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Service Development Initiatives, Adult Mental Health & Learning Disabilities Division: Acute & low secure (crisis services) This briefing is produced.

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Presentation on theme: "Service Development Initiatives, Adult Mental Health & Learning Disabilities Division: Acute & low secure (crisis services) This briefing is produced."— Presentation transcript:

1 Service Development Initiatives, Adult Mental Health & Learning Disabilities Division: Acute & low secure (crisis services) This briefing is produced to support managers within adult mental health community to cascade updates on the Service Development Initiative to their staff. February 2015

2 Box Tree Farm 5 Main Street, Ratby

3

4 Population covered People aged 18 years or over who are registered with an LLR GP People aged 18 years or over who are not registered with a GP, but are resident within LLR People must be able and willing to engage with their recovery in order to be accepted into the service Whilst a history of drug and alcohol misuse would not be an automatic reason for exclusion, anyone whom presents to the CRT under the influence of either alcohol or illicit substance misuse would not be referred at that time as they would be unable to engage with the programme of support with the service not be able to meet their needs and ensure other service users safety. The service is not staffed or equipped to manage anyone whose behaviour or key risks are indicative of requiring any form of restraint or whose history indicates that the use of instrumental aggression may lead to escalating physical aggression. It will not be practical for the Crisis service to be used as a bail address because it is a service that is limited to 7days. Clients who are homeless should be directed to the existing support services within Leicestershire, Leicester City and Rutland as per current arrangements unless there is a clear clinical rationale to explore this option, and there is a clear arrangement and agreement with CHRT around discharge and housing.

5 Criteria Exclusion criteria Acceptance criteria
Service users who are currently detained under the Mental Health Act Service users who are actively suicidal, or presenting at significant risk of life-threatening harm to themselves Service users with a recent history of aggression or violence towards others Service users with significant impairment of cognitive function (e.g. dementia) Reasonable adjustments will be made under the Equality Act and Green light principles, for people with a learning disability, to ensure not only equity of access, but also equity of outcome. Acceptance criteria Service users aged 18 years or over who are suffering from significant mental health distress Referrals deemed appropriate by the Crisis Resolution Team

6 People must be able and willing to engage with their recovery in order to be accepted into the service Anyone whom presents to the CRT under the influence of either alcohol or illicit substances would not be referred at that time The service is not staffed or equipped to manage anyone who requires any form of restraint or whose history indicates that the use of instrumental aggression may lead to escalating physical aggression.

7 Proposed Referral Process
CRT contact Crisis House to establish bed availability and to discuss the presentation and initial 72 hour care plan. CRT will establish with Richmond Fellowship staff transport arrangements i.e. transport to be arranged by RF staff or being transported by relative/friend. CRT to ensure that the relevant paperwork and information is sent/given to the Crisis House prior to or at the time of admission. CRT to provide copy of referral details, assessment and formulation, risk assessment and 72 hour care plan to Crisis House staff.

8 CRT will make decision to admit
On completion of their assessment, the team will determine the suitability and benefits to the service user having a period of time within the Crisis House. The rationale and plan should be clear and agreed with two Richmond Fellowship staff before placement commences.

9 Residents: what to expect
6 en-suite bedrooms Residents will have keys to their own room Two communal areas (one with TV and one quiet) One communal kitchen Short stay (24 hours to 7 nights) The crisis house has places for up to six individuals and provides a home from home environment in which individuals are helped to stabilise their situation and to develop coping strategies to handle future crises. The team of support workers, who are all trained in crisis intervention, provide round the clock support tailored to individual needs through one to one sessions and group work. The team liaises closely with the local NHS crisis team to ensure there is appropriate clinical support as needed. It will accommodate men and women in a mixed environment

10 What to expect: 2 A CRT qualified worker will visit Box Tree Farm daily to review the progress of the service user (with the service user) and in conjunction with Richmond Fellowship support staff.

