Derbyshire Constabulary Mental Health Steering Group

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Derbyshire ConstabularyMental Health Steering
Group

• Assistant Chief Constable
• Gary Knighton

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Derby Street Triage Pilot Gary Parkin
Superintendent Tracey Holtom - Service Line
Manager Alexa Sidwell - Clinical Lead Laura
Barker - Police Officer
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Why do we need this service?Gary
Parkin- Superintendent
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Department of Health (DoH) response backed by
the Home Office

• Part of the Governments response to people with
  mental illness that come into contact with the
  Criminal Justice System
• DoH Funding - 200,000
• 9 Pilot Forces
• Police-led partnership
• 12 month project
• Cleveland, Leicester, Hants.

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Aims of the service

• More appropriate signposting for people who
  present to police and are in need of mental
  health services
• Preventing people with mental illness being
  detained in the wrong environment
• Avoids people being assessed under Section 136
  unnecessarily
• Improves multi-agency working and decision making

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The Derbyshire Pilot

• Secondary resource, dedicated Street Triage Car
• 1x Police officer and 1x mental health nurse
  working in collaboration
• Based at Radbourne Unit, Derby
• Operating 4pm to midnight 7 days per week
• Mobile data information from 3 databases (Health,
  Police and Social care records)
• Taking police referrals from D Division
• All age service

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Progress to date Activity data
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Triage attendances by month
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Number of S136 during Triage hours
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Initial findings

• Total 8 people s136 Feb- May 2014 (Inc)
• 1 person 1st February 2014- Triage had not
  started
• 1 ED presentation needing physical intervention
• 1 person presented at police station 23.55hrs
• 2 were detained on section MHA
• 1 open to Crisis and admitted informally
• 1 slipped through 18th February
• 1 open to services plan was in place.

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Number of S136 outside triage hours
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136 custody
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Initial findings

• Total 2 people section 136 in custody in April
  2014 during operating hours
• - 1 person charged with offences violent
• and aggressive
• - 1 person intoxicated

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Custody suites
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Activity data by patient local authority
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Triage attendances by time periods
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Activity data by day of the week.
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Triage attendances by age and gender
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Training

• The team have received the following additional
  training
• MHA Law
• VARM
• Suicide prevention
• Child and Adolescence
• The team have delivered training/briefings to
• Reactive Sergeants
• Call centre staff
• Partner agencies, eg Street Pastors, YMCA

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Establishing links with partner agencies

• YMCA
• Samaritans
• Focusline
• Derbyshire Healthcare United
• EMAS
• CINTRA Language Line
• Ron Brooks Toyota
• Other policing, healthcare and social care
  services

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Case Vignette 1

• Lady known to mental health services, was
  persuaded from jumping off a bridge by member of
  public. Highly agitated and distressed.
• Triage attended and completed comprehensive
  assessment
• Family had complex issues including financial
  concerns resulting from serious assault on father
  hospitalized with head injury
• Agreed action plan with family to manage her
  overnight.
• Nurse concentrated on addressing mental health
  issues, ie treatment review
• Officer concentrated on security and witness
  intimidation concerns, security assessment and
  support from local beat team.
• Food parcels were sourced from social care and
  crisis team.
• Difficulties were dealt with rapidly, and
  anxieties quickly reduced.
• Good joint working with local community officers
  and mental health teams

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Case Vignette 2

• Triage asked to look into numerous repeat calls
  from a member of the public who was complaining
  of frequent assaults. Police attended numerous
  occasions found no evidence of any criminal
  offences
• CareNotes reviewed - Person not been in MH
  services for past 10 years
• Triage nurse reviewed Police reports and
  suspected mental illness was evident
• Triage team visited person at home address and
  nurse completed mental health assessment. Serious
  mental health concerns identified
• MHA assessment requested from Care Line
• Triage provided follow up and encouraged
  engagement into services until MHA assessment was
  carried out
• Person was admitted on s2 MHA
• Risks managed safely
• Person received appropriate support

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Case Vignette 3

• Male reported missing after a note had been left
  to his father saying that he was sorry, that he
  had to complete his investigation as he was a
  scientist. Father worried that his son was
  unwell.
• Male well known to mental health services and
  care plan in place.
• Triage nurse weighed up the information given by
  response officers and what was contained on the
  healthcare database.
• Section 136 detention under the Mental Health Act
  advised.
• Male was transported by police to the Radbourne
  Unit. Male was found to be in possession of a
  number of bladed articles and retractable
  chainsaw.
• Full mental health act assessment conducted and
  the male was admitted to hospital informally.
• Quick decision from nurse enabled officers to
  resume to their other duties within a few minutes

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Partner agency feedback
The best thing about the service is
Changes that I would make to the Street Triage
Team would be
There has been a recognisable reduction in
detentions under section 136. I really enjoy
doing them but havent had to do one for some
time.
AMHP
Cover more hours, in out of hours and possibly
assist with missing patients who are informal or
sectioned under the mental health act. Lead
Nurse, RU
Pilot to see if the car could be used to assist
with safe and well checks on people in the
community. Crisis Home Treatment Team
The triage car is real benefit and I have
noticed a big difference in section 136
assessments coming into hospital, there appears
to be a lot less. The people that are poorly are
getting signposted to the most appropriate
service instead of inappropriate mental health
act assessments. Bleep holder
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Partner agency feedback
I have nothing but positive things to say about
Triage that night.   Before Triage were in
operation, that job would have meant us arresting
the female under s.136 and sitting with her up
the Radbourne Unit for a number of hours.
Instead, triage team were waiting for us at the
hospital and the initial assessment was very
quick and painless.  The female in question was
able to return to a safe address with family
support a lot sooner than she would have been
able to before. I have found that hanging around
at the hospital for hours can often increase the
anxiety and symptoms the patient is already
experiencing.  I fully support Triage and would
like to see it stay.  It frees up officer time,
which is generally in short supply, and the
patient gets access to the right help quickly. 
I cannot think of anything specific Triage could
do to improve the service although I would be
interested to see how it would work if Triage
could be first response in some cases, and lose
the need for section to attend altogether.

PC3299 Hayhurst, Derby North 760 3134
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Service User feedback
The best thing about the service is
Changes that I would make to the Street Triage
Team would be
The nurse made me feel really relaxed. I felt
that someone was there for me. I didnt know
what help was out there until I spoke with the
nurse and the officer. I have my appointment and
feel so much better.
A bigger team so that you are not having to wait
to see them. Cover more hours.
That the team are involved with the follow-up
because I have felt that I have no support since
I had contact with the team.
They come out to see you it isnt just a
telephone call. It has really helped because
they have given me information that other places
I have been to havent. I am no longer lost and
I am finally going to get the help that I have
been longing for.
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Points to consider

• Diverse range of presentations - Learning
  disability, young people, older adults
• Hours of operation is it right?
• Geographical cover diversity of area will need
  consideration if service rolls out county-wide
• Ability to provide follow up / seamless service
• Ability to provide more robust packages of
  support
• Understanding of roles - clarified
• Efficiency of working together
• Enjoyment of partnership working
• Pooling of resources
• Shared training

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Options for development

• Increase/adjust hours of operation.
• County-wide service
• Advising custody re detained persons
• Monitor pre-arrest calls
• Yearly/6 month secondment for police onto Triage
  car
• Triage Officer to develop process from local
  officers to work with care teams for people
  identified with risks and vulnerabilities
• Explore potential to initiate a project to target
  repeat callers and presenters to emergency
  services.

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Next Steps

• Superintendent Gary Parkin
• Service Line Manager Tracey Holtom

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