Liaison and Diversion (L and D) services have been set up nationally as part of a 5 year pilot to ensure people within the Criminal Justice System (CJS) have the opportunity to be assessed by a mental health team which ensures they are diverted out of the CJS or diverted appropriately. L and D exist to help to achieve better outcomes for those people within the CJS, identifying not just mental health needs, but many vulnerabilities egg substance use, housing or financial issues. L and Ds assessment is shared where appropriate to enhance decision making within the CJS. The team is co-located with the Police within custody to allow access and responsivity to the people within custody.
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
Liaison and Diversion (L and D) services have been set up nationally as part of a 5 year pilot to ensure people within the Criminal Justice System (CJS) have the opportunity to be assessed by a mental health team which ensures they are diverted out of the CJS or diverted appropriately. L and D exist to help to achieve better outcomes for those people within the CJS, identifying not just mental health needs, but many vulnerabilities egg substance use, housing or financial issues. L and Ds assessment is shared where appropriate to enhance decision making within the CJS. The team is co-located with the Police within custody to allow access and responsivity to the people within custody. The team had been working as part of the pilot for 4 years when the NPCC published the report “Interim guidance. Suicide Prevention Risk Management for Perpetrators of child sexual exploitation and indecent images of Children” which highlighted high suicide rates amongst people arrested for viewing online images of children. The report highlighted several factors which could increase the risk of people taking their own lives egg whether a parent, age at time of offence and whether in a relationship. The team’s belief is that every suicide should be preventable and therefor changed practice considerably as a result of the report. A process was created whereby by working closely with the police, the person receives support, a risk assessment and at least one follow up visit with the Police to review how they are feeling. This visit takes place within 72 hours, as this timeframe was identified as the highest risk. The team also changed their risk assessment to incorporate the identified risk factors. Closer partnerships were formed with the police team who dealt with the people who had committed the offence in order to try to reduce the number of people taking their own lives.
What makes your service stand out from others? Please provide an example of this.
The team initially made the changes highlighted above, however after a number of local incidents where people in the Tees community who the team had assessed , took their lives the team wished to revisit the initial process and see where this could be improved upon. Therefor we looked at areas our trust and the police had identified that could potentially influence the care we gave and the risk assessment within our practice. The incidents had demonstrated that people tended to take their own lives within the first 24hours of leaving custody. They often did not disclose they felt suicidal, and we learnt they most often, had not a previously attempted suicide. This has changed our risk assessments and follow up visit procedure accordingly. We noted that carers and family members felt a high level of distress so we are developing ways we can help to support them in this very sensitive situation. We are looking to research the interventions and increase our knowledge in conjunction with York University to enhance practice in this area and prevent suicide. The team are developing strong links with the Lucy Faithful Foundation and in conjunction with the Police we recently hosted an event around the work we are doing as a team around the prevention of suicide for those who have been arrested for this offence.
How do you ensure an effective, safe, compassionate and sustainable workforce?
Staff resilience was an issue as it was very distressing to hear of people who found it so painful to live, that they took their own lives. Some staff also were unclear why our team should be working with people just because of the type of offence committed ? The team had a lot of discussions around this and we did agree suicide prevention is emotional pain and because for the offence, the risk increases and we as L and D practitioners are in an ideal position to offer support, hope and prevent a person from taking there own life. In response to the incidents and to ensure compassion amongst the staff was present and not threatened, we set up supervision, and the offender health speciality within TEWV has taken forward a very strong focus upon staff resilience, the speciality has set a wellbeing strategy for the staff. this involves the development of a book describing how to maintain your own wellbeing and the tea have also benefited from a 2 weekly supervision group specifically to allay anxiety and improve the care given. We have also arranged for all of the staff to receive ASIST training to ensure the team are able to crisis plan and discuss the management of suicidal thoughts confidently with people whilst they are in custody to work with peoples strengths when they are feeling very desperate due to their situation following arrest
Who is in your team?
our team consists of: 0.5 service manager @ band 8 1 team manager @ band 7 1 advanced nurse practitioner @ band 7 1 support worker @ band 3 3 CAMHS Practitioners @ band 6 10.41 Band 6 nurses
How do you work with the wider system?
the team have developed very strong links wth the Police in this work and have developed protocols to enhance the support given to people. There is a joint visit which takes place with the police to ensure communication and continuity for the person. There are regular meetings with the police who work with those who are arrested for viewing indecent images of children online and the changes in te ris assessments and the improvement in the information and support offered to carers is a result of the joint working initiatives with this police team
Do you use co-production approaches?
The team were aiming to adopt a strong coproduction approach but are finding this difficult due to this particular area of suicide prevention. the work to increase and provide coproduction will continue in other ways if direct work is not currently possible. The teams new protocols and operational policies are to involve service users input and will not be signed off until this work is complete. The information to be given out to people will be coproduced with service users. There are barriers which have prevented engagement in this area but the team are striving to overcome the barriers to allow co production principles within our work.
Do you share your work with others?
