HSJ Awards 2014
Entry for category: Innovation in mental health
Operation Serenity
Summary
Operation Serenity is an innovative pilot project in Hampshire to improve the
response from police and mental health services for people in mental health crisis.
By putting mental health workers on the frontline with police, and side-by-side in
police control centres, we have been able to significantly reduce the number of
people being detained in police custody, amongst other benefits to service users and
professionals. One service user, who has been detained by police in the past,
described the project as ‘the best thing to happen in mental health services in the
last ten years.’ Based on its success, we are now extending the Operation for a
further six months.
Background
Police cells are rarely an appropriate place for people in crisis. Yet far too many
people are being detained in police custody when they are at their most vulnerable.
This can have a significant impact on recovery and even worsen their mental health.
Police can detain people under Section 136 of the Mental Health Act, if they believe
a person is a risk to themselves or others. However, police are not trained to assess
risk in the same way as clinicians, and may detain people when less restrictive
methods are more appropriate. Police arriving at a scene can also increase stigma
and add to the public perception of mental illness being linked to crime.
In January, national police and health bodies, alongside politicians and the voluntary
sector, signed the Crisis Care Concordat – a commitment to improve the situation so
people in crisis get the right support from different agencies involved.
Southern Health NHS Foundation Trust and Hampshire Constabulary, alongside local
authorities and other health services, have been working together for the past
decade. We have created hospital-based ‘places of safety’ for people in crisis, and
reduced the use of police cells. Operation Serenity emerged from this strong
foundation of trust and collaboration as a response to the Concordat and the need
to improve support for people in crisis.
Description of project
Operation Serenity was a two-month pilot between January and February 2014. The
main aim was to improve experience and outcomes for people in mental health
crisis, by offering the most appropriate support. Other aims were to improve the
way mental health and police colleagues work together, share information and
expertise, and make the best use of limited resources.
We used a two-pronged approach to test the effectiveness of different methods: a
‘street triage’ scheme where mental health workers joined police on patrol, and
embedding clinicians in the police control centre. The pilot ran during evenings and
weekends, where evidence shows the highest number of mental health-related calls
take place.
Southern Health funded the Operation and provided mental health staff, using
existing resources.
Clinicians, with their access to information and knowledge on individuals, and
expertise on risk assessment, provided support directly to people in crisis, and
advised police colleagues to provide the most appropriate response.
In most cases (further information below), therapeutic conversations, informal
referrals to community mental health services, or signposting were sufficient to
support people in crisis. This meant people who did not need to be detained were
able to remain in their homes, rather than being taken to a police cell or hospital
place of safety. For people already known to mental health services, continuity of
care was improved, as mental health professionals remained involved in people’s
care throughout a crisis.
The designated Operation Serenity police patrol car was unmarked, to reduce the
distress and stigma caused when attending a call.
The impact
The numbers below demonstrate the success of the project. But more importantly
than the numbers is the difference this has made to vulnerable, frightened people
who have received compassionate support from police and clinicians working in
partnership.
In the control centre, out of approximately 160 calls received, only 2% resulted in
detention under the Mental Health Act. In 40% of calls, people in crisis were offered
routine follow-up support from mental health community services. In 32% of cases,
emergency community follow-up was arranged from ‘Hospital at Home’ services. In
other cases, people were signposted to primary care, substance misuse, voluntary
sector or other support services.
Without this input from health services at the point of crisis, many more of these
calls would have resulted in detention and time spent in police custody.
Another way to assess the effectiveness of the Operation is to compare the figures
for January/February 2014 (when Operation Serenity was in action) with those of the
previous year:
JANUARY / FEBRUARY 2013
Section 136 was used by police 56 times, of which 38 people were detained in police
cells (18 in hospital places of safety). After mental health assessment by
professionals, only five people required hospital care (only 9% of those initially
detained by police), which shows that Section 136 was rarely the most appropriate
course of action.
JANUARY / FEBRUARY 2014 (OPERATION SERENITY IN ACTION)
Section 136 was used by police 19 times (a 34% reduction on the previous year), of
which five people were detained in police cells (14 in hospital places of safety).
Following mental health assessment, eight people required hospital care (26% of
those initially detained by police).
The results show that, as well as fewer detentions by police, and less use of police
cells, Section 136 was being used more appropriately during Operation Serenity.
In addition to these statistics, police and health colleagues have reported the
positive impact of the Operation on their practice and the relationships they have
built over the period. There is now a greater understanding of each other’s
expertise, as well as the challenges facing each organisation.
Next steps
Following the success of the pilot, we are now extending Operation Serenity for a
further six months, and have applied to the Regional Innovation Fund for resources
to do this. We strongly believe this type of innovative joint working is the best
solution to providing appropriate crisis-care to people with mental health problems.
Colin Edwards
Area Manager, Southampton Mental Health Services, SHFT.