to say when crisis care is working well.
Further engagement was also undertaken with children and young people to better understand where their experiences and needs might differ from those of adults. As a result, some additional statements have been compiled to try and reflect what we heard from Londoners who have experienced a mental health crisis as a young person. They should be read alongside and not instead of the other statements, which apply to Londoners of all ages.
We hope these powerful statements will help guide the NHS and partner organisations in making improvements to mental health crisis care across London. If you have any queries of comments relating to the statements please email england.mentalhealthcrisis@nhs.netSlide4
Key themes identified through engagement
The following areas were identified through the engagement process as
particularly important
in
the delivery of crisis care. The survey responses and focus group have helped to identify both the current problems across these areas and how service users think improvements could be achieved.Access to the right help – less than half of survey respondents knew how to access advice and support to get the help they needed when in crisisTimeliness of care – nearly 70% of survey respondents felt there were missed opportunities to prevent their mental health deteriorating to crisis pointCompassion – only 34% who attended an emergency department and 27% who attended a place of safety agreed that staff had treated them with compassionChoice and Involvement – only 30% felt involved in discussions about their mental health problemsStaff attitudes and knowledge
–
only 36% of those who attended an emergency department felt listened to and that their concerns were taken seriously
Environment
– 93% of respondents feel that being in an environment that suits their needs when in crisis is either important of very important
Continuity of care
– Over 95% said that receiving appropriate follow-up care after their crisis was either important of very important
4
As of the 4th February 2016,131 people had completed the online survey. The quantitative data presented
above,
some of which was shared at London’s first Mental Health Crisis Care Summit, is based on analysis of responses received up until this date
.Slide5
Londoners’ Mental Health Crisis Care ‘I’ Statements: Preventing Crisis
5
I feel reassured because I know
I can easily access extra support
when I need it, and I can rely on it being there. This includes local community mental health services that offer rest and respite, such as sanctuaries and crisis houses.
Friends and family are involved in my care
where we both want this and staff recognise their contribution.
My carer is offered support in their own right, to help them stay well.
The care I receive is tailored to my needs
and circumstances at that time, and helps me reach my aspirations. It follows any plan I have agreed with mental health services, and covers all areas where I need assistance, such as physical health care, practical and emotional needs.
When I’m not coping
I can get the support I need at that time to manage everyday life
, such as practical assistance with getting meals, or help to keep me from becoming isolated.
My care is coordinated
by someone I can trust, who will listen and take seriously what I say I need. They take time to understand my situation and if at all possible I will know them.Slide6
Londoners’ Mental Health Crisis Care ‘I’ Statements: During Crisis
6
If I am taken to an emergency department or place of safety, it is in
health service transport
such as a paramedic car or ambulance and not a police vehicle.Right from the beginning, and throughout the crisis, all the professionals involved (whether paramedics, police, frontline emergency department staff, or any other staff) recognise me as a person in crisis. They treat me skilfully and lawfully, with care, compassion and respect.
If I am taken to an emergency department or place of safety, I am let in straight away.
I don’t have to wait in the transport or any other unsuitable place
such as a general waiting room, corridor or outside, while staff negotiate whether or not I can go in.
When I am in crisis
police presence is as low key as possible
and there is no unnecessary use of restraint.
Emergency staff and paramedics treat me with
the same respect
,
confidentiality and care as all other patients and are
skilled in managing mental health
problems.
I am listened to and my voice is heard
;
at the point of crisis I might not be able to think clearly, make decisions or say everything I am feeling, but I am still a person and should not be ignored. If my behaviour is not appropriate I am not judged for this.
Emergency staff pay attention to any advance statement or crisis plan I have made
and adhere to it, referring to my medical records when I have given consent.
In the emergency department or place of safety
I am seen (and where necessary wait) in an environment that is safe and calm
.
Staff welcome me and offer me refreshment. The room is private, quiet, clean and comfortable – it does not feel like a prison. If it is important to me to be cared for by female or male staff this is respected and I can choose to have someone with me to provide friendly support.
Staff in the emergency department, place of safety or any other setting spend time with me and explain clearly and calmly what is happening and what is going to happen.
They keep communicating with me and my family or carer
and tell me if the plan changes. I am not left waiting for hours, without explanation or on my own.
If I wish to involve family members, friends or carers,
staff listen to them in my presence
; they do not exclude them or ignore what they say.Slide7
Londoners’ Mental Health Crisis Care ‘I’ Statements: Following Crisis
7
There is a reasonable and realistic plan for my aftercare
that I and any chosen friends, family and carers have made with relevant professionals. I choose who knows about the plan and which parts of it they can access. People who are responsible for providing aftercare understand and perform their role fully.
