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Cynulliad Cenedlaethol Cymru
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National Assembly for Wales
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Y Pwyllgor Iechyd, Gofal Cymdeithasol a
Chwaraeon
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Health, Social Care and Sport
Committee
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Ymchwiliad i iechyd meddwl yng
nghyd-destun plismona a dalfa’r heddlu
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Inquiry into Mental health in Policing
and Police Custody
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HSCS(5) MHP06
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Ymateb gan Fwrdd Iechyd Prifysgol
Aneurin Bevan
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Evidence from Aneurin Bevan University
Health Board
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Aneurin Bevan University Health Board Response to the Health,
Social Care and Sport Committee Inquiry into Mental Health in
Policing and Police Custody
Executive Summary
This submission is made of behalf of Aneurin
Bevan University Health Board and aims to provide relevant
information in relation to the inquiry into mental health in
policing and police custody.
Key points to note from this submission
include;
·
Crucial to this is that we have a shared language and understanding
across agencies regarding ‘mental health’.
·
The majority of individuals do not require access to specialist
mental health services, but agencies must work in partnership with
communities to implement care and support that promotes emotional
and psychological well-being for the entire population.
·
Within Gwent a multi-agency approach is being taken to transform
support for those with a mental health need who present in crisis.
A number of initiatives within the programme aim to prevent people
experiencing a mental health crisis having to be taken into police
custody and these are described in the paper.
·
In order to ensure individuals are conveyed to hospital in a manner
that protects the individuals’ privacy and dignity, the Gwent
region has invested in a 24 hour conveyance service.
·
Within Gwent the number of people arrested under section 136 of the
Mental Health Act 1983, where police custody is being used as the
first place of safety, is 17 people since the implementation of the
Police and Crime Act in December 2017.
·
Continued challenges within the region include the management of
violent and intoxicated people in the designated health based place
of safety.
·
We believe that there are appropriate joint working and governance
arrangements in place in order to implement the Mental Health
Crisis Care Concordat.
Defining Mental Health Need and the Wider Context of
Well-Being
In order to set the context for the current
response, we believe it is important to recognise some of the
different terminology used in agencies. Many people find it
difficult to manage their emotions and engage in behaviours that
areoften viewed as chaotic or engage in behaviours that may cause
harm to themselves such as self-harm or substance misuse. Many of
these individuals will have experienced Adverse Childhood
Experiences and have been exposed to wider socioeconomic
determinants of poor emotional well-being such as poverty, lack of
access to meaningful occupational/learning opportunities, poor
housing or loneliness. The majority of these individuals would not
have a formal mental health diagnosis and do not access support
from specialist secondary care mental health services. Whilst some
statutory agencies would describe individuals who present in this
way as having a “mental health need” it is vital that
we collectively acknowledge the factors that contribute to the
individuals’ presentation and statutory and third sector
agencies work in partnership with communities, to implement
seamless care and support that improves overall population
well-being building on the existing assets within communities.
A key initiative being taken forward within
Gwent to promote the physical and psychological well-being of the
population is the implementation of place based Integrated
Well-being Networks (IWBN). The diagram below provides a summary of
the key elements of an IWBN and the Regional Partnership Board has
recently had Transformational Funding approved from the Welsh
Government to support the further development of IWBNs.
“Whole
Person, Whole System” Acute and Crisis Model
Within the Gwent region, statutory agencies and third sector
organisations are working together to transform support and service
provision for those with a mental health need who present in crisis
and also support for their carers. This programme of work focusing
on a “Whole Person, Whole System” approach is overseen
by the Mental Health and Learning Disability Strategic Partnership
which in turn reports to the Gwent Regional Partnership Board.
Agencies represented within the programme include the Health Board,
the five Local Authorities, Gwent Police, Housing and the third
sector.
The implementation of the Mental Health Crisis Care Concordat is
one of the key drivers for the above programme alongside service
user and carer feedback, stakeholder feedback across agencies, the
need to develop sustainable models of support and broader Welsh
Government strategic context such as the Social Services and
Well-being Act, The Well-being of Future Generations Act and
‘A Healthier Future’.
