MENTAL HEALTH CRISIS CONCORDAT STAKEHOLDER EVENT January 22 2016

1. MENTAL HEALTH CRISIS CONCORDAT STAKEHOLDER EVENTJanuary 22 2016 David Pugh Independent Consultant MCA & MHA david.pugh@gloucestershire.gov.uk Karl Gluck Lead Commissioner, Mental Health karl.gluck@nhs.net

2. CONTENT • MH Crisis Concordat • The national background & update • CQC report ‘Right here, right now’ • How Gloucestershire turned ‘green’ • Equality Act considerations • SWOT analysis • Task & Finish Group • MH Crisis Action Plan - 95 actions! • Next Steps/maintaining momentum • Questions/discussion

3. MH Crisis Care Concordat (Feb 2014) • An agreement about the standard of responses that any person experiencing a MH crisis in England should expect • Agreed national leadership statements from all orgs with a statutory function or duty of care. Agreement to ‘jointly hold ourselves to account’ • One vision and principles for ensuring there is an effective emergency MH response system • Examples of best practice/case studies • Expectation that each local area makes a Crisis Care Declaration accompanied by an Action Plan + Review: www.crisiscareconcordat.org.uk

4. The 4 Stage Crisis Care Pathway

5. Who needs to improve outcomes ? (Statutory responsibility or duty of care)

6. The service user’s perspective : What should I expect if I, or the people that depend on me, need help in a mental health crisis? Access to support before crisis point • When I need urgent help to avert a crisis I, and people close to me, know who to contact 24/7. • People take me seriously and trust my judgement, and I get speedy access to a service that helps me get better.

7. What should I expect if I, or the people that depend on me, need help in a mental health crisis? Urgent and emergency access to crisis care • If I am in mental health crisis this is treated as an emergency, with as much urgency as if it were a physical health problem. If I have to be taken somewhere, it is done safely and supportively in suitable transport. • I am seen by a mental health professional quickly and do not have to wait in conditions that make my mental health worse. I then get the right service for my needs, quickly and easily.

8. What should I expect if I, or the people that depend on me, need help in a mental health crisis? Quality of treatment and care when in crisis • I get support and treatment from people who have the right skills and who focus on my recovery, in a setting that is suited to my needs. • I have support to speak for myself and make decisions about my treatment and care. • If I do not have capacity to make decisions about my treatment and care, any statements of wishes, or decisions, that I made in advance are checked and respected.

9. What should I expect if I, or the people that depend on me, need help in a mental health crisis? Recovery and staying well / preventing future crises • I, and people close to me, have an opportunity to reflect on the crisis, and to find ways to manage my mental health in the future, that takes account of other support I may need, around substance misuse for example. • We have an agreed strategy for how I will be supported if my mental health gets worse in the future.

10. NICE Quality Standard (QS) 14 • People in crisis referred to mental health secondary care services are seen within 4 hours • Service users have access to a local 24-hour helpline staffed by mental health and social care professionals • CRHTTs are accessible 24 hours a day, 7 days a week, regardless of diagnosis • People using MH services at risk of crisis are offered a crisis plan Source: NICE : Quality standard for service user experience in adult mental health, Quality Statement 6, ‘Access to Services’ & Statement 9, ‘Crisis Planning’

11. ‘Right here, right now’ Report (CQC) ‘There is a distinct gap between people’s perceptions of how they are treated by staff working in A & E Dept’s & specialist MH services compared to other services’... ‘ A heath & care system where over 4 in 10 respondents feel their crisis was not resolved raises serious questions about the fairness & safety of services responses’

12. Individual Survey Results(CQC)

14. Local Context – CCG Commissioned Review Outcomes • A shared pathway for SMI people in Crisis • Improved individual experience • A safe and effective CRHTT • Organisations work together

15. Independent review : methodology • Semi-structured interviews with 46 local stakeholders – key informants included GPs, Service Users, Carers, Police, Probation Service, Acute Hospital Emergency Department, Mental Health Medical and Clinical staff, Ambulance Trust, Healthwatch, Local Medical Committee, Voluntary/Independent Sector • Review and analysis of local services operational policies, joint working protocols and local care pathways • Review of evidence base e.g. NICE Quality standards, CORE Study Outcomes, HTAS • Equality Act ‘Due Regard Statement’

16. Equality Prompts • Does the MH Crisis Pathway exclude any groups? • Is any group reaching crisis at a disproportionate rate? Concordat B2: Equality of access: ‘Commissioners & providers should be aware that the Equality Act 2010 applies to MH services & requires that people should have equal, appropriate access’

17. Due Regard Findings • Current pathway exclusions; dementia, CYP, LD + need for ‘reasonable adjustments’ • Over-representation of women as repeat S136 detainees • Subjects of S136 socially isolated (0.6% married). • Under-representation of some BME communities • BME not over represented in S136 detainees? • IMHA access to BME in-patients • Perception CRHTT could be more accessible to BME community • Need to recognise vulnerability of transgender community

19. Summary Overview

20. Crisis Concordat Task and Finish Group: A Managed Process • CCG Clinical Chair and Individual with ‘Lived Experience’ recruited as Task Group Co- Chairs • Task Group membership included - 17 local organisations including all the requisite statutory signatory organisations, voluntary sector SU advocacy and D&A services, Healthwatch and Local Medical Committee representation • January to July 2014 – 6 x monthly structured meetings • Agreed Governance for Declaration Sign off by each agency – Communication Plan included Executive and Operational leads

21. Crisis Concordat Task and Finish Group : Progress to Date • Gloucestershire Concordat signed off by19 local organisations • Equality Act Due Regard Statement • Over 96 actions across the 19 organisations set out for implementation within Continuous Improvement Plan • Gloucestershire – 1 of 4 evaluation sites nationally • Stocktake / Progress Reviews x 2 during 2015 – 46 actions completed • Revised Action Plan V19! • Accountability to MH Partnership Board

22. Action Plan Content • Equality actions • Commissioning actions • Access to support pre-crisis actions 4. Urgent & Emergency Care access to care actions 5. Quality of treatment & care in a crisis actions 6. Recovering/staying well/preventing further crisis actions

23. Thank you for listeningQuestions/Discussion www.crisiscareconcordat.org.uk contact@crisiscareconcordat.org.uk @crisis concordat