If I am discharged from an emergency department or place of safety, I am provided with advice and support if I want it and safe transport home, especially at night.
My aftercare is helpful, reliable, easily accessible and local
- it covers my wider needs (such as housing or benefits), supports my wellbeing and helps me achieve my aspirations
. Slide8
Londoners’ Mental Health Crisis Care ‘I’ Statements: Children and Young People
8
Those caring for me
involve me
in discussions about my care and listen to what I think works well.Staff believe what I am saying and take my opinion seriously. My voice is not ignored just because I have an adult with me and I am not spoken over or about just because I am young.
Wherever possible
I am given options
in my care that recognise that I am an individual and that every situation is different
I am never left waiting on my own without knowing what is going on
and I am always involved in making plans for what happens next.
Those involved in my care are
always honest with me
.
They support me to gain confidence in them when I am feeling vulnerable.
I
am supported to achieve my aspirations
for other areas of my life such as education, hobbies and relationships.
I am prepared for the changes which are coming up
and not left feeling I am going into the unknown.
Those
caring for me
take the time to find out about my fears.
They take them seriously and reassure me.
Those involved in my care
make the effort to get to know me
. They understand that although I may be an adult legally, I may not always feel like one.
As far as possible
my confidentiality is respected
and only the friends, family and carers that I choose are involved in my care.
The children and young people’s ‘I’ statements should be read in addition to, and not instead of, the overarching London Mental Health Crisis Care ‘I’ statements, which apply to Londoners of all ages. These additional statements were developed with the intention of capturing and emphasising the specific needs and expectations of children and young people in crisis.Slide9
North Central London
Detentions under Section 136 of the Mental Health Act Designated Health Based Places of Safety (HBPoS)Mental Health in Emergency Departments
HLP Audit Findings
Liaison Psychiatry
901Slide10
NCL Mental Health Crisis
Care: Detentions under S136 of the MHA
10
The
boroughs covered by the NCL
UEC Network
are
served by two Mental Health Trusts:
- Camden
and Islington NHS Foundation Trust
- Barnet
, Enfield and Haringey Mental Health NHS
Trust
The data below shows the number of people assessed at these Trusts following formal detention under the
Section
136 of the
Mental Health Act
1983, between Jan
2015 – Sep
2015.
MH Trust
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Total
Camden and Islington NHS Foundation Trust
37
26
40
27
52
57
30
31
29
329
Barnet, Enfield and Haringey Mental Health NHS Trust
26
14
27
24
25
28
33
29
41
247
London MH
Trust
Average
32
29
41
36
37
45
46
40
42
349
Data Source:
Mental Health & Learning Disabilities Minimum Dataset – MHLDDS excepting C & I which are drawn from local systems)Slide11
HBPoS Site
Mental health Trust Provider
Boroughs covered by HBPoS site
Assessment Capacity (according to CQC 2014 data)
Age range accepted by service
Dedicated staffing attached to the unit
1
University College London
Hospital
(ED)
Camden and Islington NHS Foundation Trust
Camden and Islington
2
All age
No – covered by the Liaison Psychiatry Team
2
Royal Free Hospital
(ED)
Camden and Islington NHS Foundation Trust
Camden and Islington
1
All age
-
5
Whittington Hospital
(ED)
Camden and Islington NHS Foundation Trust
Camden and Islington
2
All age
-
6
Chase Farm Hospital
Barnet, Enfield and Haringey Mental Health NHS Trust
Barnet, Enfield, Haringey
2
All age
Dedicated nursing staff from 8am-8pm. 8pm-8am is covered by staff from the CRHTT.
7
St Ann’s Road Hospital
Barnet, Enfield and Haringey Mental Health NHS Trust
Barnet, Enfield, Haringey
1
All age
Yes - 2 nursing staff available 24/7. Medical staff available via
oncall
system.
NCL: Designated Health Based
P
laces of Safety (HBPoS)
11
Barnet
Enfield
Haringey
Camden
Islington
2
1
7
5
Royal Free
Whittington
UCLH
6
Chase Farm Hospital
St Ann’s Road Hospital
The designated health based places of safety across the NCL UEC network are identified on the map below.
