Mental Health
Crisis Plans
Steve Lennox
31 July 2017
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
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
4
Illness/Incident Code Report
PCT:
Illness Code:
Incident Code:
All
All
All
Date from:
Date to:
Care Pathway
_none
01/04/2011
01/12/2011
Count
Percentage
32344
4.689%
5033
0.73%
Care Pathway - conveyed
34383
4.985%
No patient
18466
2.677%
Patient not conveyed
87842
12.736%
Cancelled
Patient not conveyed - referred
13302
1.929%
Taken to A&E
498361
72.254%
Total
689731
100.00%
5
Illness/Incident Code Report
PCT:
Illness Code:
Incident Code:
All
All
Psychiatric
Date from:
Date to:
Care Pathway
_none
Cancelled
Care Pathway - conveyed
No patient
Patient not conveyed
Patient not conveyed - referred
Taken to A&E
Total
01/04/2011
01/12/2011
Count
Percentage
112
0.928%
53
0.439%
1418
11.743%
173
1.433%
1459
12.083%
274
2.269%
8586
71.106%
12075
100.00%
6
Illness/Incident Code Report
PCT:
Illness Code:
Incident Code:
All
All
Self-harm
Date from:
Date to:
Care Pathway
_none
01/04/2011
01/12/2011
Count
Percentage
113
0.875%
18
0.139%
Care Pathway - conveyed
260
2.014%
No patient
116
0.899%
1649
12.776%
Cancelled
Patient not conveyed
Patient not conveyed - referred
54
0.418%
Taken to A&E
10697
82.878%
Total
12907
100.00%
7
Illness/Incident Code Report
PCT:
Illness Code:
Incident Code:
All
Psychiatric problems - diagnosed
Psychiatric
Date from:
Date to:
Care Pathway
01/04/2011
05/12/2011
Count
Percentage
_none
58
0.868%
Cancelled
17
0.254%
968
14.482%
Care Pathway - conveyed
No patient
Patient not conveyed
Patient not conveyed - referred
78
1.167%
744
11.131%
172
2.573%
Taken to A&E
4647
69.524%
Total
6684
100.00%
8
Borough
Borough
Number
A&E
Barnet
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
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
• 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
12
Mental Health Care
Case Study
13
Mental Health Care
• Issues for 136 and Emergency
Assessment
• Accessibility
• Full
• Short of staff
• Regarded as “out of area”
• Not seen as an emergency
14
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
15
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
16
Mental Health Care
Case Study
17
Mental Health Care
• 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
18
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
Acute Care
Respond / assess as per
agreed timescale
with AMHP if MHA required
(as per Acute care pathway)
Community Mental Health Team
* If timescale
cannot be
achieved then
patient will be
taken to the
nearest ED
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?
YES
NO
Isolated MH issue, no
complication
MH issue complicated with
illness/injury or
drug/alcohol intoxication?
Question: within the last 6 months,
has the patient had a MH diagnosis/are
they known to local MH services?
YES
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
20
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
21
Mental Health Care
• 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