1. Sustainability and Transformation Plans – Mental Health Crisis Care 1 Supporting information

2. Mental Health Crisis Care Contents: Understanding What Londoners Expect from Mental Health Crisis Care -Key themes identified through engagement -Londoners’ Crisis Care ‘I’ Statements Crisis Care Data Analysed by Network 1.North Central London 2.North West London 3.South East London 4.South West London 5.North East London 2

3. Understanding What Londoners Expect from Mental Health Crisis Care 3 With support from Mind and YoungMinds, Healthy London Partnership has undertaken an engagement process to understand what matters most to Londoners with lived experience of mental health crisis and what they expect from the capital’s crisis care system. More than 140 service users and carers took part in an online survey, telling us about their recent experiences of crisis care, including those in emergency departments and health-based places of safety. They told us what was good and what could have been better. They also told us what is most important to them in helping to prevent a crisis, during a crisis and following a crisis. A face-to-face service user focus group was undertaken to help develop a series of ‘I’ statements from the survey responses. The statements were then tested and refined through further online consultation. They are first person statements that say what Londoners expect from the services and agencies involved in their care. They are what people should be able to say when crisis care is working well. Further engagement was also undertaken with children and young people to better understand where their experiences and needs might differ from those of adults. As a result, some additional statements have been compiled to try and reflect what we heard from Londoners who have experienced a mental health crisis as a young person. They should be read alongside and not instead of the other statements, which apply to Londoners of all ages. We hope these powerful statements will help guide the NHS and partner organisations in making improvements to mental health crisis care across London. If you have any queries of comments relating to the statements please email england.mentalhealthcrisis@nhs.net

4. Key themes identified through engagement The following areas were identified through the engagement process as particularly important in the delivery of crisis care. The survey responses and focus group have helped to identify both the current problems across these areas and how service users think improvements could be achieved.  Access to the right help – less than half of survey respondents knew how to access advice and support to get the help they needed when in crisis  Timeliness of care – nearly 70% of survey respondents felt there were missed opportunities to prevent their mental health deteriorating to crisis point  Compassion – only 34% who attended an emergency department and 27% who attended a place of safety agreed that staff had treated them with compassion  Choice and Involvement – only 30% felt involved in discussions about their mental health problems  Staff attitudes and knowledge – only 36% of those who attended an emergency department felt listened to and that their concerns were taken seriously  Environment – 93% of respondents feel that being in an environment that suits their needs when in crisis is either important of very important  Continuity of care – Over 95% said that receiving appropriate follow-up care after their crisis was either important of very important 4 As of the 4th February 2016,131 people had completed the online survey. The quantitative data presented above, some of which was shared at London’s first Mental Health Crisis Care Summit, is based on analysis of responses received up until this date.

5. Londoners’ Mental Health Crisis Care ‘I’ Statements: Preventing Crisis 5 I feel reassured because I know I can easily access extra support when I need it, and I can rely on it being there. This includes local community mental health services that offer rest and respite, such as sanctuaries and crisis houses. Friends and family are involved in my care where we both want this and staff recognise their contribution. My carer is offered support in their own right, to help them stay well. The care I receive is tailored to my needs and circumstances at that time, and helps me reach my aspirations. It follows any plan I have agreed with mental health services, and covers all areas where I need assistance, such as physical health care, practical and emotional needs. When I’m not coping I can get the support I need at that time to manage everyday life, such as practical assistance with getting meals, or help to keep me from becoming isolated. My care is coordinated by someone I can trust, who will listen and take seriously what I say I need. They take time to understand my situation and if at all possible I will know them.

