22 April 2023

Mental Health Crisis PlansSteve Lennox

2

• 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

Mental Health Care

3

• 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

Mental Health Care

4

  Care Pathway Count Percentage  _none 32344 4.689%  Cancelled 5033 0.73%  Care Pathway - conveyed 34383 4.985%

  No patient 18466 2.677%

  Patient not conveyed 87842 12.736%  Patient not conveyed - referred 13302 1.929%  Taken to A&E 498361 72.254%  Total 689731 100.00%

Illness/Incident Code ReportPCT:Illness Code:Incident Code:

AllAllAll

Date from:Date to:

01/04/201101/12/2011

5

  Care Pathway Count Percentage  _none 112 0.928%  Cancelled 53 0.439%  Care Pathway - conveyed 1418 11.743%

  No patient 173 1.433%

  Patient not conveyed 1459 12.083%  Patient not conveyed - referred 274 2.269%  Taken to A&E 8586 71.106%  Total 12075 100.00%

Illness/Incident Code ReportPCT:Illness Code:Incident Code:

AllAllPsychiatric

Date from:Date to:

01/04/201101/12/2011

6Illness/Incident Code ReportPCT:Illness Code:Incident Code:

AllAllSelf-harm

Date from:Date to:

01/04/201101/12/2011

  Care Pathway Count Percentage  _none 113 0.875%  Cancelled 18 0.139%  Care Pathway - conveyed 260 2.014%

  No patient 116 0.899%

  Patient not conveyed 1649 12.776%  Patient not conveyed - referred 54 0.418%  Taken to A&E 10697 82.878%  Total 12907 100.00%

7

  Care Pathway Count Percentage  _none 58 0.868%  Cancelled 17 0.254%  Care Pathway - conveyed 968 14.482%

  No patient 78 1.167%

  Patient not conveyed 744 11.131%  Patient not conveyed - referred 172 2.573%  Taken to A&E 4647 69.524%  Total 6684 100.00%

Illness/Incident Code ReportPCT:Illness Code:Incident Code:

AllPsychiatric problems - diagnosedPsychiatric

Date from:Date to:

01/04/201105/12/2011

8Borough

Borough Number A&EBarnet 275 65%

Lambeth 246 61%

Newham 244 79%

Southwark 209 62%

Ealing 208 78%

Croydon 204 67%

Kensington & C. 84 59%

Richmond 81 67%

9

10

• 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

Mental Health Care

11

• 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

Mental Health Care

12

Mental Health Care

Case Study

13

• Issues for 136 and Emergency Assessment

• Accessibility• Full• Short of staff• Regarded as “out of area”

• Not seen as an emergency

Mental Health Care

14

• Section 136• Emergency mental health care to be equivalent

to emergency acute commissioning by all• Treat the patient first and ask the questions

afterwards

Mental Health Care

15

• 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

Mental Health Care

16

Mental Health Care

Case Study

17

• Issues for those in crisis• 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

Mental Health Care

18Kent & 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 referralWhen referring the term ‘Ambulance on scene’ will identify that an urgent response is required from the mental health service

Contact nubers for MH advice/referral

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 servicesRespond / 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

19

Patient suffering with mental health issue calls 999 and receives a

pre hospital assessment

Convey to MH Liason

Team in local

Emerg. Dept.

Question: is the patient presenting with an isolated MH issue, or is it

complicated with illness/injury drug/alcohol intoxication?

MH issue complicated with illness/injury or

drug/alcohol intoxication?

Isolated MH issue, no complication

Known diagnosis, known to local services

Convey patient to

Royal local Emergency

Dept.

No known diagnosis, not known to local

services

Question: within the last 6 months, has the patient had a MH diagnosis/are

they known to local MH 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

YES NO

NO YES

20

• 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

Mental Health Care

21

• Looking for commissioner support for:• Section 136• London Ambulance to have access to

crisis teams for advice• Crisis teams to accept referrals• Think about next year

• Alcohol• Frequent callers

Mental Health Care