Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
1. Commissioning to allow earlier intervention and responsive crisis services
No.
Action
Timescale
Led By
Outcomes
Matching local need with a suitable range of services
1.1
1.2
1.3
Implementing
newly
commissioned MH
services and
monitoring for
quality
Establish access to
MH first aid training
across a wide range
of stakeholders in
Bristol
Raise awareness
with carers about
pathways available
By April 2015
Bristol CCG
and MHBristol
A range of services are available in a timely way for people with
mental health problems in Bristol.
CASS
Community
Access Service
Those involved in the crisis care pathway will be better able to
 Recognise and deal with the onset of a crisis through
having a greater understanding of the conditions
affecting the person
 Know where to see help appropriately
Carers better able to
 Recognise and deal with the onset of a crisis through
having a greater understanding of the conditions
affecting the person they care for
 Respond to changes in the person’s condition knowing
what is normal to expect and when to alert others
Ask questions that might otherwise not be able to ask
CASS
1
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
Improving mental health crisis services
1.4
Continue to
commission the
Bristol CRHT which
is rated as
‘Excellent” by HTAS
in January 2014
Ongoing
Bristol CCG
and MHBristol
A safe, less restrictive, alternative to hospital admission for
those in a mental health crisis.
1.5.1
Continue to
commission two
crisis houses (one
male one female)
for those in MH
Crisis who do not
need a hospital
admission
Investigate
possibility of
commissioning a
third crisis house in
Bristol
Investigate the
need for a safe
place for
care/containment
and subsequent MH
assessment for
people in MH crisis
who are intoxicated
Ongoing
Bristol CCG in
partnership
with Missing
Link and St
Mungos
Broadway
A safe, less restrictive, alternative to hospital admission for
those in a mental health crisis.
April15/March
16
Bristol CCG
Great choice for service users of less restrictive alternatives to
hospital admission
April –March
15/16
Bristol
CCG/Safer
Bristol
Reduction in an inappropriate use of S136 suite and ED,
improves assessments
Reduction in resources wasted by partner agencies ‘containing’
very intoxicated individuals
1.5.2
1.6
2
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
1.7
Street Triage pilot
to be established
1.8
Bristol MH to
implement new role
of intensive support
workers into Crisis
team.
Investigate ways
that BME
communities are
informed and
supported around
early intervention
regarding MH
1.9
JanuarySeptember
2015 for pilot
between
September
2015 and
May2016
October 2014
–April 2015
Bristol CCG
AWP Avon and
Wiltshire
Constabulary
Reduction in inappropriate use of the S136 suite
Better outcomes for service users
Reduction in stigma experienced by service users
Reduction in police time taken up with conveying people to 136
suite
Bristol MH
More personalised and practical support available to those in
crisis
February 2015 CASS
onwards
Carers/Family/Friends/lay people from the BME community
better able to
 Recognise and deal with the onset of a crisis through
having a greater understanding of the conditions
affecting the person they care for
 Respond to changes in the person’s condition knowing
what is normal to expect and when to alert others
Ask questions that might otherwise not be able to ask
Ensuring the right numbers of high quality staff
Improved partnership working in Bristol
1.10
Set up Crisis
Concordat working
July –
December
Bristol CCG
Agreed work plan of deliverables
3
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
group
2014
4
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
2. Access to support before crisis point
No.
Action
Timescale
Led By
2.1
Commission Crisis
Sanctuary
Bristol Primary
Care agreement
will include
support to raise
awareness of MH
for GPs
April 2015
Bristol CCG
October 2014
Onwards
Bristol CCG
Outcomes
Improve access to support via primary care
2.2
Providing a safe space out of hours for those who are
experiencing high levels of emotional distress or “pre crisis”
GPs are better informed and supported to manage people
presenting with MH needs at primary care level.
Improve access to and experience of mental health services
2.3
2.4
2.5
Exploring possible
street triage
service pilot in
Bristol
Review links with
other local
agencies across
the Crisis team
and assessment
and recovery
services develop
as needed.
Outstanding need
to provide local
June 2014December
2014
Bristol CCG
Redirecting people who may otherwise being placed under
section 136 to more suitable alternative services.