6. Londoners’ Mental Health Crisis Care ‘I’ Statements: During Crisis 6 If I am taken to an emergency department or place of safety, it is in health service transport such as a paramedic car or ambulance and not a police vehicle. Right from the beginning, and throughout the crisis, all the professionals involved (whether paramedics, police, frontline emergency department staff, or any other staff) recognise me as a person in crisis. They treat me skilfully and lawfully, with care, compassion and respect. If I am taken to an emergency department or place of safety, I am let in straight away. I don’t have to wait in the transport or any other unsuitable place such as a general waiting room, corridor or outside, while staff negotiate whether or not I can go in. When I am in crisis police presence is as low key as possible and there is no unnecessary use of restraint. Emergency staff and paramedics treat me with the same respect, confidentiality and care as all other patients and are skilled in managing mental health problems. I am listened to and my voice is heard; at the point of crisis I might not be able to think clearly, make decisions or say everything I am feeling, but I am still a person and should not be ignored. If my behaviour is not appropriate I am not judged for this. Emergency staff pay attention to any advance statement or crisis plan I have made and adhere to it, referring to my medical records when I have given consent. In the emergency department or place of safety I am seen (and where necessary wait) in an environment that is safe and calm. Staff welcome me and offer me refreshment. The room is private, quiet, clean and comfortable – it does not feel like a prison. If it is important to me to be cared for by female or male staff this is respected and I can choose to have someone with me to provide friendly support. Staff in the emergency department, place of safety or any other setting spend time with me and explain clearly and calmly what is happening and what is going to happen. They keep communicating with me and my family or carer and tell me if the plan changes. I am not left waiting for hours, without explanation or on my own. If I wish to involve family members, friends or carers, staff listen to them in my presence ; they do not exclude them or ignore what they say.

7. Londoners’ Mental Health Crisis Care ‘I’ Statements: Following Crisis 7 There is a reasonable and realistic plan for my aftercare that I and any chosen friends, family and carers have made with relevant professionals. I choose who knows about the plan and which parts of it they can access. People who are responsible for providing aftercare understand and perform their role fully. If I am discharged from an emergency department or place of safety, I am provided with advice and support if I want it and safe transport home, especially at night. My aftercare is helpful, reliable, easily accessible and local - it covers my wider needs (such as housing or benefits), supports my wellbeing and helps me achieve my aspirations.

8. Londoners’ Mental Health Crisis Care ‘I’ Statements: Children and Young People 8 Those caring for me involve me in discussions about my care and listen to what I think works well. Staff believe what I am saying and take my opinion seriously. My voice is not ignored just because I have an adult with me and I am not spoken over or about just because I am young. Wherever possible I am given options in my care that recognise that I am an individual and that every situation is different I am never left waiting on my own without knowing what is going on and I am always involved in making plans for what happens next. Those involved in my care are always honest with me. They support me to gain confidence in them when I am feeling vulnerable. I am supported to achieve my aspirations for other areas of my life such as education, hobbies and relationships. I am prepared for the changes which are coming up and not left feeling I am going into the unknown. Those caring for me take the time to find out about my fears. They take them seriously and reassure me. Those involved in my care make the effort to get to know me. They understand that although I may be an adult legally, I may not always feel like one. As far as possible my confidentiality is respected and only the friends, family and carers that I choose are involved in my care. The children and young people’s ‘I’ statements should be read in addition to, and not instead of, the overarching London Mental Health Crisis Care ‘I’ statements, which apply to Londoners of all ages. These additional statements were developed with the intention of capturing and emphasising the specific needs and expectations of children and young people in crisis.

9. 03 Transforming London’s health and care together North Central London Detentions under Section 136 of the Mental Health Act Designated Health Based Places of Safety (HBPoS) Mental Health in Emergency Departments HLP Audit Findings Liaison Psychiatry 9 01

10. NCL Mental Health Crisis Care: Detentions under S136 of the MHA 10 The boroughs covered by the NCL UEC Network are served by two Mental Health Trusts: - Camden and Islington NHS Foundation Trust - Barnet, Enfield and Haringey Mental Health NHS Trust The data below shows the number of people assessed at these Trusts following formal detention under the Section 136 of the Mental Health Act 1983, between Jan 2015 – Sep 2015. MH TrustJanFebMarAprMayJunJulAugSeptTotal Camden and Islington NHS Foundation Trust 372640275257303129329 Barnet, Enfield and Haringey Mental Health NHS Trust 261427242528332941247 London MH Trust Average 322941363745464042349 Data Source: Mental Health & Learning Disabilities Minimum Dataset – MHLDDS excepting C & I which are drawn from local systems)