One of the key outcomes from a multi-agency Action Learning set
that was jointly facilitated with the International Mental Health
Collaborating Network in 2016 was the development of a proposed
Gwent “Whole Person, Whole
System” Acute and Crisis model and over the last two years
partners have been working together to implement the model. It is
important to emphasise that this model needs to be in addition to
the wider population wide Integrated Well-being Networks described
above that promotes emotional and psychological well-being for the
entire population. The key elements of the model are described
below in Figure One.
Figure One: Gwent “Whole
Person, Whole System” Acute and Crisis model
It is envisaged that in order to fully implement the model it will
take up to five years and the current document now provides a
summary of some of the initiatives that have either been
implemented or are in progress that will have the greatest impact
on preventing people with a mental health difficulty experiencing a
crisis being taken into police custody.
Re-designing Community Based Crisis Assessment
Services – there are currently three Crisis
Assessment and Home Treatment Teams in Gwent providing an
assessment service until 10 pm at night. During 2018, the Health
Board undertook a small test of change to separate the assessment
function from the home treatment function with the aim of improving
both elements of the service provision. In April 2019 a more
extensive pilot will commence that will aim to offer a 24 hour
assessment service from a single team, with three locality teams
available to provide intensive home treatment. Additional
investment from Welsh Government has facilitated the addition of an
increase of multi-disciplinary practitioners.
Gwent Police Mental Health Triage Team - In September
2016, an 18- month pilot commenced to enable police officers to
access timely specialist mental health advice whilst having face to
face contact with a member of the public by having a mental health
practitioner within the Police Force Control Room. Following a
successful initial evaluation the service has now been expanded and
since February 2018 a team of 6.0 wte staff having been providing a
service 8am – 2am 7 days a week. In addition to providing
support to manage “live incidents” an information
sharing protocol has been developed to enable the practitioner to
access health and social care information that can guide decision
making to ensure appropriate support can be offered. This service
is currently being evaluated by Swansea University.
Timely Access to Mental Health Care within Primary Care
Settings - Many individuals with mental health need
experience a crisis will initially present to primary care. The
Health Board is working with Primary Care colleagues to pilot
urgent access to mental health support for individuals who present
to in hours primary care within 5 surgeries across the ABUHB
region. A further pilot is also being undertaken to enable
practitioners within the Out of Hours primary Care service to
access timely specialist mental health advice.
Sanctuary Provision – the provision of a
Sanctuary aims to support people in a self-defined or early stage
of mental health crisis. It provides a safe place where people can
go to talk to others and access self-help resources available to
help people to manage the things that are causing them distress and
worry. A work stream led by third sector organisations has been
established to review the need for sanctuary provision with Gwent
and is currently developing a proposal to seek funding to support a
pilot of sanctuary provision in three different areas across
Gwent.
Single Point of Contact and Access to Support –
Work is starting to commence to explore the potential of developing
a single point of contact within Gwent for individuals, carers or
professionals who wish to seek advice and support at any point in
the day or night 7 days a week. It is envisaged that the service
will provide an opportunity for the individual to discuss their
difficulties and agree and facilitate access to what support the
individual may require.
Conveyance
of individuals to hospital in a manner most likely to protect their
dignity and privacy
There are a range of circumstances where people experiencing mental
health crisis need to be conveyed from the community to hospital
for assessment. In addition there are circumstances where patients
need to be conveyed between hospitals, from and between places of
safety, returned to a unit if they are absent without leave, or are
subject to a Community Treatment order and are being recalled from
the community. Many of these people will be detained under the
Mental Health Act (MHA) 1983 amended 2007 and many will be
voluntarily coming to hospital. The most common situations
requiring conveyance are:
·
taking a person to hospital who has been assessed and detained
under the mental health act or agreed to a voluntary admission
following the assessment
·
taking a person to or between places of safety under S136 or S135
so an assessment can take place
·
transferring a patient from one hospital to another so they can
obtain appropriate assessment and treatment
·
returning detained patients to hospital who are absent without
leave
·
returning people subject to Guardianship to the place they are
required to reside
·
taking Supervised Community Treatment (SCT) patients or
conditionally discharged patients to hospital on recall
·
transferring patients to and from court
A number of individuals and agencies have a key role to play to
coordinate conveyance including the Approved Mental Health
Professionals, Responsible Clinicians, hospital Managers, Ambulance
staff and the Police. Those responsible for taking patients from
one place to another must ensure the most humane and least
restrictive method of conveying the patient is used, consistent
with ensuring no harm comes to the patient or to others. There are
a range of factors to be taken into account when deciding the most
appropriate method for conveyance including:
·
the guiding principles in Chapter 1 of the MHA Code of Practice for
Wales (CoPfW)
·
the wishes and views of the patient, including any relevant care
plan or advanced statement
·
the nature of the mental disorder and its current course
·
any physical disability that the patient has
·
the impact that any particular transport will have on the
patient’s relationship with the community to which he or she
will return
·
the availability of various transport options
·
the distance to be travelled
·
the patient’s need for support and supervision during
travel
·
the availability of transport to return to home/office base for
those who accompany the patient (including whether the
professionals will need to return to their own vehicles)
·
The risk of the patient absconding and the risk of harm in the
event of the patient absconding before admission to hospital.
