Initial Response Team
Sunderland and South of Tyne
Improving Access to Urgent Mental
Health Services
Dr Paul Brown- NTW Lead Consultant for Access,
IRT/ CRHT
David Hetherington- Senior Clinician- Sunderland
IRT/ CRHT
Rachel Winter- Sunderland IRT/ CRHT Clinical Lead
Overview
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•
•
•
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Context
Model Development
Engagement and Commissioning
IRT Evaluation
Case Examples and Service User
Feedback
Service Model
Request for Help
Information & Advice
Initial Response
Initial evaluation regarding nature, risk, complexity and urgency of the problem
More Intensive Packages of Care
Hospital
Signposting to principal service pathway for assessment and formulation
Psychiatric Intensive Care
Treatment Intensity
Low Security
Specialist Ward
Crisis Beds
PICU
Environment
Acute Ward
Intermediate
In the Community
Low Security
beds
Intermediate Facility
Challenging
Crisis Bed
Behaviour
Acute Ward
Mild severe
non psychotic
Very
severe &
complex
nonpsychotic
Psychosis
Dementia
Assessment
Intensive Home
Treatment
At Home
Intensive
Home
Home
Etc.
Challenging
Behaviour
Treatment
Assessment Formulation
& Treatment Planning
Crisis Assessment
Discharge
Neuro disability
Learning
Disability
Children &
Young
People
Substance
Misuse
Scaffolding
Medium Security
Access?
Access is the term used by NTW to describe the Initial Response to
Urgent and Routine requests for help.
Urgent Requests – Phase 1- (2012)
Routine Requests – Phase 2- (2014)
Integration with other routes of entry such as…
• IAPT
• Specialist Services
• Social Care
Demographics: North and South
Population
Geographic
Area
North of Tyne
Northumberland North Tyneside Newcastle
(18+)
(18-65)*
(18+)
225,100
254,979 (42% )
127,560 (21% )
(37% )
2000 miles sq
32 miles sq
South of Tyne
South Tyneside
Sunderland
(18+)
(18+)
Population
118,569 (26% )
220,528 (47% )
Geographic
Area
25 miles sq
53 miles sq
44 miles sq
Gateshead
(18-65)*
126,753
(27% )
Total
607,639
2076 miles
sq
Total
465,850
55 miles sq 133 miles sq
Phase 1: The case for change
Sunderland was chosen as the location for the development of a
new access model following discussions with service users, carers,
GPs and commissioners.
•Clear issues with contacting the Crisis Team by phone as Triage
saturated++
•Overnight and at peak demand times callers could wait hours for a
return call from a clinician
•No ready point of access for Older People or People with a
significant Learning Disability seeking Urgent Advice/ Intervention
•Fewer than 35% of referrals needed a Crisis Team Response
•Most of the “inappropriate” calls required some form of advice/
signposting but at low risk/ acuity
Engagement
• Large scale events- Local Authority, GP’s,
Commissioners, Service Users
• Focussed Group Events- Service Users,
GP’s, Staff
Engagement- Commissioners
• Sunderland PCT facilitated and supported
Initial Engagement process
• Recognised need for change
• Supported 1st year (Pilot) through
imaginative use of CQUIN
• On basis of initial evaluation have
commissioned ongoing service
• Ongoing development of whole-system
Initial Response Team
South of Tyne and Wear
Gateshead
GH UCT
ICTS
Home Based
Treatment
Rapid
Response
11
Nurses
Information
Collection & Routing
Triage & Action
South Tyneside
REQUEST
FOR
HELP
OPS
Assessment
Gatekeeping
LD
ST UCT
ICTS
Home Based
Treatment
Rapid
11
Response
Nurses
Triage & Action
Sunderland
OPS
Assessment
Gatekeeping
LD
SL UCT
ICTS
Home Based
Treatment
ROUTING
Rapid
11
Response
Nurses
Triage & Action
OPS
Assessment
Gatekeeping
LD
Phase 2 Model
UCT
IRT
Urgent
Rapid
Response
11
Nurses
Triage & Action
Single
Point of
Referral
ICTS
Home Based
Treatment
OPS
Assessment
Gatekeeping
LD
Triage
Team
Noncomplex
Clinical
Diary
Routine
Complex
Huddle
Clinical
Diary
Phase 1: The Model
•IRT to offer 24/7 Universal telephone access for requests for urgent
help.
•No restrictions on who could refer
•Triage and Routing over the phone- (Mental Health and other local
Services)
•Face to Face Triage (Rapid Response) if clear plan cannot be
determined over the phone
•Seven Band 6 Nurses for Telephone and Rapid Response
•Five Band 3 Nurses for call handling and Rapid Response
•Use of digital dictation and 3G laptops for clinical documentation
•Flexible interchangeable roles and rotation between Crisis Team
and IRT roles dependant on demand.
Phase 1: Benefits of IRT
• Quick and efficient responses to requests for help
• Effective routing to the correct services in and out of NTW
• Flexible and collaborative working with newly configured UCT
which will focus on the work for which it is commissioned
• Reduction of clinician administration burden, and freeing time to
care (mainly through adoption of digital dictation)
• Improving personal and clinical outcomes for people in crisis with
mental ill health by reducing harm and premature mortality,
improving patient safety and patient experience
Evaluation-IRT in numbers
Typical weekly activity
•1500+
•1000
•400
•50
•100
Incoming telephone calls
Total Contacts
Home-based Treatment contacts
Crisis Assessments
Rapid Responses
…and growing
•90% calls answered within 15 seconds
•>98% within 3 minutes (Average=9 Seconds)
•>80% rapid responses achieved in under one hour
IRT Referrals (Q3 2013)
Other includes:
• Self Harm Team
• Acute Care Trust
• NTW Inpatient Ward
• Ambulance
• Consultant Psychiatrist
• Residential Care Facility
• Drug and Alcohol Services
• IAPT
• Member of Public
• EDT
• Probation
Service Feedback
Service User and Carer
GP
The service is
responsive and friendly
I felt listened to and
was delighted
Fantastic – a huge
improvement!!
You should have
done it before
Staff
More manageable
A lot happier
Skills are valued
Spend more time
I cannot imagine where I
would be today if you had not
been there for me.
I couldn’t
have got this
far without
your help
You do an
amazing job!
You listened
and told me
what to do
Keep this very valuable
service going
You are all very dedicated,
patient, compassionate
people
Wonderful support!
Service User Feedback- Word Cloud
Service User Narrative Feedback
• “Its because of IRT that I haven’t self
harmed in four months. Before, I would
self harm two or three times a week and
would end up in A&E, but knowing that
they are there and knowing that I’m going
to get the same positive response every
time means that I have been able to listen
to their advice and develop coping
strategies. I’m much more hopeful about
my future”
Case Example 1- John- 31
• First contact from brother, family
concerned ++
• “odd” ideas, becoming reclusive
• Triage completed via Rapid Response
(Face to Face) within one hour (after
contact with John.
• Engaged in period of home-treatmentreferred to EIP
Case Example 2- Jenny 60
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•
•
•
•
Local Community Police Referral
Jenny had been contacting them regularly
Concern re mental health and self-neglect
Rapid-Response to join police at property
Crisis Assessment identified depression,
alcohol dependence and social issues
• Home Treatment
• Joint work with social care
Summary
• IRT developed in a context of shared
goals with commissioner and wider
partners
• IRT shown to vastly improve access &
responsiveness with widely positive
feedback
• Next steps planned will look at
incorporating all referrals and wider
system