Peninsular Neighbourhood Liaison and Diversion Service – Devon Partnership NHS Trust & Cornwall Partnership NHS Foundation Trust – HC – #MHAwards19

We provide an innovative extension of the NHSE Liaison and Diversion Service to those identified as vulnerable by Devon and Cornwall Police. We call this the Neighbourhood L&D Service. It departs from the NHSE L&D model by meeting the needs of those who are not suspects of crime but who present as concerning to Police staff. The purpose of the service is to acknowledge the very high levels of vulnerability encountered by the Police in their daily work and to provide a timely assessment, stabilisation and onward referral service to those assessed as having needs for support. Support needs are very broad and can include Primary and Secondary Mental Health care, Substance Misuse problems, unrecognised difficulties due to Intellectual Disabilities/ Difficulties and Neuropsychiatric problems such as autism.

Hours the service operates    08:00- 18:00, 7 day service

Highly commended #MHAwards19

Co-Production

  • From start: No
  • During process: Yes
  • In evaluation: No

Evaluation

  • Peer: No
  • Academic: Yes
  • PP Collaborative: Yes

Find out more

 

Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.

We provide an innovative extension of the NHSE Liaison and Diversion Service to those identified as vulnerable by Devon and Cornwall Police. We call this the Neighbourhood L&D Service. It departs from the NHSE L&D model by meeting the needs of those who are not suspects of crime but who present as concerning to Police staff. The purpose of the service is to acknowledge the very high levels of vulnerability encountered by the Police in their daily work and to provide a timely assessment, stabilisation and onward referral service to those assessed as having needs for support. Support needs are very broad and can include Primary and Secondary Mental Health care, Substance Misuse problems, unrecognised difficulties due to Intellectual Disabilities/ Difficulties and Neuropsychiatric problems such as autism. The primary aims are to enable early identification of emerging difficulties and diversion into relevant support services following assessment by skilled and supported Mental Health practitioners. This aims to prevent escalation of situations from a “pre-crisis” phase into one that might require statutory intervention (such as Mental Health Act detentions or arrests for crime) at a later date.

The means of service delivery is one of a positive partnership between Police staff and the L&D Mental Health practitioners. It is a consent based service which seeks to empower the person of concern. The service has been recently commissioned on the basis of a local, published, evaluation of a previous pilot service run between 2012 and 2014, the evaluation demonstrating both positive outcomes for recipients and 32% reduction in subsequent utilisation of Police resources. Clinical outcomes for the client seen range from re-referral for Mental Health input, revision of on-going care plans, new commencements of mental health care and, in a small number of cases, an emergency response involving admission for severe, acute mental health problems under the Mental health Act 1983.

 

What makes your service stand out from others? Please provide an example of this.

This is a unique service building on an existing NHSE commissioned structure, proactively seeking contact with those in “hidden need”. It is delivered jointly with MH and Police partners over a challenging geographic area. The commissioning background is unusual, involving numerous Clinical Commissioning partners and the Office of the Police and Crime Commissioner. The service, although not subject to randomised controlled trial analysis, has been “field tested” both in the area where it was initiated and also in two other localities, suggesting that it has passed the real world test of innovations, in that it is effective in areas other than those in which it was conceived.

 

How do you ensure an effective, safe, compassionate and sustainable workforce?

Our workforce is recruited on the basis of scenario and task based interviews. Service user representatives are part of the interview panel. The managers of the L&D team consider the skill mix of the whole service in seeking to appoint new staff. This ensures coverage of the range of needs of clients by enabling a comprehensive range of competencies in the staff group. Staff are supervised in a weekly meeting, which includes monthly attendance by peer-mentors to ensure their integration in the functioning of the team. Staff are able to nominate themselves as “champions” in different developmental areas, most notably that of prison release support within the Neighbourhood L&D scheme. Staff are supervised monthly by their line manager, who actively encourages professional development and seeks funding for relevant external courses. Our retention rate is good. The L&D team is also supported with access to senior clinicians working across the three services hosted within the Centre for Mental Health and Justice. Hence the skills of a Forensic Psychiatrist, a Forensic Clinical Psychologist, an AMHP and Learning Disability specialist staff are available to the team when consultation is required on complex cases.

 

Who is in your team?

In addition to the established L&D services across the peninsular of Devon and Cornwall, the commissioned capacity for Neighbourhood L&D amounts to 5 band 6 Mental Health practitioner posts. This funding allows for an economy of scale that ensures the deployment of the skill set of the Professional staff and that of the Support Time and Recovery Workers to Neighbourhood clients.

 

How do you work with the wider system?

We have a Memorandum of Understanding between MH and Police partners, supported by a bespoke information sharing agreement. We have Service Level Agreements with Devon’s CoLab and the Cornwall Rural Community Council, third sector support organisations. We link with local Women’s Centre staff to support our approaches to the specific needs of vulnerable women. We are working towards a MoU with the Royal British Legion for clients with Armed Forces histories. Catch 22, a local 3rd Sector provider resourcing prisoners prior to release, have been actively involved in developing our pre-release vulnerable prisoner plans. Our team follows up onward referrals with non-Trust services, such as those to 3rd sector substance misuse services, so that we can monitor the effectiveness of our interventions in securing onward care. Because the service is an “all age/ all vulnerability” service, the expectation is that staff will liaise with any relevant health and social care provider based on the needs in the case.

 

Do you use co-production approaches?

We have commissioned a researcher to engage service users to shape the service through a Formative Evaluation based on a Participatory Research paradigm. This is mixed methods research which involves the users of services shaping the questions that should be asked in their evaluation, ensuring a service user focus in ongoing improvements.