11. HBPoS SiteMental health Trust Provider Boroughs covered by HBPoS site Assessment Capacity (according to CQC 2014 data) Age range accepted by service Dedicated staffing attached to the unit 1 University College London Hospital (ED) Camden and Islington NHS Foundation Trust Camden and Islington 2All age No – covered by the Liaison Psychiatry Team 2 Royal Free Hospital (ED) Camden and Islington NHS Foundation Trust Camden and Islington 1 All age - 5 Whittington Hospital (ED) Camden and Islington NHS Foundation Trust Camden and Islington 2 All age - 6 Chase Farm Hospital Barnet, Enfield and Haringey Mental Health NHS Trust Barnet, Enfield, Haringey 2All age Dedicated nursing staff from 8am- 8pm. 8pm-8am is covered by staff from the CRHTT. 7 St Ann’s Road Hospital Barnet, Enfield and Haringey Mental Health NHS Trust Barnet, Enfield, Haringey 1All age Yes - 2 nursing staff available 24/7. Medical staff available via oncall system. NCL: Designated Health Based Places of Safety (HBPoS) 11 Barnet Enfield Haringey Camden Islington 2 1 7 5 Royal Free Whittington UCLH 6 Chase Farm Hospital St Ann’s Road Hospital The designated health based places of safety across the NCL UEC network are identified on the map below. The information regarding the age range of individuals accepted by HBPoS and staffing arrangements is self-reported and taken from an NHS England Mental Health bed audit undertaken in November 2015. (Where no data is entered this indicates that information was no submitted.) Assessment capacity is taken from the CQC’s thematic data review report on experience and outcomes for people experiencing a mental health crisis (Nov 2014).

12. Overview All the EDs in NCL reported that they are aware of the MH Crisis Commissioning Standards and have at least one designated room specially equipped for assessing mental health patients within the department. They all reported high levels of activity, with the MH rooms being in use the majority of the time at all hours of the day. Mental Health Staff Training within Emergency Departments The majority of sites reported that most frontline staff were trained in mental health awareness/crisis management, but this mainly comprises internal training. Only the Whittington reported that all ED consultants were trained in these areas. The main barriers to undergoing training were identified as lack of time/competing demands and lack of nationally recognised accessible programmes. Mental Health Act Assessment and AMHPs UCLH was the only ED in NCL that reported completing the majority of MHA assessments within four hours. The other sites claim this rarely or never happens, with waits of up to 12hrs not uncommon. Cited reasons for delayed assessments across the geography include: difficulty accessing AMHPs, particularly out of hours; the inability to identify a bed leading to an unwillingness for assessments to be carried out; boundary disputes regarding AMHP coverage and bed allocation. Children and Young People All sites reported that their frontline staff had knowledge of children and young people's mental health, however, both the Royal Free and North Middlesex hospitals reported that quick access to CAMHS expertise in ED is rare. Repeat presentations All the sites identify those patients who attend ED frequently when experiencing a mental health crisis, which they report account for less than half of those who go on to be admitted following assessment. NCL Mental Health Crisis Care in ED: Audit Findings 12 Findings based on responses from the following EDs University College London Hospital ED and designated HBPoS Royal Free HospitalED and designated HBPoS Barnet HospitalED North Middlesex University Hospital ED Whittington HospitalED and designated HBPoS HLP undertook an audit during the summer of 2015 to better understand London’s current position in relation to delivering London's Mental Health Crisis Commissioning Standards in emergency departments. London's Mental Health Crisis Commissioning Standards Summarised below are some key findings from this audit for the EDs located within NCL UEC Network. The information presented was self-reported by the EDs.

13. NCL Mental Health Crisis Care in ED: Liaison Psychiatry 13 The information below regarding Working Age Adult and Older Adult Liaison Psychiatry provision in EDs was taken from NHS England’s 2nd annual survey of liaison mental health, completed in August 2015. This information was used to make decisions regarding the distribution of the £30 million non-recurrent funding made available by NHS England in October 2015 for improving Liaison Psychiatry in ED nationally. Any service changes that have occurred since this survey was undertaken are not accounted for in the data below. ED Hospital Site Current Consultant Provision Recommended Total Consultants for Core 24 Difference (Consultants Required for Core 24) Current Nurses Recommended Total Nurses for Core 24 Difference (Nurses Required for Core 24) Service Grading University College London Hospital 1.503.57 2.07 6.0023.22 17.22 SubCore Royal Free Hospital 1.502.49 0.99 9.0016.17 7.17 SubCore Barnet Hospital 2.001.74 -0.26 10.0011.34 1.34 Core 24 North Middlesex University Hospital 2.001.82 -0.18 9.5011.83 2.33 Core 24 Whittington Hospital 1.001.12 0.12 9.007.25 -1.75 Core 24

