Urgent and Emergency care Mental Health Better Access Standards What are the key points? Dr Chris Schofield Clinical Lead Liaison and CRHT East Midlands Clinical Networks 31st January 2017

Key Statements 24/7 cover Liaison mental health is a separate specialty 1 hour response to emergency departments 4 hour standards of evidence based treatment package from patient arriving in ED Older adult team is specifically mentioned Wards have a 1 hour and 24 hour standard. Follow-ups should be part of the service.

1.5 Expectations of commissioners Improving provisions for liaison mental health is one of the 9 must dos 2017-19.

3.3 Service level Core 24 service levels are recommended for hospital’s circa 500 beds. All liaison mental health services within hospitals providing regional and supra-regional services should aim to implement the comprehensive service model.

1.4.1 full biopsychosocial assessment

2.3.3 Follow-ups Offer follow-up care within the service (or refer to another service if clinically appropriate). This has been shown to improve and reduce ED re-attendance rates.

1.4 4 hour Evidence based Treatment Package (EBTP) ALL from Patients view point. Some is deliverable by Liaison Some by the acute Trust Some by other parts of the Mental Health Trust Parity was key to the 4 hour EBTP

4 hour Evidence based Treatment Package (EBTP) Not only should liaison psychiatry respond to see a patient in ED within 1 hour of referral. Within 4 hours of the patient attending ED the following should be completed a full biopsychosocial assessment and an urgent and emergency mental health care plan and one of: Be en route to next location of geographically different Being accepted and scheduled for follow-up care by a responding service Been discharged because the crisis has resolved Started a mental health act assessment

There are numerous flow charts and diagrams depicting clocks starting and stopping The spirit of reading these is from a patients view that after 4 hours there should be something that I recognise as a decision AND actioned.

1.4.2 Wards In relation to wards within the acute trust that should be a 1 hour response to referrer deciding the urgency of the referral and a 24-hour response to see the patient.

Various Recommendations Liaison services are distinct specialty and should not be commissioned as hybrid models with crisis resolution and treatment teams. 3.1.2 Liaison service should be based on site at the acute trust. 3.1.3

Ambulances should take no more than one hour to respond to a transport request. 4.4.5 Data collection including processes in outcome measures should be done. 4.4.9 There should be integrated governance with the acute trust and the mental health trust (involving senior clinical staff should look at Pathways and improve quality and safety) 3.4.3 .

Where NHS trusts have more than one ED across the hospitals, a liaison mental health service should be commissioned specifically to meet the needs of each hospital, rather than considering the trust population as a whole. 5.1.1 Consideration should be done for establishing drug and alcohol use services 5.2.2

Questions