Tuesday, December 19, 2017

Huge improvements for people experiencing a mental health crisis at London’s first 24/7 staffed ‘Place of Safety’ pilot

Findings from the first 24/7 staffed ‘place of safety’ to implement London’s section 136 pathway and Health Based Place of Safety specification has received overwhelmingly positive feedback from users of mental health crisis services and has shown significant improvement in the pressure often experienced by the police, paramedics, A&E departments and the sites themselves.

The London guidance, developed by Healthy London Partnership bringing together partners across the health, care and justice system, was launched last year by the Mayor of London, Sadiq Khan. 

The guidance intended to bring in consistent standards of care for the most vulnerable people in our city to make sure they are treated by the right people, in the right place, at the right time. 

The guidance was supported by London’s service users, the NHS (ambulance services, acute and mental health trusts), London’s three police forces and social services.

The pilot site at South London and Maudsley Trust is the first of its kind in London to fully implement the guidance and provide a 24/7 staffed place of safety for adults and children detained under section 136 of the Mental Health Act (2017).

Key findings from the pilot evaluation include (full report here)

  • The site accepts on average 15% more admissions than previously across the four sites in that area. The activity increase represents the amount of patients turned away at previous single occupancy sites located in Croydon, Lambeth, Lewisham and Southwark.
  • Having a dedicated team at the centralised site has meant that it has only been closed once over the past year - a stark improvement - sites were closed 279 times previously over a 12 month period.
  • The number of individuals detained under section 136 that have had to be taken to A&E before going to the centralised site has fallen - partly due to the fact that the staff based at the pilot site are better trained to address physical health issues.
  • Individuals detained under section 136 are being admitted to the sites quicker, with 96 % of cases being admitted within 30 minutes of arrival.
  • The physical environment has been transformed through the new purpose built facility which is much more conducive to recovery.
  • Service user’s satisfaction with the centralised site has significantly improved with 76 % of service users providing positive feedback.
  • The rate of admission to an inpatient bed has fallen by 13% under the new model following comprehensive assessment by dedicated staff.
  • Improving flow will be important to reduce the time patients are detained at the suite in light of new legislation.

The feedback from service users is that they received a more respectful, more responsive and less fragmented experience from all agencies involved; from the police and ambulance services, to NHS A&E departments, and social and mental health services.

Vincent Kirchner, Healthy London Partnership Mental Health Clinical Lead said: “We are delighted that the pilot at the South London and Maudsley NHS Foundation Trust has demonstrated many positives of providing a dedicated place of safety for those in mental health crisis; from better user experience, improved clinical efficiencies to reduced pressure on the police, paramedics, HBPoS staff and the A&E department.

"This pilot and the evaluation findings support a wider roll out of this model of care across London and the importance of consolidating health based places of safety sites into centres of excellence with specialist 24/7 staffing. We will be incorporating these findings and the impacts of the new model into a pan-London business case for decision makers to take forward.”

Dr Matthew Patrick, Chief Executive, South London and Maudsley NHS Foundation Trust said: “Having a mental health crisis can be an extremely frightening and distressing experience for patients. The feedback from those using this new model of care has been extremely positive and highlights the importance of having dedicated places of safety with professionals available around the clock; making the experience more  respectful  and tailored to individual’s needs.

“The findings also show that this model of care also makes the process more efficient and less fragmented for those involved in the care pathway.”

Briony Sloper, Deputy Director of Nursing and Quality, London Ambulance Service said: “Working with Healthy London Partnership has been instrumental in improving communication, relationships and patient experience. Staff from London Ambulance Service have embraced this new model of working and we have seen local networks develop.

"The new pilot site has seen an improvement in handovers and patient care.  It has set the benchmark for other places of safety across London creating better pathways for patients.”

Superintendent Mark Lawrence, Metropolitan Police Service Lead for Mental Health, Drug and Alcohol Abuse and Suicide Prevention said: “As the lead for mental health, I am genuinely excited by the findings of the evaluation into South London and the Maudsley Trust’s centralised health based place of safety pilot.  Supported by a fantastic facility, this is a model which puts the needs of people in crisis at the forefront of services and one which other trusts across London would do well to replicate. 

"The reductions in waiting times and ready access to advice from mental health professionals have been embraced by our officers and helped improve the way the police local to SLaM support people in mental health crisis.”

First-hand accounts from Londoners

Healthy London Partnership and South London and the Maudsley NHS Foundation Trust have worked together to evaluate the new model of care in South East London.

The guidance was developed with the support of over 300 Londoners who gave vivid first-hand accounts of their experience of London’s mental health crisis care services. The guidance was a significant achievement in multi-agency partnership working with input from over 70 police officers from London’s three police forces and over 350 front line staff in mental health and emergency services.

The pilot site acts as a good example of how despite tight fiscal constraints surrounding mental health, innovative models of care can provide excellent solutions, respond to service user needs and lead to significant benefits to the wider urgent and emergency and mental health landscape.

The ambition is to have this model of care rolled out across London and transform care for those in mental health crisis. This has been compared to other developments in physical health care in London’s Urgent and Emergency Care system which have seen the set-up of centres of excellence in stroke, heart attack and major trauma services. This demonstrates a track record of London delivering significant transformational change to build on and achieve parity of esteem.  

The success of the model is particularly significant in light of legislative changes in effect from Monday, 11 December, made within the Police and Crime Act 2017 which include;

  • Section 136 powers may be exercised anywhere other than in a private dwelling;
  • It is unlawful to use a police station as a place of safety for anyone under the age of 18 in any circumstances;
  • A police station can only be used as a place of safety for adults in specific circumstances, which are set out in regulations; 
  • The previous maximum detention period of up to 72 hours will be reduced to 24 hours (unless a doctor certifies that an extension of up to 12 hours is necessary); 
  • Before exercising a section 136 power police officers must, where practicable, consult a health professional.

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