The information regarding the age range of individuals accepted by HBPoS and staffing arrangements
is
self-reported and taken from an NHS England Mental Health bed audit undertaken in November 2015. (Where no data is entered this indicates that information was no submitted.)
Assessment capacity is taken from the CQC’s thematic
d
ata review report on experience
and outcomes for people experiencing a mental health
crisis (Nov 2014).Slide12
Overview
All the EDs
in NCL reported that they are aware of the
MH Crisis Commissioning Standards and have
at least one designated room specially equipped for assessing mental health patients within the department.They all reported high levels of activity, with the MH rooms being in use the majority of the time at all hours of the day.Mental Health Staff Training within Emergency DepartmentsThe majority of sites reported that most frontline staff were trained in mental health awareness/crisis management, but this mainly comprises internal training. Only the Whittington reported that all ED consultants were trained in these areas.
The main barriers to undergoing training were identified as lack of time/competing demands and lack of nationally recognised accessible programmes.
Mental Health Act Assessment and AMHPs
UCLH was the only ED in NCL that reported
completing the majority of MHA assessments within four hours. The other sites claim this rarely or never happens, with waits of up to 12hrs not uncommon.
Cited reasons for delayed assessments across the geography include: difficulty accessing AMHPs, particularly out of hours; the inability to identify a bed leading to an unwillingness for assessments to be carried out; boundary disputes regarding AMHP coverage and bed allocation.
Children and Young
People
All sites reported
that their frontline staff had knowledge of children and young people's mental health, however, both the Royal Free and North Middlesex hospitals reported that quick access to CAMHS expertise in ED is rare.
Repeat
presentations
All the sites
identify those patients who attend ED frequently when experiencing a mental health crisis, which they report account for less than half of those who go on to be admitted following assessment.
NCL Mental Health Crisis Care in
ED: Audit Findings
12
Findings based on responses from the following EDs
University College London Hospital
ED and designated HBPoS
Royal Free Hospital
ED and designated HBPoS
Barnet Hospital
ED
North Middlesex University Hospital
ED
Whittington Hospital
ED and designated HBPoS
HLP undertook an audit during the summer of 2015 to better understand London’s
current position in relation to delivering
London's Mental Health Crisis Commissioning Standards
in
emergency
departments.
Summarised below are some key findings from this audit for the EDs located within NCL UEC Network.
The information presented was self-reported by the EDs.Slide13
NCL Mental Health Crisis Care in ED: Liaison
Psychiatry
13
The information
below
regarding Working
Age Adult and Older Adult Liaison Psychiatry
provision in EDs was
taken from NHS England’s 2nd annual survey of liaison mental health, completed in August 2015
.
This information was used to make decisions regarding the
distribution
of the £30 million
non-recurrent
funding made available by NHS England
in October 2015
for
improving Liaison
Psychiatry in ED
nationally.
Any service changes that have occurred since this survey was undertaken are not accounted for in the data below.
ED Hospital Site
Current Consultant Provision
Recommended Total Consultants for Core 24
Difference (Consultants Required for Core 24)
Current Nurses
Recommended Total Nurses for Core 24
Difference (Nurses Required for Core 24)
Service Grading
University College London Hospital
1.50
3.57
2.07
6.00
23.22
17.22
SubCore
Royal Free Hospital
1.50
2.49
0.99
9.00
16.17
7.17
SubCore
Barnet Hospital
2.00
1.74
-0.26
10.00
11.34
1.34
Core 24
North Middlesex University Hospital
2.00
1.82
-0.18
9.50
11.83
2.33
Core 24
Whittington Hospital
1.00
1.12
0.12
9.007.25-1.75Core 24Slide14
North West London
Detentions under Section 136 of the Mental Health Act Designated Health Based Places of Safety (HBPoS)Mental Health in Emergency Departments
HLP Audit Findings
Liaison Psychiatry
1402Slide15
NWL
Mental Health Crisis
Care: Detentions under S136 of the MHA
15
The
boroughs covered by the NCL
UEC Network
are
served by two Mental Health Trusts:
-
Central and North West London NHS Foundation Trust
- West
London Mental Health NHS Trust
The data below shows the number of people assessed at these Trusts following formal detention under the
Section
136 of the
Mental Health Act
1983, between Jan
2015 – Sep
2015.