The team have applied to the University of York to enable the work we are doing to be examined, via research and also any results disseminated nationally as a result. This work and the associated processes are potentially unique in terms of L and D teams. Louis Appleby from the University of Manchester and the Director of the Homicide and Suicide Inquiries, felt this work was “leading the way” and he was unaware of any similar work nationally. The team also hosted a recent event within the local region, with the aim of sharing our knowledge and practice with partner agencies eg social services. Police, crisis teams and local suicide prevention strategy groups.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
The team are looking to have the work evaluated by York University. the process is at the Ethical approval stage. We also locally monitor any serious incidents and review subsequent practice, we use any findings to develop practice eg the changes in the risk assessment and the follow up procedure. We also use the FFT to inform our practice and have used direct service user feedback to influence our practice and develop the support received for carers and family members. We also use a MDS in which we monitor the engagement into other service to ensure people are receiving the support we have offered, and the level of involvement the person feels with their plan. We look at this every day within our team meeting to ensure people are engaged in the plan and review this if they are not participating.
Has your service been evaluated (by peer or academic review)?
as stated previously, we are looking for research around suicide prevention n with York university. The work is very new and the team will be very pleased to assist the practice develop in this area and will plan the dissemination plan to share the findings via the research network group developed in offender health TEWV NHS
How will you ensure that your service continues to deliver good mental health care?
The service will sustain this work and develop good mental health care and this work is mentioned in performance reports to the local commissioners within monthly reports. this work has been highlighted to and supported by commissioners. The commissioners support this work and have very close links with the service manager and the Head of Service as this work has been developed in conjunction with the local commissioners. Cleveland Police have also declared an interest in maintaining this work as the work has resulted in anecdotally reducing suicide rates in this population.
What aspects of your service would you share with people who want to learn from you?
The challenges regarding the staff confidence when working with a very risky population- The procedures we have developed to reduce risk and increase support and recovery The work we have completed around staff resilience in order to maintain compassion, staff motivation and retention. The reduction observed locally in suicide rates within this particular population The impact of developing a very close working relationship with our partner organisation the police, in developing good practice The importance of pursuing research in the area the challenges in achieving co-production Developing an effective support framework for carers and family members within this area. The identification of the correct skill mix and the seeking of the correct training to meet needs.
How many people do you see?
The team see hundreds of people per year however, the population discussed in the nominations is around 200 per year.
How do people access the service?
the population discussed in this nomination are referred by the police teams who deal with the people who commit this offence.
How long do people wait to start receiving care?
People are seen immediately following their police interview as part of the process, as this was seen as the point at which the impact of the offence may affect them the most.
How do you ensure you provide timely access?
We are available 7 days a week and the process developed with the police team ensures people are seen immediately following their interview with the Police. This process is in place to offer people immediate support as people have often lost all protective factors and perceive a lack of hope following their arrest. This is why responsiveness is deemed a priority with those arrested for this offence.
What is your service doing to identify mental health inequalities that exist in your local area?
We regularly look at our MDS and also have an up to date impact assessment which looks at inequalities withy the service. as we work with those in the CJS we are aware of the inequalities within the services an try to educate others as to same.
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
The people within the CJS have a higher rate of each mental health diagnosis and are subject to prejudice when trying to access treatment and recovery within society. The team are acutely aware that the population we work with do not engage and are not help seeking so we ensure access is very easy for those people we see. We offer assertive follow up to help them gain support
What is your service doing to address and advance equality?
our service has been developed purely to ensure those people within the CJS who are excluded from the mainstream services, are supported to be able to seek and receive the proper support and help. The group we work with are very socially excluded and do not seek help or treatment, our services have to be designed to ensure we advance equality by responding to their needs at the right time.
How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?
We have identified that we need to look at developing a screening tool for those referred to our team, however, we did identify de to the national report and te local incidents, that ALL people arrested for this offence should be seen within the identified timeframes as the risk has been identified. We ensure the person has the opportunity to discuss all their needs by creating the process as the person is often experiencing an acute change in their circumstances following their arrest for this particular offence.
How do you meet the needs of people using the service and how could you improve on this?
We are looking to continually improve and the reach and the constant local monitoring of the cases is hoped to improve upon practice and how we can develop this as a team.
What support do you offer families and carers? (where family/carers are not the service users)
We identified that the carer and families of this particular group of service users had very particular needs. We are looking to include carers of service users in the development of how we can improve on our information and support we offer. We currently utilise the local services and signpost to services available but we wish to enhance this support due to the devastating effect this offence can have upon those involved. The stigma and shame can prevent help seeking, therefore we must get this right.
Hours the service operates *
8am -8pm 7 days a week
Brief description of population (e.g. urban, age, socioeconomic status):
urban area , high deprivation , high unemployment rates, high rates of suicide in area
Size of population and localities covered:
population of 500,000 Tees covers Hartlepool, Stockton, Middlesbrough and Redcar and Cleveland
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
Provided by (e.g. name of NHS trust) or your organisation: *
Tees Esk and Wear valley NHS Foundation Trust