14. 03 Transforming London’s health and care together North West London Detentions under Section 136 of the Mental Health Act Designated Health Based Places of Safety (HBPoS) Mental Health in Emergency Departments HLP Audit Findings Liaison Psychiatry 14 02

15. NWL Mental Health Crisis Care: Detentions under S136 of the MHA 15 The boroughs covered by the NCL UEC Network are served by two Mental Health Trusts: - Central and North West London NHS Foundation Trust - West London Mental Health NHS Trust The data below shows the number of people assessed at these Trusts following formal detention under the Section 136 of the Mental Health Act 1983, between Jan 2015 – Sep 2015. MH TrustJanFebMarAprMayJunJulAugSeptTotal Central and North West London NHS Foundation Trust 355790544765694851516 West London Mental Health NHS Trust 282528303755486039350 London MH Trust Average 322941363745464042349 Data Source: Mental Health & Learning Disabilities Minimum Dataset – MHLDDS excepting C & I which are drawn from local systems)

16. NWL: Designated Health Based Places of Safety (HBPoS) HBPoS SiteMental health TrustBoroughs covered by HBPoS site Assessment Capacity (according to CQC 2014 data) Age range accepted by service Dedicated staffing attached to the unit 1 Northwick Park Mental Health Unit Central and North West London NHS Foundation Trust Harrow 1 16+Yes - Band 6 RMN Unit Coordinator 2 Park Royal Mental Health Unit Central and North West London NHS Foundation Trust Brent116+ Yes - Band 6 RMN Unit Coordinator 3 Gordon Hospital Central and North West London NHS Foundation Trust Westminster116+ Yes - Band 6 RMN Unit Coordinator 4 Riverside Centre Central and North West London NHS Foundation Trust Hillingdon116+ Yes - Band 6 RMN Unit Coordinator 5 Hammers mith & Fulham Mental Health Unit West London Mental Health NHS Trust Hammersmith & Fulham 1All age B5 Nurse & B2 HCA 24/7 6 Lakeside Mental Health Unit West London Mental Health NHS Trust Hounslow1All age B5 Nurse & B2 HCA 24/7 7 St Bernard’s, Ealing Hospital West London Mental Health NHS Trust Ealing2All age B5 Nurse & B2 HCA 24/7 16 6 4 1 3 7 5 Brent Ealing H&F Harrow Hounslow K&C Westminster Hillingdon Riverside Centre Northwick Park MH Unit Lakeside Gordon Hospital St Bernard’s 2 Park Royal H&F MH Unit The designated health based places of safety across the NWL UEC network are identified on the map below. The information regarding the age range of individuals accepted by HBPoS and staffing arrangements is self-reported and taken from an NHS England Mental Health bed audit undertaken in November 2015. (Where no data is entered this indicates that information was not submitted.) Assessment capacity is taken from the CQC’s thematic data review report on experience and outcomes for people experiencing a mental health crisis (Nov 2014).

17. Overview All the EDs in NWL reported awareness of the MH Crisis Commissioning Standards apart from London North West Healthcare Trust, which runs the EDs at Ealing Hospital and Northwick Park. They all have at least one designated room specially equipped for assessing mental health patients within the department apart from Hillingdon hospital. They all reported high levels of activity, with the MH rooms being in use the majority of the time, particularly at night/ Mental Health Staff Training within Emergency Departments The sites reported that almost all frontline staff and ED consultants were trained in mental health awareness/crisis management, but this mainly comprises internal training. Lack of time was identified as the main barrier to training. Mental Health Act Assessment and AMHPs Northwick Park was the only ED that reported completing the majority of MHA assessments within four hours. The other sites claim this happens less than half of the time. Cited reasons for delayed assessments across the geography include difficulty accessing AMHPs and S12 Drs, particularly out of hours, and the inability to identify a MH bed. Children and Young People All sites reported that their frontline staff had knowledge of children and young people's mental health, however, Hillingdon indicated that this knowledge was limited. All EDs reported that quick access to CAMHS expertise was rare, apart from Chelsea and Westminster that said it was often possible during the day, Monday-Friday. Repeat presentations All the sites identify those patients who attend ED frequently when experiencing a mental health crisis, which they report account for less than half of those individuals who go on to be admitted. NWL Mental Health in ED: Audit Findings 17 Findings based on responses from the following EDs West Middlesex University HospitalHillingdon Hospital Ealing HospitalCharing Cross Hospital Northwick ParkSt Mary's Hospital Chelsea and Westminster Hospital HLP undertook an audit during the summer of 2015 to better understand London’s current position in relation to delivering London's Mental Health Crisis Commissioning Standards in emergency departments.London's Mental Health Crisis Commissioning Standards Summarised below are some key findings from this audit for the EDs located within NWL UEC Network. The information presented was self-reported by the EDs.