(Chapter 9 MHA CoPfW 9.5)
In order to ensure timely access to transport that protects an
individual’s privacy and dignity, since April 2017, the Gwent
region has funded a 24 hour conveyance response via the use of an
ABUHB vehicle based at one of the acute mental health in-patient
units. The 5.5wte staff who drive these vehicles are based on the
inpatient psychiatric ward as an addition to the establishment in
order to respond in a timely manner to requests for conveyance. At
present the model requires that the person experiencing a mental
health crisis must be escorted by a suitably competent person. This
may be the AMHP, Health Professional and/or Police, dependent on
the circumstances of the situation.
For those whose presentation and risk assessment indicate they
require a more specialist skilled paramedic response this continues
to be accessed via WAST and only when the risk of significant harm
to self or others necessitates the use of a police vehicle in order
to manage the identified risk is a police vehicle used.
The benefits of the above provision include;
·
Improved experience for service users in crisis
·
Individuals being seen in the right place at the right time in
order to receive care and /or assessment
·
Reduced waiting time for transportation thereby freeing up key
resources to respond to other demands in the wider system
·
Safety benefits for those professionals involved as the response
would be timely and reduce the likelihood of escalation
·
Reduction in demand on ambulance usage and freeing up of emergency
vehicles
·
Assists in releasing police resources
The number of people arrested under section 136 of the Mental
Health Act 1983 and the extent to which police custody is being
used as a place of safety for people in mental health crisis
Partners agencies within Gwent are fully committed to ensuring that
police custody is only used as a place of safety for people
experiencing a mental health difficulty when there are exceptional
circumstances.
Within the Gwent Police area, partnership agencies have jointly
agreed that the regional place of safety for the purpose of Section
136 of the Act is Adferiad Ward at St Cadoc’s Hospital. The
provision is a single suite outside the ward area for the purposes
of assessment. It is currently supported by nursing staff from
Adferiad Ward.
The graph below provides information relating to the use of Section
136 both prior to and post the implementation of the Police and
Crime Act in December 2017).
|
Period
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Total s136s for the
period
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Total s136s going first to
Custody
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How many Custody were Under
18s
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Total s136s going direct to Hospital
PoS
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How many Hospital were Under
18s
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1 Dec 16 -
30 Nov 17
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251
|
39
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2
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212
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11
|
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1 Dec 17 -
30 Nov 18
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266
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13
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0
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253
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29
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1 Dec 18 -
28 Feb 19
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72
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4
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0
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68
|
5
|
Graph One: Gwent Section 136
Detentions
Of the 17 people who were first detained in police custody all of
these people were subsequently transferred to St Cadoc’s
Hospital for assessment. Prior to December 2017, it would have been
the case that some of these people would have been assessed by a
Doctor and an Approved Mental Health Practitioner (AMHP) in police
custody.
The graph below shows the reasons why police custody was used in
the first instance and the length of time before arrival at a
hospital based place of safety.