 

Do you share your work with others? If so, please tell us how.

Within our organisations we promote the work of the service to ensure their uptake by as many members of staff as possible. The service has been presented at the National Police Chief’s Council Mental Health and Policing Forum. The pilot work has been published (Forbes Earl, Karen Cocksedge, Bernadette Rheeder, John Morgan & Joanne Palmer (2015) Neighbourhood outreach: a novel approach to Liaison and Diversion, The Journal of Forensic Psychiatry & Psychology, 26:5, 573-585 and Forbes Earl, Karen Cocksedge, John Morgan & Mark Bolt (2017): Evaluating liaison and diversion schemes: an analysis of health, criminal and economic data, The Journal of Forensic Psychiatry & Psychology). The service has been promoted with interagency partners via the Local Criminal Justice Board Mental Health Sub-group and at the Devon and Cornwall Multi-Agency Public Protection Arrangements Practitioners Development Group. In 2019 over 400 Police charging gatekeepers have been informed of the availability of the Neighbourhood L&D scheme in their mandatory CPS sessions.

What outcome measures are collected, how do you use them and how do they demonstrate improvement?

The services triages and assesses a range of vulnerabilities and makes relevant onward referrals. Outcomes from those referrals are gathered with the service user’s consent from the agencies who deliver onward care and support.

 

Has your service been evaluated (by peer or academic review)?

Two evaluations of Neighbourhood L&D have been performed, one an internal service evaluation and one published (see previous entries). The Centre for Mental Health have visited our services and recommended the Neighbourhood L&D model in their “Bradley 5 Years On” report. We have verbal feedback from a recent CQC custody inspection praising the implementation of our local L&D model, as well as an on-going Mixed Methods, Participatory study in progress.

 

How will you ensure that your service continues to deliver good mental health care?

The service is reviewed with commissioners and providers at the Peninsular L&D governance group. Positive partnerships with the Office of the Police and Crime Commissioner are maintained through working relationships between senior clinicians, clinical managers and mental health liaison senior Police Officers. Funding is in place for 2019/20 and will remain in place on the basis of the outcome of the independent evaluation. Stepping outside the box of a narrow focus on solely mental health outcomes and understanding the value of this service to the whole of the public sector has enabled a recognition of the extent of non-cashable savings system-wide, such that arguing for the continuation of this service has been relatively easy.

 

What aspects of your service would you share with people who want to learn from you?

We started with a joint Police and Mental Health assumption that either an arrest and custody episode, or a Mental Health Act detention, should be seen as a potential failure of proactive work to engage and support individuals pre-crisis. We think that this, at times flawed, assumption has created a drive for cooperative, proactive engagement between MH and Policing Services that is necessary for schemes like ours to flourish. Additional requirements are the recruitment of aspirational, assertive staff who are prepared to assert the needs of service users with services who tend to stigmatise those “tainted” with criminal or Police involvement. Access to creative Support Workers and the provision of a qualified skill mix spanning addictions, MH crisis services, Forensic Services and Community Mental Health work, preferably with MH Act awareness and social care is required to facilitate effective responses to the range of clients seen. Working with Commissioners to identify the whole-system benefits of an intervention that spans Crime and Vulnerability, and having Commissioners who are flexible and forward thinking, is seen as critical to the success of our initiative.

 

How many people do you see?

Across Devon and Cornwall referral rates vary monthly between 80-100, of which none are refused.

 

How do people access the service?

Referrals are automated through the Police VIST (Vulnerability Screening Tool) system. This can be clinically over-ridden to ensure that individuals of concern who do not yet hit the referral threshold can still be considered on the basis of Officer concern.

How long do people wait to start receiving care?

No more than a week.

 

How do you ensure you provide timely access?

We structure the allocation of our staff to make assessment slots available on a regular basis for community based clients.

 

What is your service doing to identify mental health inequalities that exist in your local area?

The independent evaluation commissioned to review the service covers the issue of identifying hidden and unreported need in our client group. The service exists with purpose of reducing health inequalities and our initial evaluations identified that the Neighbourhood L&D service received nearly double the rate of referrals for serious and enduring mental health problems in comparison to the Crime based L&D referrals. 60% of those seen with MHP’s had insight impairing problems and would never have sought care. Having been seen by our team they were facilitated into care episodes with the local CMHT, who would not otherwise have known of their need.

 

What inequalities have you identified regarding access to, and receipt and experience of, mental health care?

Insight impairing disorders in socially isolated individuals can lead to years of loneliness and distress. No particular group of people seemed to be at more risk of this than any other.

 

What is your service doing to address and advance equality?

We have an active engagement with Cornwall’s Women’s centre, who help us with peer mentoring and service recruitment. The Veterans pathway within L&D is available to the Neighbourhood L&D clients. Our staff are trained in the recognition of Learning Disability and Autism.

 

How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?

Our Band 6 Mental Health practitioners conduct a full screening assessment for a range of vulnerabilities, not limited to mental heatlh, and compile their findings within a nationally agreed L&D template. Where Intellectual Disabilities are suspected the LDSQ is used. People presenting with an unusual set of complex co-morbidities can be discussed with the senior clinicians in the Centre for Mental health and Justice.

 

Population details

Brief description of population (e.g. urban, age, socioeconomic status):

Mixed urban, rural and coastal communities, high levels of social inequality, with deprivation nestling closely alongside high levels of affluence. The dispersed rural population allows for hidden vulnerabilities to go undetected and unaddressed for many years.

 

Size of population and localities covered:  Resident population of approximately 1.7 million, fluctuating seasonally to a peak of an estimated 3.2 million.

 

 

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