18. NWL Mental Health in ED: Liaison Psychiatry 18 The information below regarding liaison psychiatry provision in EDs was taken from NHS England’s 2nd annual survey of liaison mental health, completed in August 2015. This information was used to make decisions regarding the distribution of the £30 million non-recurrent funding made available in October 2015 for improving Liaison Psychiatry in ED nationally. Any service changes since this survey was undertaken are not accounted for in the data below. ED Hospital Site Current Consultant Provision Recommended Total Consultants for Core 24 Difference (Consultants Required for Core 24) Current Nurses Recommended Total Nurses for Core 24 Difference (Nurses Required for Core 24) Service Grading West Middlesex University Hospital 3.501.41 -2.09 15.009.18 -5.82 Enhanced Ealing Hospital 3.201.42 -1.78 23.109.20 -13.90 Comprehensive Northwick Park 2.001.85 -0.15 15.0012.04 -2.96 SubCore Chelsea and Westminster Hospital 1.001.57 0.57 9.0010.22 1.22 Core Hillingdon Hospital 2.001.68 -0.32 12.0010.95 -1.05 Core 24 Charing Cross Hospital 3.001.68 -1.32 6.7010.89 4.19 Core St Mary's Hospital 2.601.94 -0.66 12.0012.58 0.58 Core 24

19. 03 Transforming London’s health and care together South East London Detentions under Section 136 of the Mental Health Act Designated Health Based Places of Safety (HBPoS) Mental Health in Emergency Departments HLP Audit Findings Liaison Psychiatry 19 03

20. SEL Mental Health Crisis Care: Detentions under S136 of the MHA 20 The boroughs covered by the NCL UEC Network are served by two Mental Health Trusts: - Oxleas NHS Foundation Trust - South London and Maudsley NHS Foundation Trust The data below shows the number of people assessed at these Trusts following formal detention under the Section 136 of the Mental Health Act 1983, between Jan 2015 – Sep 2015. MH TrustJanFebMarAprMayJunJulAugSeptTotal Oxleas NHS Foundation Trust 412627354039384342331 South London and Maudsley NHS Foundation Trust 514755655773795272551 London MH Trust Average 322941363745464042349 Data Source: Mental Health & Learning Disabilities Minimum Dataset – MHLDDS excepting C & I which are drawn from local systems)

21. SEL: Designated Health Based Places of Safety (HBPoS) HBPoS SiteED/Mental health Trust Boroughs covered by HBPoS site Assessment Capacity (according to CQC 2014 data) Age range accepted by service Dedicated staffing attached to the unit 1 Green Parks House Oxleas NHS Foundation Trust Bexley, Bromley & Greenwich 1All age No 2 Oxleas House Oxleas NHS Foundation Trust Bexley, Bromley & Greenwich 1All age No 3 Lambeth Place of Safety Suite, Eden Ward, Lambeth Hospital South London and Maudsley NHS Foundation Trust Lambeth 1All age One allocated nurse as POS co-ordinator 4 Ladywell Unit, University Hospital Lewisham South London and Maudsley NHS Foundation Trust Lewisham 1All age One allocated nurse as POS co-ordinator 5 Southwark Place of Safety Suite, ES1 Ward, Maudsley Hospital South London and Maudsley NHS Foundation Trust Lewisham Southwark 1All age One allocated nurse as POS co-ordinator 6 Croydon Place of Safety Suite, Gresham PICU, Bethlem Royal Hospital South London and Maudsley NHS Foundation Trust Southwark Croydon 1All age One allocated nurse as POS co-ordinator 21 Lambeth Bromley Bexley Greenwich Lewisham Southwark 2 1 3 5 64 6 4 Maudsley Hospital Oxleas House Greenparks House Ladywell Unit Lambeth Hospital’ Croydon 136 Suite The designated health based places of safety across the SEL UEC network are identified on the map below. The information regarding the age range of individuals accepted by HBPoS and staffing arrangements is self-reported and taken from an NHS England Mental Health bed audit undertaken in November 2015. (Where no data is entered this indicates that information was not submitted.) Assessment capacity is taken from the CQC’s thematic data review report on experience and outcomes for people experiencing a mental health crisis (Nov 2014).