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Reason, if
Police PoS Used First
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Time
until arrival at Hospital
PoS
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|
1
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At
Police Station when Arrested under S136
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1
hour 25 mins
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|
2
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Arrested for
Substantive Offence
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6
hours
|
|
3
|
Violent
behaviour
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1
hour 30 mins
|
|
4
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Arrested for
Substantive Offence
|
20
mins
|
|
5
|
Arrested for
Substantive Offence
|
2
hours 55 mins
|
|
6
|
Arrested for
Substantive Offence
|
20
mins
|
|
7
|
Investigating
missing person
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1
hour
|
|
8
|
Arrested for
Substantive Offence
|
25
mins
|
|
9
|
Arrested for
Substantive Offence
|
1
hour 15 mins
|
|
10
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Ambulance took
too long
|
1
hour 45 mins
|
|
11
|
Arrested for
Substantive Offence
|
30
mins
|
|
12
|
Violent
behaviour
|
1
hour
|
|
13
|
Arrested for
Substantive Offence
|
1
hour
|
|
14
|
Arrested for
Substantive Offence
|
15
mins
|
|
15
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Violent
behaviour
|
6
hours 35 mins
|
|
16
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Arrested for
Substantive Offence
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3
hours 55 mins
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|
17
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Located behind
Police Station
|
45
mins
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Graph Two: Number of People arrested
under Section 136 with Police Custody being used as the first Place
of Safety
In the majority of cases the use of the police station as the first
place of safety it is because the individual has also been arrested
for a criminal offence, is violent or is in close proximity to the
police station at the time of detention under Section 136.
There are two occasions of note: the conveyancing delay attributed
to ambulance delay and the use of police custody due to the
investigation of a missing person.
In the fifteen months since the implementation of the Police and
Crime Act (2017) there have been 338 detention under Section 136 of
the Mental Health Act (1983). On average the single place of safety
at St Cadoc’s Hospital is used on 22 occasions each month,
which suggests that the provision of a single suite is sufficient
to meet this demand. Due to the unplanned nature of the use of
Section 136, there are times when there is concurrent use of the
suite. Concurrent use is defined as a Section 136 that occurs
within 4 hours of a previous Section 136.
Since December 2017, there have been 19 instances of concurrent use
of the suite. This means that 95% of all people detained under
Section 136 are able to be immediately supported in the Section 136
suite at St Cadoc’s Hospital, without waiting for the suite
to be vacated.
Remaining
Challenges
The implementation of the Police and Crime Act (2017) has resulted
in an increase in the numbers of people detained in the designated
suite at St Cadoc’s Hospital. It has also resulted in a
change in the profile of people with a subsequent increase in the
numbers of people presenting with violent and intoxicated
behaviour, which is not always in the context of a mental health
problem. This has proven to be a challenge for Health Board
clinical staff and is resulting in a review of how the designated
136 suite is staffed and supported through the 24 hour period.
Joint Working Arrangements
In addition to the governance structure established to oversee the
implementation of the Gwent “Whole Person, Whole
System” Acute and Crisis model described earlier Gwent has
also established a multi-agency group to specifically focus on the
implementation of the Mental Health Crisis Care Concordat. This
group reports to the Gwent Mental Health and Learning Disability
Criminal Justice Planning Forum which in turn reports to the Mental
Health and Learning Disability strategic partnership. The most
recent version of the delivery plan (see attachment) is currently
being implemented and monitored.
In addition to local assurance mechanism senior representation from
Gwent attend the Welsh Government National Mental Health Crisis
Care Concordat Assurance Group. In addition to providing assurance
regarding progress being made in implementing the delivery plan the
national group also provides an opportunity for shared learning and
this is welcomed.
At a practice level, Health Board practitioners work in partnership
with the Police and AMHP colleagues to review individual cases
where there is opportunity for learning. This provides an
opportunity to review practice in order to prevent future
incidents.
In addition to the formal structures described above a Crisis
Support Community of Practice has also been established across
Gwent that brings together people across Gwent who share a common
interest in improving support for those with a mental health need
who experience a crisis and their carers. The community of Practice
is currently meeting three times a year and has over 100 people on
the membership list.
Mental Health
Crisis Care Concordat: the joint statement
This Concordat is a shared statement of commitment, endorsed by
senior leaders from the organisations most heavily involved in
responding to mental health crisis.
The Welsh Government, its partners from the Police, NHS, the Welsh
Ambulance Services NHS Trust, Local Authorities and third sector
are committed to work together to improve the system of care and
support for people in crisis due to a mental health condition and
who are likely to be detained under section 135 and136 of the
Mental Health Act 1983.
