CJ Liaison and Diversion- The team provides mh assessments for anyone within the cj pathway. Custody Sergeants and interviewing officers are supported. The aim of the street triage Team is to reduce inappropriate police use of Section 136. Prior to the service being set up Leics Police were detaining on average 40 people a month and 80% of those did not require any mh follow up. Since 2013 we now are averaging 8 detentions under Section 136 which is an 70% reduction. Patients who require home treatment with the crisis team now only have to have 1 assessment rather than several. The PAVE team is a joint initiative between Leics Police, Leicestershire Partnership NHS Trust and Turning Point. It is funded by the Office of the Police and Crime Commissioner, and has been specifically introduced to work with individuals who have complex needs and present to services on a regular basis. The team will work with an individual intensively for a short period of time so that the demands placed upon services by the individual are reduced. The team consists of 2 mental health practitioners, 2 warranted police officers and 2 drug and alcohol workers. The team also receives support from an extended team which includes a consultant psychiatrist, senior mental health practitioner and a police inspector.
Co-Production
From start: No
During process: No
In evaluation: Yes
Evaluation
Peer: No
Academic: Yes
PP Collaborative: Yes
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Vicki Noble - Clinical Lead and Senior Mental Health Practitioner Leicestershire Partnership NHS Trust
Criminal Justice Liaison and Diversion – The team is part of NHS England’s L and D service providing mental health assessments for anyone within the criminal justice pathway. At any point prior to sentencing an individual can be seen by the team. Patients who are arrested and are unwell are quickly diverted out of the system if possible and support put in place in managing them whilst awaiting an inpatient bed. Custody Sergeants and interviewing officers are supported and risk management plans and improved communication for mental health teams about their patient’s journey in the criminal justice system. The street triage Team – The aim of the service is to reduce inappropriate police use of Section 136 of the Mental Health Act and to reduce voluntary attendances to the local Accident and Emergency Department. It was originally set up as a 3 month pilot in January 2013 and following significant results it was commissioned. It is set up with a warranted police officer and a qualified Mental Health Practitioner who monitor all live police incidents that come in to Leicestershire Police. The officer and nurse will offer advice, support and attend incidents with people who have come into contact with the police who are felt to have a mental health issue.
The service sits alongside the Crisis Team which allows the Mental Health Practitioners to have the facility to take people on directly for Home Treatment and to also admit informally to the acute Mental Health inpatient beds. The team work closely in collaboration with the local authority AMHP’s and local CMHT’s, GP’s and other voluntary organisations in having a joint seamless approach for the people of Leicester, Leicestershire and Rutland. The team cover the whole of Leicester, Leicestershire and Rutland so everyone has access to this service if they are in contact with the police, this includes it being an all age service and all mental health vulnerabilities.
Prior to the service being set up Leicestershire police were detaining on average 40 people a month and 80% of those did not require any mental health follow up. Since 2013 when the team started there has been a reduction and we now are averaging 8 detentions a month under Section 136 which is an 70% reduction. This not only benefits the individual as they no longer are taken to a Place of safety un- necessarily but there has been a reduction of those detained under Section 136 entering custody suites in Leicester. By having made these reductions in Section 136 there are fewer admissions to inpatient beds follow Section 136.
Patients who require home treatment with the crisis team now only have to have 1 assessment rather than several which is positive for the patient experience. All individuals who have contact with the team are contacted within 7 -10 days of contact to check how they are and to see if they have been able to access the pathway put in place and are also asked about their experience of the engagement from the team as part of a service user feedback. The PAVE Team – The PAVE team is a joint initiative between Leicestershire Police, Leicestershire Partnership NHS Trust and Turning Point. It is funded by the Office of the Police and Crime Commissioner. It has been specifically introduced to work with individuals who have complex needs and present to services on a regular basis. The team will work with an individual intensively for a short period of time in order to facilitate referrals and treatment where necessary so that the demands placed upon services by the individual are reduced. The proof of concept is based on the work brought over from the States The team consists of 2 mental health practitioners, 2 warranted police officers and 2 drug and alcohol workers. The team also receives support from an extended team which includes a consultant psychiatrist, senior mental health practitioner and a police inspector for additional advice. The team will work intensively with identified service users to ensure that the correct criminal justice, health and social care pathways are accessed and utilised appropriately.
Wider Active Support
The street triage Team.
The team work closely in collaboration with the local authority AMHP’s and local CMHT’s, GP’s and other voluntary organisations in having a joint seamless approach for the people of Leicester, Leicestershire and Rutland. Leicester’s team have spent time working the police forces regionally supporting them in setting up a similar version of the Leicester model. The team have advised other teams from around the country on how they can make it work with their different geography and health/police boundaries. The team have worked locally with British Transport police to support them in how they can gain support from the team when encountering people on the railway lines and giving that individual the right care and experience.