MH Trust
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Total
Central and North West London NHS Foundation Trust
35
57
90
54
47
65
69
48
51
516
West London Mental Health NHS Trust
28
25
28
30
37
55
48
60
39
350
London MH
Trust
Average
32
29
41
36
37
45
46
40
42
349
Data Source:
Mental Health & Learning Disabilities Minimum Dataset – MHLDDS excepting C & I which are drawn from local systems)Slide16
NWL: Designated Health Based Places of Safety (HBPoS)
HBPoS Site
Mental health Trust
Boroughs covered by HBPoS site
Assessment Capacity (according to CQC 2014 data)
Age range accepted by service
Dedicated staffing attached to the unit
1
Northwick Park Mental Health Unit
Central and North West London NHS Foundation Trust
Harrow
1
16+
Yes - Band 6 RMN Unit Coordinator
2
Park Royal Mental Health Unit
Central and North West London NHS Foundation Trust
Brent
1
16+
Yes - Band 6 RMN Unit Coordinator
3
Gordon Hospital
Central and North West London NHS Foundation Trust
Westminster
1
16+
Yes - Band 6 RMN Unit Coordinator
4
Riverside Centre
Central and North West London NHS Foundation Trust
Hillingdon
1
16+
Yes - Band 6 RMN Unit Coordinator
5
Hammersmith & Fulham Mental Health Unit
West London Mental Health NHS Trust
Hammersmith & Fulham
1
All age
B5 Nurse & B2 HCA
24/7
6
Lakeside Mental
Health Unit
West London Mental Health NHS Trust
Hounslow
1
All age
B5 Nurse & B2 HCA 24/7
7
St Bernard’s,
Ealing Hospital
West London Mental Health NHS Trust
Ealing
2
All age
B5 Nurse & B2 HCA 24/7
16
6
4
1
3
7
5
Brent
Ealing
H&F
Harrow
Hounslow
K&C
Westminster
Hillingdon
Riverside Centre
Northwick Park MH Unit
Lakeside
Gordon Hospital
St Bernard’s
2
Park Royal
H&F MH Unit
The designated health based places of safety across the NWL UEC network are identified on the map below.
The information regarding the age range of individuals accepted by HBPoS and staffing arrangements
is
self-reported and taken from an NHS England Mental Health bed audit undertaken in November 2015. (Where no data is entered this indicates that information was not submitted.)
Assessment capacity is taken from the CQC’s thematic data review report on experience and outcomes for people experiencing a mental health crisis (Nov 2014).Slide17
Overview
All the EDs
in NWL reported awareness of the
MH Crisis Commissioning Standards apart from
London North West Healthcare Trust, which runs the EDs at Ealing Hospital and Northwick Park. They all have at least one designated room specially equipped for assessing mental health patients within the department apart from Hillingdon hospital.They all reported high levels of activity, with the MH rooms being in use the majority of the time, particularly at night/Mental Health Staff Training within Emergency DepartmentsThe sites reported
that almost all frontline staff and ED consultants were trained in mental health awareness/crisis management, but this mainly comprises internal training.
Lack of time was identified as the main barrier to training.
Mental Health Act Assessment and AMHPs
Northwick Park was
the only ED that
reported
completing the majority of MHA assessments within four hours. The other sites claim this happens less than half of the time.
Cited reasons for delayed assessments across the geography include difficulty accessing AMHPs and S12 Drs, particularly out of hours, and the inability to identify a MH bed.
Children and Young
People
All sites reported
that their frontline staff had knowledge of children and young people's mental health, however, Hillingdon indicated that this knowledge was limited.
All EDs reported that quick access to CAMHS expertise was rare, apart from Chelsea and Westminster that said it was often possible during the day, Monday-Friday.
Repeat
presentations
All the sites
identify those patients who attend ED frequently when experiencing a mental health crisis, which they report account for less than half of those individuals who go on to be admitted.
NWL Mental Health in ED: Audit Findings
17
Findings based on
responses
from the following EDs
West Middlesex University Hospital
Hillingdon
Hospital
Ealing
Hospital
Charing Cross Hospital
Northwick Park
St Mary's Hospital
Chelsea and Westminster Hospital
HLP undertook an audit during the summer of 2015 to better understand London’s current position in relation to delivering
London's Mental Health Crisis Commissioning Standards
in emergency departments.
Summarised below are some key findings from this audit for the EDs located within
NWL
UEC Network
.
The information presented was self-reported by the EDs
.Slide18
NWL Mental Health in ED: Liaison Psychiatry
18
The information below
regarding liaison psychiatry
provision in EDs was
taken from NHS England’s 2nd annual survey of liaison mental health, completed in August 2015
.