As partners we agree to work together and to intervene early, if
possible, to reduce the likelihood of people presenting a risk of
harm to themselves or others because of a mental health condition
deteriorating to such a crisis point.
They will be helped to find the most appropriate support needed in
whatever situation that need arose and whichever service they turn
to. Assistance with personal recovery is paramount. We will work to
ensure that any intervention is carried out without recourse to
unnecessary or inappropriate placement; for example within police
custody.
We
agree to work together toward delivering this commitment across
Wales.
Within the published Crisis Care Mental Health Concordat, area
Mental Health Criminal Justice Partnership Boards (MHCJPB) are
asked to revise their regional ‘Section 136’ delivery
plans to include the following indicative performance
indicators:
·
%
Reduction on overall rate of use of Section 136
·
%
Ratio – Achieve a Health/Police place of safety ratio of
(85/15)
·
No
use of Police based place of safety for Children and Young
People
·
Strategic
development of alternative places of safety (non
Health/Police)
The previous template plans focussed mainly on the police and
health service interactions during a mental health crisis. In order
to move the work forward this template plan looks across the four
main areas of the concordat and we are looking for MHCJPBs to align
activity to deliver on those outcomes, namely:
o
Access to
support before crisis
o
Urgent
emergency access to crisis care
o
Quality
treatment and care
o
Recovery from
crisis and staying well
This approach also reflects the findings of the early review of the
Concordat. The Concordat Assurance Group is also suggesting adding
two further areas in relation to:
o
Data and
analysis
o
Communications
and partnerships
The purpose of these is to create a deeper understanding of the
information available on a local level and how this can be used to
inform local plans and to ensure that the local plans are being
communicated to other partnerships that have a role to
play.
Queries in
relation to all delivery plans can be routed via
|
|
 |
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How will we do it?
|
How will we know?
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Who is Responsible?
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Key Actions
|
Planning and
Commissioning
|
Improvement Approach/Training
and
Development
|
Lead Agency Time -scale
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Theme 1: Access to support before
crisis
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|
|
Gwent’ Whole Person, Whole
System Acute and Crisis Model’
|
Crisis Support Programme Board
established to oversee the ongoing development of the
model.
4 Task and Finish work streams
established and reporting to the programme board
·
Crisis Housing and Sanctuary
provision
·
Shared Lives/Host
Families
·
Review of In patient and Crisis and
Home Treatment
·
Single point of contact
|
Regional partnership approach across
Health, Social Care, Police, third sector.
Building on strengths across the
whole system and identifying gaps and areas for
development.
Ø ICF bid for capital – Crisis House.
Feasibility study commissioned and completed.
Ø Separating Crisis House and Sanctuary
provision
Ø Coproduction with third sector on range of
sanctuary provision- funding to be identified and bids
progressed
Ø Engaged with Gwent Shared Lives service to
explore opportunities for Host Families
|
Model implemented across the Gwent
region.
Opportunities to intervene earlier
to avert crisis
é
Network of sanctuary provision
across the region
é
Information, advice and assistance
contained within CTP relapse and recovery plans for all secondary
patients
é
Staff across whole system aware of
support and can signpost appropriately
é
Uptake and satisfaction
data
Alternative to hospital admission
resulting in improved outcomes for people.
ê
Bed occupancy
ê
Length of stay
é
Use of shared lives/Host
families
|
ABuHB- Crisis Support Programme
Board Ongoing – see Project Plan
|
|
|
 |
|
Establish a Community of Practice to
engage with the whole system and design together to coproduce
solutions
Mental Health Triage Practitioners
in Force Control Room
|
Quarterly Community of Practice
Workshops to engage and consult with people – people with
lived experience, carers and supporters, staff across
organisations, leaders.