Reduction in use of 136 suite
October 2014
onwards
AWP/MH
Bristol
More co-ordinated services in MH
Less people requiring intervention form crisis team
Ongoing
AWP/MH
Bristol
Less people have to go out of area to receive treatment
Better experience for service users and carers
5
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
2.6
2.7
2.8
No.
inpatient beds.
Continue work
with CCG in
reviewing the
current in-patient
provision and use,
for mental health
crises in AWP.
Ensure crisis team
continues to
accepts self and
carer referrals and
provides 24/7
service.
Commission
Community
Access Service
Pilot Crisis
Outreach Service
for children and
young people
Action
Better outcomes for service users and carers
Ongoing
AWP/MH
Bristol
Higher levels of service user and carer satisfaction
Reduces risk of crisis escalating
April 2015
Bristol CCG
Increasing awareness in local communities about how to
access mental health services when required.
September
2015
Bristol City
Reduce the number of children needing crisis services
council and
Improve outcomes for children and young people in crisis
Bristol CCG
NBTChildren’s
Partnership
3. Urgent and emergency access to crisis care
Timescale
Led By
Outcomes
Improve NHS emergency response to mental health crisis
6
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
3.1
3.2
3.3.1
3.3.2
3.4
Exploring possible
street triage
service pilot in
Bristol
Review with social
services, police,
and ambulance,
what multiagency training
should be
developed.
Improving Acute
services/ED
response to
mental health
crisis by
commissioning
high quality
extended hours
liaison psychiatry
services
Increase
Paediatric Liaison
to respond to
mental health
crisis
Improving Acute
services/ED
response to
April 2015
Bristol CCG
Redirecting people who may otherwise being placed under
section 136 to more suitable alternative services.
Reduction in use of 136 suite
February 2015
AWP/MH
Bristol
Service users experiencing a MH crisis are treated with greater
sensitivity by all stakeholders involved in their pathway
Providers of services in crisis pathway are better informed and
supported to deal with people experiencing a MH crisis
UHB –
currently
NBT- April
2015
Bristol
CCG/UHB and
North Bristol
Trust
Promote parity of esteem by establishing a high quality
response to mental health crises presenting in ED and Acute
hospital wards.
Services are of a high quality –accredited by PLAN (Psychiatric
liaison network)
May 2015
Bristol CCG
and UHB
Paediatric
Liaison service
Develop a business case by May 2015
April 2015
Bristol
CCG/UHB and
North Bristol
Improve patient safety by establishing a POS in an acute
hospital where ‘Red Flag’ s136 and s135 can fully assessed.
7
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
mental health
crisis by providing
Acute hospital
based POS (place
of safety) for
people with a
physical health
need who also
have MH crisis
Trust
Reduce Police waiting time in ED
Reduce stigma for the service user (currently the police wait
whilst the person receives urgent treatment for their physical
health needs)
Social services’ contribution to mental health crisis services
3.5
Outstanding need
to reduce delay
for MHA
assessments to
meet 4hr target.
Review provision
of AHMP and EDT
service
April 2015
Bristol City
council AHMP
service and
EDT
8
Reduce delay in AHMP led mental health act assessments of
s135 and s136 to come within 4 hour target of Crisis
concordat where this is clinically appropriate
Identify where in the system the delays occur that affect this
target.
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
3.6.1
3.6.2
Improved quality of response when people are detained under Section 135 and 136
of the Mental Health Act 1983
Reduce delays for
April 2015
Bristol CCG,
Reduce delay in s135 and s136 assessments due to causes
MHA assessments
AWP,
other than AHMP related
by analysing
MHBristol, UHB
causes and
and NBT.
addressing them in
cross agency crisis
concordat group
Review Section 12 February 2015 Bristol CCG,
Reduce delay in s135 and S136 assessments due to causes
doctor availability
EDT, Bristol CC related to Section 12 doctor availability
and the systems
AMHP service.
surrounding this
Improved information and advice available to front line staff to enable better response to individuals
3.7
Improve police,
ambulance, acute
hospitals and non
statutory staff
awareness of
mental health
April 2015
3.8
Review IT systems
across the Crisis
Care pathway to
look at where
March 2015
Bristol CCG.