22. Overview All the responding EDs in SEL reported awareness of the MH Crisis Commissioning Standards apart from University Hospital Lewisham. They all have at least one designated room specially equipped for assessing mental health patients within the department which they all report is often in use. Mental Health Staff Training within Emergency Departments The sites reported that most frontline staff and all ED consultants were trained in mental health awareness/crisis management, but this is achieved through internal training only. Availability of recognised education packages was identified as a barrier to undertaking further training in this area. Mental Health Act Assessment and AMHPs Queen Elizabeth Hospital was the only ED that reported completing the majority of MHA assessments within four hours. The other sites said this happens less than half of the time. Cited reasons for delayed assessments across the geography include lack of available AMHPs and S12 Doctors and the inability to identify a Mental Health bed. Children and Young People All sites reported that their frontline staff had knowledge of children and young people's mental health. St Thomas’ and King’s reported that quick access to CAMHS expertise was often possible, particularly during the day however, the other sites said this was rare. Repeat presentations All the sites identify those patients who attend ED frequently when experiencing a mental health crisis. They report that these individuals account for less than half of the total number who go on to be admitted, apart from the Queen Elizabeth Hospital, which claims that the majority of those admitted are frequent attendees. SEL Mental Health in ED: Audit Findings 22 Findings based on responses from the following EDs King's College Hospital NHS Foundation Trust University Hospital Lewisham St Thomas' Hospital Queen Elizabeth Hospital N.B. no response received from the Princess Royal HLP undertook an audit during the summer of 2015 to better understand London’s current position in relation to delivering London's Mental Health Crisis Commissioning Standards in emergency departments.London's Mental Health Crisis Commissioning Standards Summarised below are some key findings from this audit for the EDs located within SEL UEC Network. The information presented was self-reported by the EDs.

23. SEL Mental Health in ED: Liaison Psychiatry 23 The information below regarding liaison psychiatry provision in EDs was taken from NHS England’s 2nd annual survey of liaison mental health, completed in August 2015. This information was used to make decisions regarding the distribution of the £30 million non-recurrent funding made available in October 2015 for improving Liaison Psychiatry in ED nationally. Any service changes since this survey was undertaken are not accounted for in the data below. ED Hospital Site Current Consultant Provision Recommended Total Consultants for Core 24 Difference (Consultants Required for Core 24) Current Nurses Recommended Total Nurses for Core 24 Difference (Nurses Required for Core 24) Service Grading King’s College Hospital 1.803.60 1.80 16.0023.40 7.40 SubCore Princess Royal0.602.001.409.0013.004.00SubCore University Hospital Lewisham 2.001.80-0.208.0011.703.70Core St Thomas' Hospital 2.304.001.7011.0025.9714.97SubCore Queen Elizabeth Hospital 1.002.081.0816.0013.55-2.45SubCore

24. 03 Transforming London’s health and care together South West London Detentions under Section 136 of the Mental Health Act Designated Health Based Places of Safety (HBPoS) Mental Health in Emergency Departments HLP Audit Findings Liaison Psychiatry 24 04

25. SWL Mental Health Crisis Care: Detentions under S136 of the MHA 25 The boroughs covered by the NCL UEC Network are served by one Mental Health Trust: - South West London and St Georges NHS Trust The data below shows the number of people assessed at these Trusts following formal detention under the Section 136 of the Mental Health Act 1983, between Jan 2015 – Sep 2015. MH TrustJanFebMarAprMayJunJulAugSeptTotal South West London and St Georges NHS Trust 252237302233433036278 London MH Trust Average 322941363745464042349 Data Source: Mental Health & Learning Disabilities Minimum Dataset – MHLDDS excepting C & I which are drawn from local systems)

