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Improving referral systems for people with mental health problems in police custody. Alison Pearsall.

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improving referral systems for people with mental health problems in police custody
Improving referral systems for people with mental health problems in police custody

Alison Pearsall

slide2

Aims To improve efficiency and effectiveness of clinical care/service provisionTo maximise service standards by removing barriers, bottle necks and smoothing transitionsDiagnostic for service improvements involving frontline staffTo improve individuals’ care experience

objectives
Objectives

Define where the process starts and ends

Identify individual activities including timescales

Assemble the pathway to create the journey (parallel activities)

Note the issues and opportunities

setting the context
Setting the context

80% of problems with care delivery is about the system not the people

30 - 70% of work in the NHS does not add value for service users

up to 50% of process steps involve handover or transition = increasing the risk of error, duplication and delay

dmaic mh in police custody
DMAIC – MH in police custody

Assessment, movement and aftercare through police custody

No current measurement established, no care pathway or clinical outcomes

Storage of information, making referrals and arranging aftercare

Assessment process & communication

Underpin with policy, procedures and agreements across services and agencies

Define

Measure

Analyse

Improve

Control

slide7

parallel to the legal framework

Remand

CPS

Bail

Police

Urgent assessment process

Routine assessment process

Ongoing treatment/support process

MH in police custody

Court

themes
Themes

12 Themes:

1. Communication 2. Hand offs

3. Documentation 4. Room changes

5. Admin time 6. IT

7. Staff involved 8. Dual/repeat processes

9. Transportation 10. Contact relatives

11. Referrals 12. Outcomes

slide9
1. Complex communication and activityReferral/assessment/liaison alongside charge/interview/prosecution

Cells

CJL team

release

M H ass’ment

records

interview

CPS

Custody

CID/

PPU

legal advice

Finger prints

Medacs & Submisuse

arrest

2 hand overs responsibilities transitions
2. Hand overs/responsibilities/transitions

Submisuse Screening

CJL

Screening

Arrest/

Entry to

Police

Custody

Legal Process

Finger prints/

Case building

Decision to

prosecute

Custody

Sergeant

FME/Medac

MH Ass’ment

Referral & f/up

Exit from Custody

(bail, court, remand,

hospital, release)

slide11

Arrest/entry to

police custody

Detailing the

assessment process

Stages of the journey through custody

Exit from Custody

(bail, court, remand,

hospital, release)

slide12

Analysing the Map

  • How many steps/variations in the process?
  • How many duplications?
  • How many hand-overs/transitions?
  • What is the approx. time of, or between, each transition?
  • Where are possible delays?
  • Where are major bottlenecks?
  • How many steps do not ‘add value’ for patient?
  • Where are the problems for patients and staff?
analysis summary
Analysis summary

Steps

Total number steps 35

Number of value steps 5

Value steps as 1.75% total steps

Time

Total time Hrs:15 Mins:47

Time of value steps: 3

Value Time as 0.45% total time

  • Waste
  • Waiting
  • Mistakes
  • Uncoordinated activity
  • Motion – repeat assessment
  • Inappropriate processing
slide14

1

Police to

detect MI

& refer

Arrest/entry to custody

3

2

Extended

CJL to

Police station

CJL hours

extended

Referrals

accepted

Police to

Identify MI

& refer

Screening

Morning

only

Submisuse

screen all

arrestees

CJS & eCPA

Records

check

CJL staff screen all arrestees

PACE

timescales

6

5

Referral to

PCMHT

OPT in letter

Referral to

CMHT/CCCT

3 failed appointments

SU discharged

Crisis Team

Gatekeeping

not if too risky

No follow up

Paper, stamps, a stable

address & be able to

read

SPAR to services

Mental Health Assessment

4

7

Exit from

custody

11. Referrals

slide15

11. REFERRALS

Mental Health Assessment

5

Referral to

PCMHT

OPT in letter

6

7

Crisis Team

Gatekeeping

not if too risky

No follow up

Referral to CMHT/

CCCT

3 failed contacts =

discharge

Paper, stamps, a stable

address & be able to

read - SPA to services

Exit from

custody

slide16

Assessment and referral processes are often influenced by PACE, MH legislation and the need to co-ordinate the two processes

Clinical assessment

Identifying issues

Clinical decisions

Referral for aftercare

Release from custody

Local teams need to understand and assist by accepting assessments to improve flow and release from custody

Improve the referral process

Change in practice - ‘opt in’ and ‘three strikes’

Local teams may require interim support from CJMHT to provide transitional care for offenders leaving custody

future work
Future Work
  • MDO Meetings
  • S.136 Policy review
  • Transitional Policy
  • Focus groups - Community Mental Health Teams
  • Funding Bid
process mapping
Process Mapping
  • Effective tool
  • Easy to use
  • Front line staff – MDT
  • Efficient use of time
  • Naturally leads to future work
  • Complements other data
acknowledgements
Acknowledgements

Thanks to:

  • Supervisors: Professor Jenny Shaw

Dr Dawn Edge

Dr Mike Doyle

  • NIHR for fellowship funding
  • Manchester University
  • Lancashire Care NHS Foundation Trust
  • All Service users, family, NHS, police & prison staff for participation in the study
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