This information was used to make decisions regarding the
distribution
of the £30 million
non-recurrent
funding made available
in October 2015
for
improving Liaison
Psychiatry in ED
nationally.
Any service changes since this survey was undertaken are not accounted for in the data below.
ED Hospital Site
Current Consultant Provision
Recommended Total Consultants for Core 24
Difference (Consultants Required for Core 24)
Current Nurses
Recommended Total Nurses for Core 24
Difference (Nurses Required for Core 24)
Service Grading
West Middlesex University Hospital
3.50
1.41
-2.09
15.00
9.18
-5.82
Enhanced
Ealing Hospital
3.20
1.42
-1.78
23.10
9.20
-13.90
Comprehensive
Northwick Park
2.00
1.85
-0.15
15.00
12.04
-2.96
SubCore
Chelsea and Westminster Hospital
1.00
1.57
0.57
9.00
10.22
1.22
Core
Hillingdon
Hospital
2.00
1.68
-0.32
12.00
10.95
-1.05
Core 24
Charing Cross Hospital
3.00
1.68
-1.32
6.70
10.89
4.19
Core
St Mary's Hospital
2.60
1.94
-0.6612.00
12.58
0.58
Core 24Slide19
South East London
Detentions under Section 136 of the Mental Health Act Designated Health Based Places of Safety (HBPoS)Mental Health in Emergency Departments
HLP Audit Findings
Liaison Psychiatry
1903Slide20
SEL
Mental Health Crisis
Care: Detentions under S136 of the MHA
20
The
boroughs covered by the NCL
UEC Network
are
served by two Mental Health Trusts:
-
Oxleas NHS Foundation Trust
- South
London and Maudsley NHS Foundation Trust
The data below shows the number of people assessed at these Trusts following formal detention under the
Section
136 of the
Mental Health Act
1983, between Jan
2015 – Sep
2015.
MH Trust
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Total
Oxleas NHS Foundation Trust
41
26
27
35
40
39
38
43
42
331
S
outh
London and Maudsley NHS Foundation Trust
51
47
55
65
57
73
79
52
72
551
London MH
Trust
Average
32
29
41
36
37
45
46
40
42349
Data Source:
Mental Health & Learning Disabilities Minimum Dataset – MHLDDS excepting C & I which are drawn from local systems)Slide21
SEL:
Designated Health Based Places of Safety (HBPoS)
HBPoS Site
ED/
Mental health Trust
Boroughs covered by HBPoS site
Assessment Capacity (according to CQC 2014 data)
Age range accepted by service
Dedicated staffing attached to the unit
1
Green Parks House
Oxleas NHS Foundation Trust
Bexley, Bromley & Greenwich
1
All age
No
2
Oxleas House
Oxleas NHS Foundation Trust
Bexley, Bromley & Greenwich
1
All age
No
3
Lambeth Place of Safety Suite, Eden Ward, Lambeth Hospital
South London and
Maudsley
NHS Foundation Trust
Lambeth
1
All age
One allocated nurse
as POS
co-ordinator
4
Ladywell
Unit, University Hospital Lewisham
South London and
Maudsley
NHS Foundation Trust
Lewisham
1
All age
One allocated nurse as POS co-ordinator
5
Southwark Place of Safety Suite, ES1 Ward, Maudsley Hospital
South London and
Maudsley
NHS Foundation Trust
Lewisham
Southwark
1
All age
One allocated nurse as POS co-ordinator
6
Croydon Place of Safety Suite, Gresham PICU, Bethlem Royal Hospital
South London and
Maudsley
NHS Foundation Trust
Southwark
Croydon
1
All age
One allocated nurse as POS co-ordinator
21
Lambeth
Bromley
Bexley
Greenwich
Lewisham
Southwark
2
1
3
5
64
6
4
Maudsley Hospital
Oxleas House
Greenparks
House
Ladywell
Unit
Lambeth Hospital’
Croydon 136 Suite
The designated health based places of safety across the SEL UEC network are identified on the map below.
The information regarding the age range of individuals accepted by HBPoS and staffing arrangements
is
self-reported and taken from an NHS England Mental Health bed audit undertaken in November 2015. (Where no data is entered this indicates that information was not submitted.)
Assessment capacity is taken from the CQC’s thematic data review report on experience and outcomes for people experiencing a mental health crisis (Nov 2014).Slide22
Overview
All the responding EDs
in SEL reported awareness of the
MH Crisis Commissioning Standards apart from
University Hospital Lewisham. They all have at least one designated room specially equipped for assessing mental health patients within the department which they all report is often in use.Mental Health Staff Training within Emergency DepartmentsThe sites reported that most frontline staff and all ED consultants were trained in mental health awareness/crisis management, but this is achieved through internal training only. Availability of recognised education packages was identified as a barrier to undertaking further training in this area.
