mental health crisis plans
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22 April 2023
Mental Health Crisis PlansSteve Lennox
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• 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
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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%
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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%
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• 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
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• Issues for 136 and Emergency Assessment
• Accessibility• Full• Short of staff• Regarded as “out of area”
• Not seen as an emergency
Mental Health Care
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• 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
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• 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
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• 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
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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
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• 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
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