Continue to evaluate this model and
develop based on evaluation and evidence base
|
Ø PDSA established for review of in patient and
CRHT pathway
Ø Further consideration of SPoC
Mechanism to coproduce and design
Whole Person, Whole System Acute and Crisis Model for
Gwent
Engagement and Consultation Peer
support and sharing ideas Test environment
Provide opportunities for a
normative experience for partner organisations across the region
and nationally to share the learning
|
é
Home treatment options
é
Crisis House as an
alternative
é
Person centred outcomes and
satisfaction
Outcomes/Outputs from Community of
Practice Workshops inform the ongoing design and delivery of the
model
People have confidence in the model
and are engaged in its design
Progress is reported and there is
open and transparent communication
ê
Inappropriate use of S136
ê
Repeat use of S136 for
individuals
é
Frontline staff confidence and
shared risk assessment/ decision making
|
ABuHB- Crisis Support Programme
Board Ongoing – see Project Plan
Gwent Police and Caerphilly
CBC
In place and ongoing
|
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 |
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Build and develop accessible
information for citizens to access such as finance and debt
management, positive relationships, resilience and coping with life
events, positive parenting support, health and wellbeing advice
including drugs and alcohol as these support mental health and
wellbeing and provide opportunities for people to self-manage and
to build networks of support
|
Access to information on which to
make decisions and divert people from statutory services to
sanctuary/third sector as appropriate
Make the linkages between Public
Service Board ( PSB) and Regional Partnership Board( RPB) plans so
that population needs assessment is understood as it relates to
whole populations and communities the 7 Wellbeing Goals and 5 Ways
of working in Wellbeing of Future Generations Act
Linkages with Public Health and
Wellbeing Networks
|
WASPI- ISP in place to be reviewed
December 2018 and to be GDPR compliant
Senior Leaders are sighted on the
Gwent MHCC Concordat Plan
Presentation and approval of Gwent
Concordat Plan by the Gwent MH/LD Partnership Board
Plan is published on
partners websites and is outward facing
Partners use their internal
governance structures to provide scrutiny and challenge on the
delivery of the plans
outcomes
|
é
Positive feedback from service users
and professionals
People are diverted away from
statutory intervention to appropriate Information, advice and
assistance- Data from MH Triage Team
Identified outcomes are delivered in
a timely manner consistent with our collective commitment to the
MHCC Concordat
People reporting increased
resilience and able to find their own solutions
Peer support at a community
level
Outcomes in Together 4 MH plan and
Talk to Me 2 are progressed
|
Gwent MH/LD Partnership
Board
|
|
|
Dewis Cymru online information
directory populated and updated
Use of Social Prescribers and
Community Connectors to support people to navigate
systems.
|
|
|
|
|
|
How will we do it?
|
How will we know?
|
Who is Responsible?
|
|
Key Actions
|
Planning and
Commissioning
|
Improvement Approach/Training
and
Development
|
Lead Agency Time-scale
|
|
Theme 2: Urgent access to crisis
care
|
|
|
Mental Health Practitioners in Force
Control Room
|
See Theme 1
|
|
|
|
|
|
|
|
Timely availability of Health Base Place of
Safety
Alternative model of
conveyance in a crisis
|
Review of current availability and
access to HBPoS
( Adeferiad) with particular focus
on
Access- including demand/capacity
Built
Environment-privacy and
dignity
Patient
safety- including
suitability for all age
Staff- knowledge, skills and experience
Policy/Procedures/Protocols
Pilot of an ABuHB conveyance
solution on going until 31st March 2019
|
Consideration of recent audit data/
outcomes
Discussion on a review adopting a
partnership approach and Vanguard Systems methodology ie Normative
experience, What matters to the person, What would a perfect system
look like, value work and waste in the system, system challenges
and blockages
Relevant partners
aware and engaged in the pilot.
Evaluation/Feedback mechanism in
place
Dependant on the evaluation need to
secure funding beyond the pilot.
|
Report of review with options
appraisal and recommendations to Partnership Board
Development of an action plan to
drive improvement as necessary
People are conveyed in a dignified
and appropriate manner appropriate to their needs and
risks.
Staff feedback is
positive
é
Use of the vehicle overtime leads to
improved outcomes across the whole system
é
Cost /benefit analysis positive and
supports ongoing funding
ê
Demand on WAST and inappropriate use
of police vehicles
|
Chair Gwent MHCC Delivery Group with
representation from partners and stakeholders
ABuHB – Reporting to Gwent
MH/LD partnership Board Autumn 2018
|
|
Access to Mental Health assessment
from an appropriate clinician for people detained in police
custody
|
Development of a pathway that
enables the identification of appropriate clinicians to assess
people experiencing a mental health crisis whilst in police
custody.