Mental Health Act Assessment and AMHPs
Queen Elizabeth Hospital was
the only ED that
reported
completing the majority of MHA assessments within four hours. The other sites said this happens less than half of the time.
Cited reasons for delayed assessments across the geography include lack of available AMHPs and S12 Doctors and the inability to identify a Mental Health bed.
Children and Young
People
All sites reported
that their frontline staff had knowledge of children and young people's mental health.
St
Thomas’
and King’s reported that quick access to CAMHS expertise was often possible, particularly during the day however, the other sites said this was rare.
Repeat
presentations
All the sites
identify those patients who attend ED frequently when experiencing a mental health crisis. They report that these individuals account for less than half of the total number who go on to be admitted, apart from the
Queen Elizabeth Hospital, which claims that the majority of those admitted are frequent attendees.
SEL Mental Health in ED: Audit Findings
22
Findings based on
responses
from the following EDs
King's College Hospital NHS Foundation Trust
University Hospital Lewisham
St
Thomas'
Hospital
Queen Elizabeth Hospital
N.B. no response received from the Princess Royal
HLP undertook an audit during the summer of 2015 to better understand London’s current position in relation to delivering
London's Mental Health Crisis Commissioning Standards
in emergency departments.
Summarised below are some key findings from this audit for the EDs located within
SEL
UEC Network
.
The information presented was self-reported by the EDs
.Slide23
SEL Mental Health in ED: Liaison Psychiatry
23
The information below
regarding liaison psychiatry
provision in EDs was
taken from NHS England’s 2nd annual survey of liaison mental health, completed in August 2015
.
This information was used to make decisions regarding the
distribution
of the £30 million
non-recurrent
funding made available
in October 2015
for
improving Liaison
Psychiatry in ED
nationally.
Any service changes since this survey was undertaken are not accounted for in the data below.
ED Hospital Site
Current Consultant Provision
Recommended Total Consultants for Core 24
Difference (Consultants Required for Core 24)
Current Nurses
Recommended Total Nurses for Core 24
Difference (Nurses Required for Core 24)
Service Grading
King’s College Hospital
1.80
3.60
1.80
16.00
23.40
7.40
SubCore
Princess Royal
0.60
2.00
1.40
9.00
13.00
4.00
SubCore
University Hospital Lewisham
2.00
1.80
-0.20
8.00
11.70
3.70
Core
St
Thomas'
Hospital
2.30
4.00
1.70
11.00
25.97
14.97
SubCore
Queen Elizabeth Hospital
1.00
2.08
1.08
16.00
13.55
-2.45
SubCoreSlide24
South West London
Detentions under Section 136 of the Mental Health Act Designated Health Based Places of Safety (HBPoS)Mental Health in Emergency Departments
HLP Audit Findings
Liaison Psychiatry
2404Slide25
SWL
Mental Health Crisis
Care: Detentions under S136 of the MHA
25
The
boroughs covered by the NCL
UEC Network
are
served by
one
Mental Health
Trust:
-
South West London and St Georges NHS Trust
The data below shows the number of people assessed at these Trusts following formal detention under the
Section
136 of the
Mental Health Act
1983, between Jan
2015 – Sep
2015.
MH Trust
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Total
South West London and St Georges NHS Trust
25
22
37
30
22
33
43
30
36
278
London MH
Trust
Average
32
29
41
36
37
45
46
40
42
349
Data Source:
Mental Health & Learning Disabilities Minimum Dataset – MHLDDS excepting C & I which are drawn from local systems)Slide26
SWL:
Designated Health Based Places of Safety (HBPoS)
HBPoS Site
Mental health Trust
Boroughs covered by HBPoS site
Assessment Capacity (according to CQC 2014 data)
Age range accepted by service
Dedicated staffing attached to the unit
1
Wandsworth Recovery Centre,
Section 136 Suite, Springfield University Hospital
South West London and St Georges NHS Trust
Sutton, Merton, Kingston, Richmond, Wandsworth
3
All age
NO - The 136 facility is managed by the PICU
staff 24/7
26
Croydon
Richmond
Wandsworth
Kingston
Merton
Sutton
1
Wandsworth Recovery Centre
The designated health based places of safety across the SWL UEC network are identified on the map below.
