Derbyshire Constabulary Mental Health Steering Group

1. Derbyshire ConstabularyMental Health Steering Group Assistant Chief Constable Gary Knighton

2. Derby Street Triage Pilot Gary Parkin – Superintendent Tracey Holtom - Service Line Manager Alexa Sidwell - Clinical Lead Laura Barker - Police Officer

3. Why do we need this service?Gary Parkin- Superintendent

4. 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.

5. 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

6. 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

7. Progress to date Activity data

8. Triage attendances by month

9. Number of S136 during Triage hours

10. 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.

11. Number of S136 outside triage hours

12. 136 custody

13. 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

14. Custody suites

15. Activity data by patient local authority

16. Triage attendances by time periods

17. Activity data by day of the week.

18. Triage attendances by age and gender

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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 haven’t 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

25. 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

26. 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 didn’t 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 isn’t just a telephone call. It has really helped because they have given me information that other places I have been to haven’t. I am no longer lost and I am finally going to get the help that I have been longing for.”

27. 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

28. 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.

29. Next Steps Superintendent Gary Parkin Service Line Manager Tracey Holtom