Agreement on funding responsibility
and governance across ABuHB and Gwent Police
|
Consideration of upskilling custody
nurses in mental health
Consideration of access to primary
and secondary clinicians in and out of hours
Mental Health custody diversion
service based in custody suite
|
ê
Blockages in the whole system as
people are able to move through the system in a timely
manner
ê
Pressure on ED and
unscheduled care
S136 is not used as a mechanism to
obtain access to a mental health assessment for a person arrested
and detained in custody due to system failures.
|
Gwent Police
|
|
|
|
|
|
How will we do it?
|
How will we know?
|
Who is Respo nsible?
|
|
Key Actions
|
Planning and
Commissioning
|
Improvement Approach/Training
and
Development
|
Lead Agency Time-scale
|
|
Theme 3: Quality treatment and
care
|
|
|
Relapse Prevent and
Crisis
|
Refresh as part of
ongoing
|
CTP audits/ quality
assurance
|
ê
Crisis situations and improved
outcomes
é
Increased access to crisis and home
treatment solutions
é
Use of Crisis house and
Sanctuary
ê
Use of S136/135 and powers under
MHA
ê
Use of inpatient beds
All parts of the model are in place
and the model functions as a whole system
|
ABuHB
|
|
Contingency Plans are
|
care coordination
training
|
in place.
|
|
|
developed and coproduced
|
across HB and LA’s
|
|
|
|
with all people as part of
CTP
|
|
Improvement plans as
required
|
|
|
in secondary MH / LD
|
|
|
|
|
services and shared with
|
|
Promote the benefit of
|
|
|
primary care.
|
|
contingency planning to
|
|
|
|
|
people and their supporters
to
|
|
|
|
|
seek early support and
review
|
|
|
|
|
to avoid crisis.
|
|
|
Delivery of the Gwent
Whole
|
Crisis Programme Board
|
Ongoing see 1 above
|
ABuHB
|
|
Person Whole System Acute
|
delivery plan
|
|
|
|
and Crisis Care model
which
|
|
|
|
|
has Crisis Model,
Recovery
|
|
|
|
|
|
|
|
Orientated services that prevent
crisis and resilient communities which are self-
supporting
Values and Principles of Social
Services and Wellbeing Wales are understood and embedded into
practice
|
Community of Practice to coproduce
and design sustainable solutions
Public Health and Wellbeing of
Future generations 5 ways of working.
We listen to understand and ensure
people have voice and control ( Advocacy)
People are expert in their own lives
with strengths and assets
We support people to find their own
solutions
We engage by treating people with
dignity and respect
We uphold the principles of equality
and diversity
We support people to understand and
exercise their rights and entitlements
|
Leaders across all organisations
model the behaviours that demonstrate our collective
values
We seek opportunities to recruit
people with lived experience and peer mentors
We recruit staff who demonstrate a
commitment to our organisational values
CTP and care coordination is person
centred , coproduced and recovery focussed
Staff are have collaborative
conversation training
|
Positive Audit and QA
outcomes
ê
Complaints and serious untoward
incidents
ê
Safeguarding ‘ duty to
report’ referrals in respect of people with MH
problems
é
Compliments and
satisfaction
é
Resilience and improved wellbeing
outcomes
é
Improved staff morale and retention
of staff
|
MH/LD Partnership Board
|
|
|
|
|
People have access to high quality
care and support that adheres to Prudent Health and Social Care (
Right person, Right Time, Right Place)
|
Review our ‘ front
doors’ and strive to make access pathways clearer whilst we
develop a single point of contact/access
|
As part of the Crisis Programme
Board develop a T&F for single point of contact/access on a
regional footprint
Remove blockages and system
conditions that exclude people from accessing care and support in a
timely manner that promotes independence, positive risk taking and
social inclusion.
Review Delayed Transfer of Care data
to understand what the blockages are and seek to find solutions in
partnership.
Improved knowledge and skills across
all organisations in respect of MHA/MH Measure/ MCA/DoLs
|
ê
Delays in the system
ê
Complaints about access
é
Integrated pathways and
MOU
ê
DToC in mental health
settings
é
Multi agency working to find
sustainable solutions to common problems that lead to delays such
as housing options.