The information regarding the age range of individuals accepted by HBPoS and staffing arrangements
is
self-reported and taken from an NHS England Mental Health bed audit undertaken in November 2015. (Where no data is entered this indicates that information was not submitted.)
Assessment capacity is taken from the CQC’s thematic data review report on experience and outcomes for people experiencing a mental health crisis (Nov 2014).Slide27
Overview
St George’s and
St Helier’s
reported awareness of the
MH Crisis Commissioning Standards (Kingston did not respond to this question) and all three EDs have at least one designated room specially equipped for assessing mental health patients within the department which is often in use at all hours of the day.Mental Health Staff Training within Emergency DepartmentsSt George’s and St Helier’s reported that most frontline staff were trained in mental health awareness/crisis management, but Kingston reported that this was the case for less than half of individuals. However, across all the Trusts most of the Consultants have some level of mental health training.
Time to undertake training and finding necessary staff cover were identified as barriers.
Mental Health Act Assessment and AMHPs
St Helier was
the only ED that
reported
completing the majority of MHA assessments within four hours. The other sites said this either happens rarely or less than half of the time.
Cited reasons for delayed assessments across the geography include lack of available AMHPs and S12 Doctors and the inability to identify a Mental Health bed.
Children and Young
People
All sites reported
that their frontline staff had knowledge of children and young people's mental health, but St Helier’s was the only ED that said quick access to CAMHS expertise was often possible.
Repeat
presentations
St George’s and St Helier’s identified
that about half of patients who are admitted are those who frequently attend ED experiencing a mental health crisis.
SWL Mental Health in ED: Audit findings
27
HLP audit findings based on
responses
from the following EDs
St
George's Hospital
St Helier’s
Hospital
Kingston
Hospital
N.B. no response received from Croydon University Hospital or Epsom Hospital
HLP undertook an audit during the summer of 2015 to better understand London’s current position in relation to delivering
London's Mental Health Crisis Commissioning Standards
in emergency departments.
Summarised below are some key findings from this audit for the EDs located within
NWL
UEC Network
.
The information presented was self-reported by the EDs
.Slide28
SWL Mental Health in ED: Liaison Psychiatry
28
The information below
regarding liaison psychiatry
provision in EDs was
taken from NHS England’s 2nd annual survey of liaison mental health, completed in August 2015
.
This information was used to make decisions regarding the
distribution
of the £30 million
non-recurrent
funding made available
in October 2015
for
improving Liaison
Psychiatry in ED
nationally.
Any service changes since this survey was undertaken are not accounted for in the data below.
ED Hospital Site
Current Consultant Provision
Recommended Total Consultants for Core 24
Difference (Consultants Required for Core 24)
Current Nurses
Recommended Total Nurses for Core 24
Difference (Nurses Required for Core 24)
Service Grading
St George's
1.00
3.47
2.47
17.60
22.57
4.97
SubCore
Epsom
3.00
1.16
-1.84
6.00
7.57
1.57
Core
St Helier’s
1.00
1.79
0.79
3.00
11.65
8.65
SubCore
Kingston
1.00
1.44
0.44
5.00
9.33
4.33
SubCore
Croydon
1.50
1.75
0.25
16.00
11.39
-4.61
Core 24Slide29
North East London
Detentions under Section 136 of the Mental Health Act Designated Health Based Places of Safety (HBPoS)Mental Health in Emergency Departments
HLP Audit Findings
Liaison Psychiatry
2905Slide30
N
EL
Mental Health Crisis
Care: Detentions under S136 of the MHA
30
The
boroughs covered by the NCL
UEC Network
are
served by two Mental Health Trusts:
-
East London NHS Foundation Trust
- North
East London NHS Foundation Trust
The data below shows the number of people assessed at these Trusts following formal detention under the
Section
136 of the
Mental Health Act
1983, between Jan
2015 – Sep
2015.