11 Service specific outcomes
Reduced levels of mental health distress for service users in crisis Increased coping strategies developed by service users and carers to support management of future crises Service users being empowered to take control of their own care Avoidance of acute hospital admissions Reduced reliance on emergency health care services as a consequence of mental distress Increased levels of service user and carer satisfaction with their experience of mental health crisis services LPT will receive quarterly monitoring reports from Richmond Fellowship which contains a wide-range of metrics, including service user experience.

12 Telephone support line

13 2pm – 1.30am 7 days per week . The telephone line will be staffed by a mix of support workers, who are all trained in crisis intervention, and volunteers and will offer practical and emotional support to callers experiencing crisis. Calls will be a maximum of 1 hour. If further support required, callers offered face to face support session at drop-in within the same/following day depending on time of call. Response times for calls made outside of these times a. The response time should all operators be busy (during hours of operation) and the caller leaves a voic (recording will give people the option to stay on the line or leave a message for a call back) is one hour for a call back. b. Outside ‘helpline hours of operation’ a dedicated address will be available, which will have a response time of one hour from time of receipt. Once the crisis house is open ( ) we will respond to answer phone messages from 8am, 7 days a week; until then we will respond to the voic messages when the help line is opened at 2pm but will respond to ‘out of hours’ s within one hour of them being left The phone number is an 0808 number. These numbers are provided by Helplines Partnerships, of which Richmond Fellowship is a member. Helplines Partnership is a technical system that allows the caller to be transferred to the Fellowship’s telephone system. The calls will be free to people holding contracts with 3, EE, O2, Orange, Tmobile, Vodaphone, Virgin mobile. Some other mobile networks also offer free calls to numbers with the xx prefix however these are not guaranteed and users are recommended to check with their provider.

14 Staffed by a mix of support workers, who are all trained in crisis intervention, and volunteers and will offer practical and emotional support to callers experiencing crisis Calls will be a maximum of 1 hour. If further support required, callers offered face to face support session at drop-in within the same/following day depending on time of call. Richmond Fellowship will respond to answer phone messages from 8am, 7 days a week

15 0808 numbers are free on these networks
Some other mobile networks also offer free calls to numbers with the xx prefix however these are not guaranteed and users are recommended to check with their provider. Some other mobile networks also offer free calls to numbers with the xx prefix however these are not guaranteed and users are recommended to check with their provider. Helplines Partnership operates the Special Freephone Tariff scheme with the agreement of Ofcom. Calls to these numbers are not free when made from outside the UK. This number is part of a call handling system which channels the caller to the Richmond House phone system and allocates callers to the next available member of staff or volunteer. Key performance indicators will be developed and monitored when the system is live. This will meaure the response rate of Richmond Fellowship.

16 address When the phone line is closed, there will be an address, which will be replied to within the hour. Richmond Fellowship has contact with other helplines and that indicates that whilst phonecalls remain the preferred method – increasingly people are using , texting and web chat.

17 Face-to-face support

18 Ratby appointment based service (referred from helpline) 8am – 8pm 7 days per week Leicester City Thursday & Friday: 10am – 5pm Apex House, Charles Street Saturday, Sunday & Monday: 10am – 10pm The Centre Project, Granby Street In addition to the telephone support service, Richmond Fellowship is also providing face-to-face support. The Ratby service will require appointments. The telephone helpline will refer people who need to see someone in person. The city service will be piloted for three months as drop-in sessions. It will be staffed by support workers. Individuals using this service are not patients. The city locations were chosen because there was some feedback that health settings weren’t appropriate as it feels like stigmatising. Richmond Fellowship will have a dedicated outreach support worker to ensure engagement with diverse communities. They will also create a dedicated website for the service which will offer information and interactive tools out of hours. For some people, we will use the Big White Wall’s interactive support tool to support them back at home.

19 Changes to Crisis Resolution Team (CRT)

20 The role of the CRT The Crisis Resolution Service has a crucial role in the interface between Tier 3 and Tier 4 services and therefore its core functions are: a. To prevent admissions to Tier 4 (resolve crisis and home treat where appropriate) b. To facilitate early discharge from Tier 4.