System Lead
for Bristol MH
and CASS
(Community
Access Support
Service)
Bristol CCG
and working
group
9
Improve response to mental health crises to ensure uniformly
high quality and predictable responses to crises.
Improved availability of information and advice for front line
staff
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
shared access can
be made available
to frontline staff
more readily
Improved training and guidance for police officers
3.9
3.10
Bristol to have a
March 2015
multi agency
agreed local
protocol describing
the approach to be
taken when a
police officer uses
powers under the
Mental Health Act.
Review of health
March 2015
POS provision in
Bristol, its usage,
quality and
capacity.
Police and
MHBristol
Improve response to mental health crises and reduce rates of
inappropriate s136s
AWP Police
and Bristol
CCG
Improve response to mental health crises and reduce rates of
inappropriate s136s
Improved services for those with co-existing mental health and substance misuse issues
3.11
Review training
needs within
access teams and
links with
specialist
April 2015
AWP Safer
Bristol
Improve response to service users presenting with substance
misuse or dual diagnosis crises.
Reduce rates of inappropriate s136.
Improve service user safety.
10
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
3.12
substance misuse
services.
Review need for
specialist crisis
drug and alcohol
team
April 2015
Safer Bristol
BCC
11
Improve response to service users presenting with substance
misuse or dual diagnosis crises.
Reduce rates of inappropriate s136.
Improve service user safety.
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
4. Quality of treatment and care when in crisis
No.
Action
Timescale
Led By
Outcomes
Review police use of places of safety under the Mental Health Act 1983 and results of local monitoring
4.1
4.2
4.3
Review POS usage
and possible less
restrictive
measures
Monitoring of
current MH Crisis
Service against
agreed KPIS
Commission a
Children’s crisis
and home
treatment service
to be part of the
children’s reprocurement
process
April 2015
AWP, MH
Bristol, Police,
AHMPs
Reduce excessive use of s136.
Improve quality of POS care.
On going
Bristol CCG
and Bristol
Recovery
Partnership
Bristol City
Council/Bristol
CCG
Crisis service achieves and maintains a high quality of service
delivery
Improved service user satisfaction with crisis service
Service to
commence
April 2017
Better outcomes for children and young people in crisis
Prevention of children being admitted to inpatient settings.
Service User/Patient safety and safeguarding
4.4
Safeguarding
forms part of the
regularly
monitored Key
Performance
indicators for
Crisis Service
On going
Bristol CCG
Services provided are safe for those in crisis
12
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
Staff safety
Primary care response
4.5
Support GPs to
provide advice and
signpost those in
MH crisis
October 2014October 2015
Bristol CCG
Improved care pathway for those in MH crisis
GPs will feel more confident in managing those with MH needs
13
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
5. Recovery and staying well / preventing future crisis
No.
Action
Timescale
Led By
Outcomes
5.1
Crisis Team to
ensure that
everyone who
receives home
treatment is
offered time to
reflect on their
crisis and write or
review their crisis,
relapse and
contingency plan.
April 2015
MHBristol
Improve interventions to prevent crises. By providing good
quality Recovery orientated care crises will be reduced in
frequency and/or severity. By intervening effectively in the
pre-crisis stage mental health crises will be avoided.
5.2
Assessment and
Recovery teams to
ensure all service
users are offered
time to complete a
crisis, relapse and
contingency plan
or re-access plan.
Psychiatric Liaison
to develop
personal support
plans which are
April 2015
MHBristol
Improve interventions to prevent crises. By providing good
quality Recovery orientated care crises will be reduced in
frequency and/or severity. By intervening effectively in the
pre-crisis stage mental health crises will be avoided
April 2015 –
March 2016
Psychiatric
Liaison
services at
UHB and NBT
Improve opportunities for self-help for those using psychiatric
liaison services
Provide potential of improved follow up for those using crisis
services
Joint planning for prevention of crises
5.3
14
Template action plan to enable delivery of shared goals of the Mental Health Crisis Care Concordat
given to patients
and sent to GPs
ACTION
Timescale
Led by
15
Outcomes