26. SWL: Designated Health Based Places of Safety (HBPoS) HBPoS SiteMental health Trust Boroughs covered by HBPoS site Assessment Capacity (according to CQC 2014 data) Age range accepted by service Dedicated staffing attached to the unit 1 Wandsworth Recovery Centre, Section 136 Suite, Springfield University Hospital South West London and St Georges NHS Trust Sutton, Merton, Kingston, Richmond, Wandsworth 3All age NO - The 136 facility is managed by the PICU staff 24/7 26 Croydon Richmond Wandsworth Kingston Merton Sutton 1 Wandsworth Recovery Centre The designated health based places of safety across the SWL UEC network are identified on the map below. The information regarding the age range of individuals accepted by HBPoS and staffing arrangements is self-reported and taken from an NHS England Mental Health bed audit undertaken in November 2015. (Where no data is entered this indicates that information was not submitted.) Assessment capacity is taken from the CQC’s thematic data review report on experience and outcomes for people experiencing a mental health crisis (Nov 2014).

27. Overview St George’s and St Helier’s reported awareness of the MH Crisis Commissioning Standards (Kingston did not respond to this question) and all three EDs have at least one designated room specially equipped for assessing mental health patients within the department which is often in use at all hours of the day. Mental Health Staff Training within Emergency Departments St George’s and St Helier’s reported that most frontline staff were trained in mental health awareness/crisis management, but Kingston reported that this was the case for less than half of individuals. However, across all the Trusts most of the Consultants have some level of mental health training. Time to undertake training and finding necessary staff cover were identified as barriers. Mental Health Act Assessment and AMHPs St Helier was the only ED that reported completing the majority of MHA assessments within four hours. The other sites said this either happens rarely or less than half of the time. Cited reasons for delayed assessments across the geography include lack of available AMHPs and S12 Doctors and the inability to identify a Mental Health bed. Children and Young People All sites reported that their frontline staff had knowledge of children and young people's mental health, but St Helier’s was the only ED that said quick access to CAMHS expertise was often possible. Repeat presentations St George’s and St Helier’s identified that about half of patients who are admitted are those who frequently attend ED experiencing a mental health crisis. SWL Mental Health in ED: Audit findings 27 HLP audit findings based on responses from the following EDs St George's Hospital St Helier’s Hospital Kingston Hospital N.B. no response received from Croydon University Hospital or Epsom Hospital HLP undertook an audit during the summer of 2015 to better understand London’s current position in relation to delivering London's Mental Health Crisis Commissioning Standards in emergency departments.London's Mental Health Crisis Commissioning Standards Summarised below are some key findings from this audit for the EDs located within NWL UEC Network. The information presented was self-reported by the EDs.

28. SWL Mental Health in ED: Liaison Psychiatry 28 The information below regarding liaison psychiatry provision in EDs was taken from NHS England’s 2nd annual survey of liaison mental health, completed in August 2015. This information was used to make decisions regarding the distribution of the £30 million non-recurrent funding made available in October 2015 for improving Liaison Psychiatry in ED nationally. Any service changes since this survey was undertaken are not accounted for in the data below. ED Hospital Site Current Consultant Provision Recommended Total Consultants for Core 24 Difference (Consultants Required for Core 24) Current Nurses Recommended Total Nurses for Core 24 Difference (Nurses Required for Core 24) Service Grading St George's1.003.47 2.47 17.6022.57 4.97SubCore Epsom3.001.16 -1.84 6.007.57 1.57 Core St Helier’s 1.001.79 0.79 3.0011.65 8.65 SubCore Kingston1.001.44 0.44 5.009.33 4.33 SubCore Croydon1.501.75 0.25 16.0011.39 -4.61 Core 24

29. 03 Transforming London’s health and care together North East London Detentions under Section 136 of the Mental Health Act Designated Health Based Places of Safety (HBPoS) Mental Health in Emergency Departments HLP Audit Findings Liaison Psychiatry 29 05

30. NEL Mental Health Crisis Care: Detentions under S136 of the MHA 30 The boroughs covered by the NCL UEC Network are served by two Mental Health Trusts: - East London NHS Foundation Trust - North East London NHS Foundation Trust The data below shows the number of people assessed at these Trusts following formal detention under the Section 136 of the Mental Health Act 1983, between Jan 2015 – Sep 2015. MH TrustJanFebMarAprMayJunJulAugSeptTotal East London NHS Foundation Trust 271829251921322816215 North East London NHS Foundation Trust 222540323536443852324 London MH Trust Average 322941363745464042349 Data Source: Mental Health & Learning Disabilities Minimum Dataset – MHLDDS excepting C & I which are drawn from local systems)

