11 April 2020

Mental Health Care
• Broadly split into two areas of provision
• Provision 1 = Conveyance
• Patients in Crisis
• Section 136 & 135
• Community Sections
• Provision 2 = Interventional
• Patients in Crisis
• Uncomplicated diagnosed patients receiving care
• Complicated diagnosed patients receiving care
• Uncomplicated undiagnosed patients
• Complicated undiagnosed patients
• Worried Well
2

Mental Health Care
• Broadly split into two areas of provision
• Provision 1 = Conveyance
• Patients in Crisis
• Section 136 & 135
• Community Sections
• Provision 2 = Interventional
• Patients in Crisis
• Uncomplicated diagnosed patients receiving care
• Complicated diagnosed patients receiving care
• Uncomplicated undiagnosed patients
• Complicated undiagnosed patients
• Worried Well
3

Illness/Incident Code Report
PCT:
Illness Code:
Incident Code:
All
All
All
Date from:
Date to:
01/04/2011
01/12/2011
Care Pathway
_none
Cancelled
Care Pathway - conveyed
No patient
Patient not conveyed
Patient not conveyed - referred
Taken to A&E
Total
Count
32344
5033
34383
18466
87842
13302
498361
689731
Percentage
4.689%
0.73%
4.985%
2.677%
12.736%
1.929%
72.254%
100.00%
4

Illness/Incident Code Report
PCT:
Illness Code:
Incident Code:
All
All
Psychiatric
Date from:
Date to:
01/04/2011
01/12/2011
Care Pathway
_none
Cancelled
Care Pathway - conveyed
No patient
Patient not conveyed
Patient not conveyed - referred
Taken to A&E
Total
Count
112
53
1418
173
1459
274
8586
12075
Percentage
0.928%
0.439%
11.743%
1.433%
12.083%
2.269%
71.106%
100.00%
5

Illness/Incident Code Report
PCT:
Illness Code:
Incident Code:
All
All
Self-harm
Date from:
Date to:
01/04/2011
01/12/2011
Care Pathway
_none
Cancelled
Care Pathway - conveyed
No patient
Patient not conveyed
Patient not conveyed - referred
Taken to A&E
Total
Count
1649
54
10697
12907
113
18
260
116
Percentage
0.875%
0.139%
2.014%
0.899%
12.776%
0.418%
82.878%
100.00%
6

Illness/Incident Code Report
PCT:
Illness Code:
Incident Code:
All
Psychiatric problems - diagnosed
Psychiatric
Date from:
Date to:
01/04/2011
05/12/2011
Care Pathway
_none
Cancelled
Care Pathway - conveyed
No patient
Patient not conveyed
Patient not conveyed - referred
Taken to A&E
Total
Count
58
17
968
78
744
172
4647
6684
Percentage
0.868%
0.254%
14.482%
1.167%
11.131%
2.573%
69.524%
100.00%
7

Borough
Borough
Barnet
Lambeth
Newham
Southwark
Ealing
Croydon
275
246
244
209
208
204
Number
65%
61%
79%
62%
78%
67%
A&E
Kensington & C.
84
Richmond 81
59%
67%
8

9

Mental Health Care
• Broadly split into two areas of provision
• Provision 1 = Conveyance
• Patients in Crisis
• Section 136 & 135
• Community Sections
• Provision 2 =Interventional
• Patients in Crisis
• Uncomplicated diagnosed patients receiving care
• Complicated diagnosed patients receiving care
• Uncomplicated undiagnosed patients
• Complicated undiagnosed patients
• Worried Well
10

Mental Health Care
• Broadly split into two areas of provision
• Provision 1 = Conveyance
• Patients in Crisis
• Section 136 & 135
• Community Sections
• Provision 2 =Interventional
• Patients in Crisis
• Uncomplicated diagnosed patients receiving care
• Complicated diagnosed patients receiving care
• Uncomplicated undiagnosed patients
• Complicated undiagnosed patients
• Worried Well
11

Mental Health Care
12

Mental Health Care
• Accessibility
• Full
• Short of staff
• Regarded as “out of area”
• Not seen as an emergency
13

Mental Health Care
• Section 136
• Emergency mental health care to be equivalent to emergency acute commissioning by all
• Treat the patient first and ask the questions afterwards
14

Mental Health Care
• Broadly split into two areas of provision
• Provision 1 = Conveyance
• Patients in Crisis
• Section 136 & 135
• Community Sections
• Provision 2 = Interventional
• Patients in Crisis
• Uncomplicated diagnosed patients receiving care
• Complicated diagnosed patients receiving care
• Uncomplicated undiagnosed patients
• Complicated undiagnosed patients
• Worried Well
15

Mental Health Care
16

Mental Health Care
• Expertise
• Accessibility
• Difficult to know who the provider is
• Can not always access
• Professional issues
• Opening hours
• Don’t respond to crisis
• Few alternatives to conveyance
17

Kent & Medway Mental Health / Ambulance referral Pathway
SECAmb Ambulance Paramedic Practitioner/paramedic/technician on scene
Mental Health (MH) problem identified does not require attendance for medical/physical intervention at the emergency department (ED).
Consider contacting MH team for advice / referral (see guidance notes), if unsure discuss with paramedic practitioner.
Contact relevant MH Team (Duty or Crisis Team) ** for advice or to make a referral
When referring the term ‘ Ambulance on scene’ will identify that an urgent response is required from the mental health service
•
•
•
•
•
MH team respond
Duty worker will co-ordinate response and ensure Ambulance crew are informed of outcome within 10 minutes of end of initial contact
Exchange phone numbers with Ambulance crew
Ask for ambulance incident number; patient details; presenting problem/concerns; observations; contact information; and patient consent
Speak with patient and carer
MH team will:
•
•
•
•
•
• determine Urgency
Identify most appropriate MH service to assess
Agree a timescale for contact from MH services with patient/carer and ambulance crew
Agree time and place for assessment.
Give the patient/carer the relevant mental health team contact number
Ambulance crew can leave unless otherwise indicated*
Community mental health services
Respond / assess within agreed timescale with
AMHP if MHA required
CRHTT
Respond / assess as per agreed timescale with AMHP if MHA required
Acute Care
(as per Acute care pathway)
Community Mental Health Team
* If timescale cannot be achieved then patient will be taken to the nearest ED
18

Patient suffering with mental health issue calls 999 and receives a pre hospital assessment
Question: is the patient presenting with an isolated MH issue, or is it complicated with illness/injury drug/alcohol intoxication?
NO YES
Isolated MH issue, no complication
MH issue complicated with illness/injury or drug/alcohol intoxication?
YES
Question: within the last 6 months, has the patient had a MH diagnosis/are they known to local MH services?
NO
Known diagnosis, known to local services
No known diagnosis, not known to local services
Contact local MH community service (Crisis or Home
Resolution Team) to discuss case/develop treatment plan
Refer patient to
Barnet, Enfield or Haringey
Crisis Teams
Convey patient to local MH facility
Convey to
MH Liason
Team in local
Emerg.
Dept.
Convey patient to
Royal local
Emergency
Dept.
19

Mental Health Care
• Broadly split into two areas of provision
• Provision 1 = Conveyance
• Patients in Crisis
• Section 136 & 135
• Community Sections
• Provision 2 = Interventional
• Patients in Crisis
• Uncomplicated diagnosed patients receiving care
• Complicated diagnosed patients receiving care
• Uncomplicated undiagnosed patients
• Complicated undiagnosed patients
• Worried Well
20

Mental Health Care
• Looking for commissioner support for:
•
•
•
•
• Alcohol
• Frequent callers
21