21 Referring to the crisis resolution team on 0300 300 1010 (option 3)
Referrers will be asked: Do you wish to make a referral to the crisis team? Do you feel your patient will require admission in the next 24 hours without involvement of the crisis team? GPs (mostly) will refer those people whom they are considering admitting within 24 hours to the crisis resolution team. Additional staff have been recruited to CMHTs (for both city and county) to accommodate the expected increase in referrals (those being diverted from the crisis resolution team). They will be asked these two questions. If both are answered yes then they will be asked the remaining referral questions to determine the needs of the patient. The CRT will accept all referrals where both of these questions are answered as yes. If either question is answered as ‘No’ then the referrer will be asked to fax the community mental health team. If the patient needs to be seen urgently, the faxes will be/should be marked as ‘Urgent - to be seen within 5 working days’ Routine cases will continue to be faxed to the CMHTs as usual.

22 If the answer is no… If either question is answered as ‘No’ then the referrer will be asked to fax the community mental health team. If the patient needs to be seen urgently, the faxes will be/should be marked as ‘Urgent - to be seen within 5 working days’ Routine cases will continue to be faxed to the CMHTs as usual.

23 Contacting a clinician
If you have a medical query between 9am and 5pm ring the community consultant in the first instance. If they are unavailable contact the on call consultant via switchboard. For non-medical queries about patients known to the team contact the relevant clinician. After 5pm ring the on call registrar. We are reviewing consultant caseloads to enable them to provide more telephone support to GPs. The CRT referral line is staffed by an administrator. If a referrer wants to speak to a clinician about a patient this explains what they should do.

24 Locality CMHT Fax Numbers
City (Referral Management Service) East Leicestershire: Melton – Rutland Market Harborough West Leicestershire North West Leicestershire Charnwood South Leicestershire 24

25 Community Mental Health Team Contacts City
Team Name Consultants Team Manager Team Contact Details City West Dr Akhtar Dr Jhingan Dr Vann Tim Colman Braunstone Health & Social Care Centre 39 Hockley Farm Road Leicester LE3 1HN Tel: City Central  Dr Tanner Dr Khokhar Maidstone Centre c/o St Peters Health & Social Care Centre Sparkenhoe Street LE2 0TA Tel: City East   Dr Muhammad Dr Rao Dr Sharma Elaine Johnson Merlyn Vaz Health & Social Care Centre 1 Spinney Hill Road LE5 3GH Tel:

26 Community Mental Health Team Contacts East Leicestershire
Team Name Consultants Team Manager Team Contact Details East Leicestershire Dr Vilanova Dr Arora Fran Bailey The Welland Centre 1 Fernie Road Market Harborough Leics LE16 7PH Tel: East Leicestershire (Melton)  Parkside Station Approach Burton Street Melton Mowbray Leics LE13 1SJ Tel: South Leicestershire Dr Pingili Dr Kestelman Dr Smith The Cedars Centre Cedar Avenue Wigston Leicester LE18 1PE Tel:

27 Community Mental Health Team Contacts West Leicestershire
Team Name Consultants Team Manager Team Contact Details West Leicestershire   Dr Arif Dr Swamy Elaine Johnson Orchard Resource Centre Hill Street Hinckley Leics LE10 1DS Tel: North West  Dr Ratan Dr Kunigiri Janine Hammersley Hawthorne Centre Broom Leys Road Coalville Leics LE67 4DE Tel: Charnwood   Dr Kinnair Dr Vaze Dr Minajagi Town Hall Chambers Town Hall Passage Market Place Loughborough Leics LE11 3EB Tel:

28 Liaison & Perinatal Services
Consultants Manager Contact details Dr Lazarus Dr Solomons Marie McGranaghan Farm Lodge, c/o Bradgate Mental Health Unit Glenfield Hospital Groby Road Leicester LE3 9EJ Tel:

29 CRT targets Depending on the answers the referrer gives to the questions asked at the point of referral, the crisis resolution team will see the patient within 4 or 24 hours.


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