31. NEL: Designated Health Based Places of Safety (HBPoS) HBPoS SiteMental health Trust Provider Boroughs covered by HBPoS site Assessment Capacity (according to CQC 2014 data) Age range accepted by service Dedicated staffing attached to the unit 1 Royal London Hospital (ED) East London NHS Foundation Trust Tower Hamlets 1All age - 2 City and Hackney Centre for Mental Health East London NHS Foundation Trust Newham 1 12+ No 3 Crystal Ward Newham Centre Mental Health East London NHS Foundation Trust City and Hackney 1 18 + ( under 18 go via Homerton University Hospital to see CAMHS medics) No 4 Sunflowers Court, Goodmayes Hospital North East London NHS Foundation Trust Barking and Dagenham, Havering, Redbridge, Waltham Forest 2 All age - 31 City Barking and Dagenham Hackney Havering Newham Redbridge Tower Hamlets Waltham Forest 4 1 2 3 City and Hackney Centre for MH Sunflowers Court Newham Centre for MH Royal London The designated health based places of safety across the NEL UEC network are identified on the map below. The information regarding the age range of individuals accepted by HBPoS and staffing arrangements is self-reported and taken from an NHS England Mental Health bed audit undertaken in November 2015. (Where no data is entered this indicates that information was not submitted.) Assessment capacity is taken from the CQC’s thematic data review report on experience and outcomes for people experiencing a mental health crisis (Nov 2014).

32. Overview All responding EDs reported awareness of the MH Crisis Commissioning Standards and all three EDs have at least one designated room specially equipped for assessing mental health patients within the department, which is often in use at all hours of the day. Mental Health Staff Training within Emergency Departments The King George and Homerton hospitals reported that most frontline staff were trained in mental health awareness/crisis management, but Queen’s said that this was only true in some cases. Only Homerton said that all ED Consultants have some level of mental health training, which had been delivered internally. Mental Health Act Assessment and AMHPs The King George was the only ED that reported completing the majority of MHA assessments within four hours. The other sites said this happens less than half of the time or almost never. The EDs reported that lack of beds was rarely the reason for delays in completing MHA assessments, but Homerton said that this did sometimes happen for out of area patients. Children and Young People Only Homerton reported that their frontline staff had knowledge of children and young people's mental health. Both the King George and Queen’s said that quick access to CAMHS expertise was often possible, but the King George qualified that over night and at weekends this support was provided by an online CAMHS doctor. Repeat presentations All the sites identify those patients who attend ED frequently when experiencing a mental health crisis, which they report account for less than half of those individuals who go on to be admitted. NEL Mental Health in ED: Audit findings 32 HLP audit findings based on responses from the following EDs Queen’s Hospital Homerton Hospital King George Hospital N.B. no response was received from EDs provided by Bart’s Health: Royal London, Newham University Hospital and Whipps Cross. HLP undertook an audit during the summer of 2015 to better understand London’s current position in relation to delivering London's Mental Health Crisis Commissioning Standards in emergency departments.London's Mental Health Crisis Commissioning Standards Summarised below are some key findings from this audit for the EDs located within NWL UEC Network. The information presented was self-reported by the EDs.

33. NEL Mental Health in ED: Liaison Psychiatry 33 The information below regarding liaison psychiatry provision in EDs was taken from NHS England’s 2nd annual survey of liaison mental health, completed in August 2015. This information was used to make decisions regarding the distribution of the £30 million non-recurrent funding made available in October 2015 for improving Liaison Psychiatry in ED nationally. Any service changes since this survey was undertaken are not accounted for in the data below. ED Hospital Site Current Consultant Provision Recommended Total Consultants for Core 24 Difference (Consultants Required for Core 24) Current Nurses Recommended Total Nurses for Core 24 Difference (Nurses Required for Core 24) Service Grading Royal London 1.502.49 0.99 9.0016.17 7.17 SubCore Queen’s Hospital 1.423.76 2.34 16.2224.41 8.19 SubCore Homerton Hospital 2.801.56 -1.24 11.0010.14 -0.86 Core 24 Newham University Hospital 3.001.58 -1.42 14.0010.24 -3.76 Enhanced Whipps Cross Hospital 2.002.94 0.94 15.5019.08 3.58 SubCore King George Hospital 0.681.80 1.12 7.7811.70 3.92 SubCore