MH Trust
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Total
East London NHS Foundation Trust
27
18
29
25
19
21
32
28
16
215
North East London NHS Foundation Trust
22
25
40
32
35
36
44
38
52
324
London MH
Trust
Average
32
29
41
36
37
45
46
40
42
349
Data Source:
Mental Health & Learning Disabilities Minimum Dataset – MHLDDS excepting C & I which are drawn from local systems)Slide31
N
EL:
Designated Health Based Places of Safety (HBPoS)
HBPoS Site
Mental health Trust Provider
Boroughs covered by HBPoS site
Assessment Capacity (according to CQC 2014 data)
Age range accepted by service
Dedicated staffing attached to the unit
1
Royal London Hospital
(ED
)
East London NHS Foundation Trust
Tower Hamlets
1
All age
-
2
City and Hackney Centre for Mental Health
East London NHS Foundation Trust
Newham
1
12+
No
3
Crystal Ward
Newham Centre Mental Health
East London NHS Foundation Trust
City and Hackney
1
18 + ( under 18 go via Homerton University Hospital to see
CAMHS
medics)
No
4
Sunflowers Court,
Goodmayes
Hospital
North East London NHS Foundation Trust
Barking and Dagenham, Havering, Redbridge, Waltham Forest
2
All age
-
31
City
Barking and Dagenham
Hackney
Havering
Newham
Redbridge
Tower Hamlets
Waltham Forest
4
1
2
3
City and Hackney Centre for MH
Sunflowers Court
Newham Centre for MH
Royal London
The designated health based places of safety across the NEL UEC network are identified on the map below.
The information regarding the age range of individuals accepted by HBPoS and staffing arrangements
is
self-reported and taken from an NHS England Mental Health bed audit undertaken in November 2015. (Where no data is entered this indicates that information was not submitted.)
Assessment capacity is taken from the CQC’s thematic data review report on experience and outcomes for people experiencing a mental health crisis (Nov 2014).Slide32
Overview
All responding EDs
reported awareness of the
MH Crisis Commissioning Standards
and all three EDs have at least one designated room specially equipped for assessing mental health patients within the department, which is often in use at all hours of the day.Mental Health Staff Training within Emergency DepartmentsThe King George and Homerton hospitals reported that most frontline staff were trained in mental health awareness/crisis management, but Queen’s said that this was only true in some cases. Only Homerton said that all ED Consultants have some level of mental health training, which had been delivered internally.
Mental Health Act Assessment and AMHPs
The King
George
was
the only ED that
reported
completing the majority of MHA assessments within four hours. The other sites said this happens less than half of the time or almost never.
The EDs reported that lack of beds was rarely the reason for delays in completing MHA assessments, but Homerton said that this did sometimes happen for out of area patients.
Children and Young
People
Only Homerton reported
that their frontline staff had knowledge of children and young people's mental health.
Both the King George and Queen’s said that quick access to CAMHS expertise was often possible, but the King George qualified that over night and at weekends this support was provided by an online CAMHS doctor.
Repeat
presentations
All the sites identify those patients who attend ED frequently when experiencing a mental health crisis, which they report account for less than half of those individuals who go on to be admitted.
NEL Mental Health in ED: Audit findings
32
HLP audit findings based on
responses
from the following EDs
Queen’s Hospital
Homerton
Hospital
King
George Hospital
N.B. no response was received from EDs provided by Bart’s Health: Royal London, Newham University Hospital and
Whipps
Cross.
HLP undertook an audit during the summer of 2015 to better understand London’s current position in relation to delivering
London's Mental Health Crisis Commissioning Standards
in emergency departments.
Summarised below are some key findings from this audit for the EDs located within
NWL
UEC Network
.
The information presented was self-reported by the EDs
.Slide33
NEL Mental Health in ED: Liaison Psychiatry
33
The information below
regarding liaison psychiatry
provision in EDs was
taken from NHS England’s 2nd annual survey of liaison mental health, completed in August 2015
.
This information was used to make decisions regarding the
distribution
of the £30 million
non-recurrent
funding made available
in October 2015
for
improving Liaison
Psychiatry in ED
nationally.
Any service changes since this survey was undertaken are not accounted for in the data below.
ED Hospital Site
Current Consultant Provision
Recommended Total Consultants for Core 24
Difference (Consultants Required for Core 24)
Current Nurses
Recommended Total Nurses for Core 24
Difference (Nurses Required for Core 24)
Service Grading
Royal London
1.50
2.49
0.99
9.00
16.17
7.17
SubCore
Queen’s Hospital
1.42
3.76
2.34
16.22
24.41
8.19
SubCore
Homerton
Hospital
2.80
1.56
-1.24
11.00
10.14
-0.86
Core 24
Newham
University Hospital
3.00
1.58
-1.42
14.00
10.24
-3.76
Enhanced
Whipps
Cross Hospital
2.00
2.940.9415.5019.08
3.58
SubCore
King
George Hospital
0.68
1.80
1.12
7.78
11.70
3.92
SubCore