é
People are afforded the appropriate
rights and protections and are safeguarded
|
|
|
|
|
|
|
How will we do it?
|
How will we know?
|
Who is Responsible?
|
|
Key Actions
|
Planning and
Commissioning
|
Improvement Approach/Training
and
Development
|
Lead Agency Time-scale
|
|
Theme 4: Recovery from crisis and
staying well
|
|
|
Gwent Whole Person
|
Crisis House Host families
Sanctuary
People are able to flow easily
through the system as required accessing the appropriate
support
Care Coordinators ensure people have
relapse and contingency plans and know how to self-refer under MH
Measure
Work with Primary and secondary
services to ensure seamless response
Dewis website is populated locally
and regionally with information and advice that supports recovery
and wellbeing
|
See 1 above
|
Whole system model is in place and
people and communities are resilient
Appropriate flow through the
system
ê
People being re referred or
self-referral to secondary services
ê
S117 Aftercare planning is effective
in supporting people to stay well
ê
Reduction in
readmission to hospital
Evidence of third sector
consortia/partnership working.
Joint projects that have recovery
outcomes as a measure.
|
ABuHB
|
|
Whole System Acute and
|
|
|
|
Crisis Model
|
|
|
|
People are discharged
from
|
Development of pathways
|
ABuHB
|
|
secondary mental health
|
between primary and
|
|
|
services and have ongoing
|
secondary care that are
|
|
|
support from primary care
|
responsive and supportive
to
|
|
|
that supports their
|
recovery
|
|
|
recovery
|
|
|
|
|
Refresh care coordination
and
|
|
|
|
MH measure
|
|
|
Range of meaningful
|
Third sector organisations
work
|
Third Sector
|
|
opportunities available
in
|
together across Gwent to
|
|
|
the community that
|
enhance and develop a
|
|
|
support wellbeing and
|
wellbeing offer that
promotes
|
|
|
universal access
|
and supports recovery
|
|
|
|
|
Community Connectors and Social
Prescribers are able to support people to access their community
and universal services to support recovery and staying
well
|
Range of information available on
Dewis that is regularly updated.
Use of website by public
Data from CC and Social
prescribers
|
|
|
|
How will we do it?
|
How will we know?
|
Who is Responsible?
|
|
Key Actions
|
Planning and
Commissioning
|
Improvement
Approach/Training and
Development
|
Lead Agency Time-scale
|
|
Theme 5: Data and
analysis
|
|
|
Nationally agreed performance
measures and performance information to enable benchmarking and
comparison
|
Single data collection tool for all
agencies with appropriate and relevant data
|
National tool /Regional tool is
developed and agreed
Tool is rolled out Quarterly
reporting data is
analysed and where indicated
partners act on the system to seek improvement
|
Performance against the indicators
across partners is tracked and supports improved
performance.
Audits provide quality assurance and
governance
|
Welsh Government then Area MH/CJ
partnership boards
|
|
|
|
|
|
How will we do it?
|
How will we know?
|
Who is Responsible
|
|
Key Actions
|
Planning and
Commissioning
|
Improvement Approach/Training
and
Development
|
Lead Agency Time-scale
|
|
Theme 6: Communications and
partnerships
|
|
|
Gwent MHCC Concordat delivery group
complete template population and agree highlanders to take forward
key actions
|
MHCC Concordat Delivery Plan
template is shared with Community of Practice for views and
consultation.
Template updated following
consultation
MHCJPB approves the delivery plan
and monitors progress against key actions quarterly via exceptions
reporting from the Chair of the Delivery Group.
Identify suitable/appropriate
digital platform to publish the plan across the region
|
Opportunities to present the
Delivery Plan across Gwent are identified and a presentation is
designed.
Link with training and workforce
development leads across the region and across partnerships to
raise awareness of the new plan with staff
Third sector to consider promoting
with people and carers
Use national days such as World MH
Day and others to promote Whole Person Whole System Acute and
Crisis Model
Continue to work with International
Mental health Collaborating Network to learn and communicate with
/from others nationally and internationally
|
Awareness of the MHCC Concordat and
regional plan at all levels across organisations, partnerships and
stakeholders
|
All
|
|
|
How will we do it?
|
How will we know?
|
|
Key Actions
|
Planning and
Commissioning
|
Improvement
Approach/Training
and Development
|
|
Theme 7:
Other ongoing
initiatives
|
|
|
|
|
|
