The Pointless Separation of Care
Health Perspective
• 1 in 4 people will experience a Mental health problem
at some time in their life
• We have introduced open access psychological therapy
services In primary care.
• In a year about 29,OOO Derbyshire people will be open
to NHS MH adult teams .
• Integrated services is a fundamental driver for the
future
• Derbyshire CCG have invested more in MH services
but…
• Non Service Solutions, community asset building and
resilience is needed .
Crisis Concordat A Health Perspective
• Casualty 1500 people a year coming to
casualty following self harm (approx.)
• Used to be seen 9-5 7 days week.
• Now 24 hours 365 days per week through
RAID investment-Liaison team in DRH and CRH
Liaison team
The view for AMP
• Increasing use of MH Act powers
• 5 % increase year on year in compulsory
admissions
• Before the street triage pilot of those that come
to hospital on a section 136 only 30% are
admitted.
• Disjointed connections between agencies and
expectations of roles and of what a person wishes
and what is offered –see the vignettes
• Reforming 136 Group and multi professional
forum to link into the Crisis concordat
136 to Hospital
Out of hours
• High priority and area of concern for People
who use services
• How to extend hours so a problem doesn't
become a crisis
• Help line Rethink Focus Line and Samaritans
• Trialling a nurse in 111 over weekend
Children and Young People
Note: Patients may be included more than once if multiple categories have been
identified.
Young People referrals
General Medical Practitioner
905
After A&E Attendance
459
Other
420
Other specialist clinical department
105
CMHT
75
Education Service
24
A&E Ref
38
Self Referral
63
Allied Health Professional
15
Same Consultant
6
Self
16
Social Services
12
Ref by Other Consultant
8
Child & Adolescent Services
4
Attendance After Inpatient Episode
4
Criminal Justice System - prison etc.
2
Police
1
For Southern Derbyshire and Erewash CCG s only data for DHcFT
Adult Crisis Team
• 43,617 contacts
• 1090 people
• Total MH contacts by Crisis team and by CCG
Erewash
Hardwick
North Derbyshire
South Derbyshire
3418
4451
16915
18833
• Average length of treatment spell is 39 days
Crisis Team By cluster
cluster
rest
13
12
11
10
8
7
6
5
4
0
5
10
15
Percentage %
20
25
30
Clusters
•
Care Cluster 4: Non-Psychotic (Severe) - This group of PATIENTS is characterised by severe depression and/or
anxiety and/or other disorders, and increasing complexity of needs. They may experience disruption to function in
everyday life and there is an increasing likelihood of significant risks.
•
Care Cluster 5: Non-Psychotic Disorders (Very Severe) - This group of PATIENTS will be severely depressed and/or
anxious and/or other. They will not present with hallucinations or delusions but may have some unreasonable
beliefs. They may often be at high risk for suicide and they may present safeguarding issues and have severe
disruption to everyday living.
•
Care Cluster 6: Non-Psychotic Disorder of Over-Valued Ideas - This group of PATIENTS suffer from moderate to
very severe disorders that are difficult to treat. This may include treatment resistant eating disorders, Obsessive
Compulsive Disorder etc, where extreme beliefs are strongly held, some personality disorders, and enduring
depression.
•
Care Cluster 7: Enduring Non-Psychotic Disorders (High Disability) - This group of PATIENTS suffer from moderate
to severe disorders that are very disabling. They will have received treatment for a number of years and although
they may have an improvement in positive symptoms, considerable disability remains that is likely to affect role
functioning in many ways.
•
Care Cluster 8: Non-Psychotic Chaotic and Challenging Disorders - This group of PATIENTS will have a wide range
of symptoms and chaotic and challenging lifestyles. They are characterised by moderate to very severe repeat
deliberate self-harm and/or other impulsive behaviour and chaotic, over-dependant engagement, and are often
hostile with services.
http://www.datadictionary.nhs.uk/data_dictionary/nhs_business_
definitions/m/mental_health_care_cluster_de.asp?shownav=1
Clusters
•
Care Cluster 10: First Episode Psychosis - This group of PATIENTS will be presenting to the Mental Health service
for the first time with mild to severe psychotic phenomena. They may also have depressed mood and/or anxiety
and/or other behaviours. Drinking or drug taking may be present but will not be the only problem.
•
Care Cluster 11: Ongoing Recurrent Psychosis (Low Symptoms) - This group of PATIENTS have a history of
psychotic symptoms that are currently controlled and causing minor problems if any at all. They are currently
experiencing a period of recovery where they are capable of full or near functioning. However, there may be
impairment in self-esteem and efficacy and vulnerability to life.
•
Care Cluster 12: Ongoing or Recurrent Psychosis (High Disability) - This group of PATIENTS have a history of
psychotic symptoms with a significant disability with major impact on role functioning. They are likely to be
vulnerable to abuse or exploitation.
•
Care Cluster 13: Ongoing or Recurrent Psychosis (High Symptoms and Disability) - This group of PATIENTS will have
a history of psychotic symptoms which are not controlled. They will present with moderate to severe psychotic
symptoms and some anxiety or depression. They have a significant disability with major impact on role
functioning.
•
Care Cluster 14: Psychotic Crisis - This group of PATIENTS will be experiencing an acute psychotic episode with
severe symptoms that cause severe disruption to role functioning. They may present as vulnerable and a risk to
others or themselves.
Crisis Team
Is a bed available ?
• Last 3 years build up of demand leading to in
1April 2013-14 March31 125 People sent
outside Derbyshire for an Acute ie urgent MH
bed
• Invested in crisis house -5 beds
• Invested in new ward in Derby and home
treatment staff
• Now no one sent outside Derbyshire (but its
very tight)
East Midlands Ambulance service
April 2014 we attended 172 calls for
psychiatric/suicide in Derbyshire alone; this does
not include many other call categories for this
patient type
We do our best!!!
But is it good enough for these patients?
We want to work with you to help these people but
we can’t do it without you
Workforce at EMAS
Clinicians
• Emergency care assistants and Technicians
• Paramedics and ECPs
• Registered Nurses
• Recruiting GPs
Emergency Control room
• Call takers and dispatchers
• Clinical assessment team
Issues we face
• Limited care pathways for patients with
mental health problems/ in crisis
• Limited referral routes especially out of hours
• Frontline staff with limited MH training
expected to treat this patient group
• No access to patients notes so unaware of the
patients background (especially when violent)
• No where to take the patient except ED ????
The question from EMAS
• “Where do we refer these patients to?? There
are very few pathways open to them and we
do not have the skills to adequately assess
them correctly.”
The NHS Questions
• What can we do differently to divert before a
crisis?
• Once a crisis has occurred what could we do
differently?
• Should we all aim to reduce compulsory
admissions by 2017 is that a sensible target
for us all?