1. London Ambulance Service NHS Trust 1

2. An evening with us… Mind Matters London Ambulance Service NHS Trust

3. Mental Health Action Plan Kuda Dimbi Mental Health Lead

4. Achievements so far… Improved support for clinical staff Clinical advisor in post Clinical Hub - access to pathways and mental health trust clinicians Working with Hear Us & MIND charities Access to mental health first aid training Complaints and incidents fed back as learning London Ambulance Service NHS Trust 4

5. Improved clinical intervention Education and training plan in place Clinical team leader sessions Core skills refresher 1 & 2 Mental health clinical performance indicator introduced Mental health appropriate care pathways established Risk awareness tool introduced London Ambulance Service NHS Trust 5

6. Communication with GPs Safeguarding / welfare referrals for frequent callers with mental health issues and non-conveyed Joint working agreements with partners (MPs and mental health trusts) Improved care of patients with dementia Joined pan-London Dementia Action Alliance Dementia in core skills training London Ambulance Service NHS Trust 6 Clinical governance and safeguarding

7. Mental health promotion / culture Local links established with mental health trusts Delivered through education Community involvement officers linking in with mental health groups Clinical staff have access to advice professionally and for wellbeing London Ambulance Service NHS Trust 7

8. Safeguarding policy for intoxicated minors now in place Initiatives in place at time of anticipated high alcohol consumption-SARC On-going work with Alcohol Concern and Clinical Audit and Research Unit London Ambulance Service NHS Trust 8 Improve management of alcohol-related harm

9. Section conveyance protocol launched in 2012 Patient transport service conveyance policy for mental health patients including forensic patients now in place Section 136 action plan setting out roles and responsibilities for organisations On-going engagement with Trust in cases of refusal / disagreements on a case by case basis London Ambulance Service NHS Trust 9 Conveyance - mental health evaluation audit and general improvements

10. Support for our staff Staff support manager and psychotherapist provide therapy Staff counselling referral line 90 trained LINC workers Trauma risk management Employee assistance programme - advice on issues including debt, housing, stress, relationships, conflict Occupational health department London Ambulance Service NHS Trust 10

11. Clinical Audit & Research influencing practice Gurkamal Virdi Assistant Head of Clinical Audit & Research Clinical & Quality Directorate

12. Background Established clinical audit and research programme for many years Led to changes in clinical practice Influenced local, national and international practice London Ambulance Service NHS Trust 12

13. Mental health clinical performance indicator (CPI) CPIs are a clinical audit tool used to assess the quality of care given to patients Mental health CPI was introduced in 2012 Focuses on patients with a diagnosed condition London Ambulance Service NHS Trust 13

14. Mental health CPI Examines elements of care that are expected to be delivered to patients by ambulance clinicians Based on best practice guidelines – UK Ambulance Services Clinical Practice Guidelines London Ambulance Service NHS Trust 14

15. Mental health CPI ObservationsObservations Blood sugar recordedBlood sugar recorded History of current eventHistory of current event Psychiatric historyPsychiatric history Medical historyMedical history Current psychiatric careCurrent psychiatric care London Ambulance Service NHS Trust 15 Description / assessment of patientDescription / assessment of patient AppearanceAppearance BehaviourBehaviour Ability to communicateAbility to communicate Expressed thoughtsExpressed thoughts Capacity toolCapacity tool Safeguarding referralsSafeguarding referrals OthersOthers PatientPatient

16. Mental Health CPI Observations Observations  Blood sugar recorded Blood sugar recorded  History of current eventHistory of current event Psychiatric historyPsychiatric history Medical historyMedical history Current psychiatric care Current psychiatric care  London Ambulance Service NHS Trust 16 Description / assessment of patient: Description / assessment of patient:  Appearance Appearance  BehaviourBehaviour Ability to communicate Ability to communicate  Expressed thoughts Expressed thoughts  Capacity toolCapacity tool Safeguarding referrals: Safeguarding referrals:  OthersOthers Patient Patient 

17. Overdose clinical audit Response to patients who have taken an overdose intentionally of a potentially harmful substance High priority calls were given a response within eight minutes On average lower category calls received a response within target London Ambulance Service NHS Trust 17

18. Overdose clinical audit Time spent on scene was within 30 minutes on average Patients arrived at hospital just over an hour after the 999 call London Ambulance Service NHS Trust 18

19. Activated charcoal feasibility study Currently designing a potential feasibility study to look at use of activated charcoal in the pre- hospital setting Recommended for use but the research evidence varies and not in UK Ambulance Services Clinical Practice Guidelines Limited pre-hospital use of activated charcoal internationally London Ambulance Service NHS Trust 19

20. Activated charcoal feasibility study Feasibility study will allow: Assessment of use and impact of activated charcoal in the pre- hospital setting (including frequency of uptake, delays) Evaluation of patient tolerance to activated charcoal Investigate clinicians’ experiences Use volunteer clinicians from across London Patient consent will be gained London Ambulance Service NHS Trust 20

21. Responding to patients with mental health needs Sue Watkins Ambulance Operations Manager 27 February 2014

22. Types of responses 999 calls – prioritisation through Medical Prioritisation Dispatch System Triage – questions based on presenting symptoms Determinant reached based on answers given Department of Health prioritisation level assigned Service agreed response levels for each determinant Calls from healthcare professionals, eg hospital requests, GPs, approved mental health professionals London Ambulance Service NHS Trust 22

23. Requests from healthcare professionals Pre-booked arrangements Non urgent referral system > 3 hours Often lengthy delays getting to patients due to the prioritisation level and incoming 999 calls Poor patient experience Trial of dedicated resources (Camden patient transport service) Trial of time slotted booking system by geographical area London Ambulance Service NHS Trust 23

24. Improvements / collaborative working Acute mental health trust leads Police leads and operations Service medical directorate Service leads and operational managers London commissioners Tactical operations group (with police) NHS111 and the directory of services London Ambulance Service NHS Trust 24

25. The process for healthcare professionals now Removal of the booking system (except for pre-arranged police operations) Healthcare professional makes call to the Service following assessment of the patient Real time clinical information provided by the caller which ensures the correct level of the response – 8, 30 or 60 minutes London Ambulance Service NHS Trust 25

26. Mental health awareness Engaging staff and service users Vicki Hirst, Community Involvement Officer

27. Let’s talk about mental health Reach Out Challenge – run by Croydon-based charity ‘Hear Us’ 15 minute conversation breaks down barriers Aims to reduce stigma and discrimination surrounding mental illness Involves frontline organisations London Ambulance Service NHS Trust 27

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29. London Ambulance Service NHS Trust 29

30. London Ambulance Service NHS Trust 30

31. Benefits to staff and volunteers Improves relationship between staff and patients Opportunity to ask questions they wouldn’t normally feel able to in a clinical setting See the volunteers when they are not in crisis Staff can talk about own mental well being Volunteers feel more confident when calling 999 London Ambulance Service NHS Trust 31

32. Staff feedback I learnt more about mental illness in two hours than five years in the service Unique – like nothing I have attended before Real people talking honestly – very enlightening Great to be able to learn from people with personal experience of mental illness, rather than reading up on the subject in a book London Ambulance Service NHS Trust 32

33. Other partnership work Drop-in sessions for call takers – Bow and Waterloo (Jules Lockett) Presentation of patient experiences to our Trust Board Presentations at local service user forum Croydon Radio London Ambulance Service NHS Trust 33

34. London Ambulance Service NHS Trust 34