Prior to the team the relationship between health and police was poor due to both agencies looking at the situation from different angles and not having a shared understanding of each other’s language.
The Mental Health Practitioners are now an integral part of the police team and the police officers are included as part on the mental health assessment team with the nurses. Together all agencies in Leicester, Leicestershire and Rutland work together as an extended team for an enhanced patient experience. The team offer attachments to other officers within the police, student nurses and social workers and overseas medical students as a unique training opportunity. The officers and nurses who work in the team will provide joint training sessions to other departments within both organisations. The PAVE Team.
The PAVE team is a joint initiative between Leicestershire Police, Leicestershire Partnership NHS Trust and Turning Point. It is funded by the Office of the Police and Crime Commissioner. It has been specifically introduced to work with individuals who have complex needs and present to services on a regular basis. The team will work with an individual intensively for a short period of time in order to facilitate referrals and treatment where necessary so that the demands placed upon services by the individual are reduced. The proof of concept is based on the work brought over from the States The team consists of 2 mental health practitioners, 2 warranted police officers and 2 drug and alcohol workers. The team also receives support from an extended team which includes a consultant psychiatrist, senior mental health practitioner and a police inspector for additional advice. The team will work intensively with identified service users to ensure that the correct criminal justice, health and social care pathways are accessed and utilised appropriately.
Co-Production
All individuals who have contact with the team are contacted within 7 -10 days of contact to check how they are and to see if they have been able to access the pathway put in place and are also asked about their experience of the engagement from the team as part of a service user feedback. Early in 2016 an evaluation was commissioned on the experience of the staff working on the triage car which was undertaken by a service user research group supported by DeMontfort University.
Looking Back/Challenges Faced
As the lead nurse at the beginning I would have spent time gather data from the police regarding the demand before 2013 as we have had to do this at a later date. Having data regarding demand and patient experience is vital for helping business cases when applying for funding as both quantitative and qualitative data tell a story.
One of the biggest challenge faced was police officers having confidence in the teams decision making, this can only be achieved with time and officers understanding that the team is there is support them at incidents. Through offering attachments with the team to both police officers and colleagues from other agencies who we work closely with has allowed all parties to form a mutual understanding for each other and increase knowledge so that everyone sees it from all perspectives without losing the patient who is at the centre of the decision making.
Also by attending incidents even if we feel that it can be managed without the teams attendance we have become visual and a human face so that trust can be formed when managing risk.
Sustainability
By having a strong robust multi-partner agency team with joint working processes and procedures and joint governance if one key leader moves on then the team is strong enough to lead itself as both LPT, Leicestershire Police and the Leicestershire CCG’s have commitment to this service and the positive benefits for the population of Leicester, Leicestershire and Rutland. There is also a national focus on the team as other National drivers come into play including the recent review on the Police and Crime Bill and the change in police powers for use of Section 136 of the MHA.
Evaluation (Peer or Academic)
Early in 2016 an evaluation was commissioned on the experience of the staff working on the triage car which was undertaken by a service user research group supported by DeMontfort University. The PAVE team is currently a proof of concept commissioned for 2 years and evaluation of the results both qualitative and quantative will be conducted by The University Of Manchester. We have regular board walks undertaken by members of the Trusts executive team which allows for an independent view of the service and staff an opportunity to have positive discussions with senior leaders within the trust.
Outcomes
Since 2013 when the team started there has been a reduction and we now are averaging 8 detentions a month under Section 136 which is a 70% reduction. This not only benefits the individual as they no longer are taken to a Place of safety un-necessarily but there has been a reduction of those detained under Section 136 entering custody suites in Leicester which is not a suitable environment for someone who is presenting as mentally unwell. By having made these reductions in Section 136 there are fewer admissions to inpatient beds follow Section 136 and this has also impacted on a reduction of 136 assessments for the AMHPS and Section 12 approved doctors.
Police officers are no longer spending time with people at the Place of safety locations which has a cost impact on the police by having saved them money in a time of austerity. Patients who require home treatment with the crisis team now only have to have 1 assessment rather than several which is positive for the patient experience. The nurses have access to electronic patient records so are able to update patient notes in a timely fashion so that their long term care teams are aware of incidents and the plans put in place.
Sharing
We have had other Liaison and Diversion teams come to visit to understand how we set the service up. We have taken part in national conferences sharing our experiences, we are part of a regional group sharing best practice within the region.
Leicester’s street triage team have spent time working the police forces regionally supporting them in setting up a similar version of the Leicester model. The team have advised other teams from around the country on how they can make it work with their different geography and health/police boundaries.
Is there any other information you would like to add?
All 3 Teams are an all age, all vulnerabilties. What is unique is that we no longer only work with those people who fit is a certain group as historically mental health services have.
