Initial Response Team Sunderland and South of Tyne

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Initial Response TeamSunderland and South of Tyne

• Improving Access to Urgent Mental Health Services
• Dr Paul Brown- NTW Lead Consultant for Access,
  IRT/ CRHT
• David Hetherington- Senior Clinician- Sunderland
  IRT/ CRHT
• Rachel Winter- Sunderland IRT/ CRHT Clinical Lead

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Overview

• Context
• Model Development
• Engagement and Commissioning
• IRT Evaluation
• Case Examples and Service User Feedback

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Service Model
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Access?

• Access is the term used by NTW to describe the
  Initial Response to Urgent and Routine requests
  for help.
• Urgent Requests Phase 1- (2012)
• Routine Requests Phase 2- (2014)
• Integration with other routes of entry such as
• IAPT
• Specialist Services
• Social Care

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Demographics North and South
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Phase 1 The case for change

• Sunderland was chosen as the location for the
  development of a new access model following
  discussions with service users, carers, GPs and
  commissioners.
• Clear issues with contacting the Crisis Team by
  phone as Triage saturated
• Overnight and at peak demand times callers could
  wait hours for a return call from a clinician
• No ready point of access for Older People or
  People with a significant Learning Disability
  seeking Urgent Advice/ Intervention
• Fewer than 35 of referrals needed a Crisis Team
  Response
• Most of the inappropriate calls required some
  form of advice/ signposting but at low risk/
  acuity

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Engagement

• Large scale events- Local Authority, GPs,
  Commissioners, Service Users
• Focussed Group Events- Service Users, GPs, Staff

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Engagement- Commissioners

• Sunderland PCT facilitated and supported Initial
  Engagement process
• Recognised need for change
• Supported 1st year (Pilot) through imaginative
  use of CQUIN
• On basis of initial evaluation have commissioned
  ongoing service
• Ongoing development of whole-system

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Phase 2 Model
Triage Team
Home Based Treatment Assessment Gatekeeping
Urgent
Single Point of Referral
Clinical Diary
Non-complex
Routine
Clinical Diary
Huddle
Complex
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Phase 1 The Model

• IRT to offer 24/7 Universal telephone access for
  requests for urgent help.
• No restrictions on who could refer
• Triage and Routing over the phone- (Mental Health
  and other local Services)
• Face to Face Triage (Rapid Response) if clear
  plan cannot be determined over the phone
• Seven Band 6 Nurses for Telephone and Rapid
  Response
• Five Band 3 Nurses for call handling and Rapid
  Response
• Use of digital dictation and 3G laptops for
  clinical documentation
• Flexible interchangeable roles and rotation
  between Crisis Team and IRT roles dependant on
  demand.

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Phase 1 Benefits of IRT

• Quick and efficient responses to requests for
  help
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• Effective routing to the correct services in and
  out of NTW
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• Flexible and collaborative working with newly
  configured UCT which will focus on the work for
  which it is commissioned
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• Reduction of clinician administration burden, and
  freeing time to care (mainly through adoption of
  digital dictation)
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• Improving personal and clinical outcomes for
  people in crisis with mental ill health by
  reducing harm and premature mortality, improving
  patient safety and patient experience
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Evaluation-IRT in numbers

• Typical weekly activity
• 1500 Incoming telephone calls
• 1000 Total Contacts
• 400 Home-based Treatment contacts
• 50 Crisis Assessments
• 100 Rapid Responses
• and growing
• 90 calls answered within 15 seconds
• gt98 within 3 minutes (Average9 Seconds)
• gt80 rapid responses achieved in under one hour

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IRT Referrals (Q3 2013)

• Other includes
• Self Harm Team
• Acute Care Trust
• NTW Inpatient Ward
• Ambulance
• Consultant Psychiatrist
• Residential Care Facility
• Drug and Alcohol Services
• IAPT
• Member of Public
• EDT
• Probation

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Service Feedback
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Service User Feedback- Word Cloud
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Service User Narrative Feedback

• Its because of IRT that I havent self harmed in
  four months. Before, I would self harm two or
  three times a week and would end up in AE, but
  knowing that they are there and knowing that Im
  going to get the same positive response every
  time means that I have been able to listen to
  their advice and develop coping strategies. Im
  much more hopeful about my future

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Case Example 1- John- 31

• First contact from brother, family concerned
• odd ideas, becoming reclusive
• Triage completed via Rapid Response (Face to
  Face) within one hour (after contact with John.
• Engaged in period of home-treatment- referred to
  EIP

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Case Example 2- Jenny 60

• Local Community Police Referral
• Jenny had been contacting them regularly
• Concern re mental health and self-neglect
• Rapid-Response to join police at property
• Crisis Assessment identified depression, alcohol
  dependence and social issues
• Home Treatment
• Joint work with social care

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Summary

• IRT developed in a context of shared goals with
  commissioner and wider partners
• IRT shown to vastly improve access
  responsiveness with widely positive feedback
• Next steps planned will look at incorporating all
  referrals and wider system