Joining Up The Dots In Mental Health Care

Last month Home Secretary, Theresa May, announced up to £15 million pounds of new funding to provide health based alternatives to police custody for those individuals held under section 136 of the Mental Health Act.

Joining Up The Dots In Mental Health Care

I welcome this new funding which will help address the lack of health based settings for those in mental health crisis, which will in turn alleviate the pressure on the Police. However the pressure will be ensuring that agencies across the country are joined up in their work and are able to deliver more health based places of safety within a reasonable timescale.

The detention in police cells of those experiencing mental health crises has always been controversial and police forces across the country are successfully working to reduce the number of people with mental health problems ending up in custody. Over half of England (and some areas in Wales) are currently providing a mental health street triage service, which sees mental health nurses provide advice to police officers during incidents where it’s believed the people need immediate mental health support. So, not surprisingly, wherever you go in the police/health arena at the moment, people are talking about street triage. It is clearly changing perceptions for those people who work with the mentally ill, be it police officer, police staff or health clinician and that is a real positive. 

Triage is this year’s buzz word amongst professionals across the policing/health landscape because we appear to be seeing huge changes in positive outcomes for people in mental health crisis, although we still await the formal evaluations. However, there is no doubt about it, shared learning leads to better outcomes. 

Models of street triage vary across the country and between urban and rural areas, however, they all have a golden thread in that they bring health professionals and police together, either virtually or in person and give police access to health data such as Care Plans and GP notes, when dealing with a person in crisis. This allows police officers to make more informed decisions and gives agencies a clearer picture on future changes to a Care Plan, which hopefully improves the overall care that service users require at that particular time, and in the future. Crucially, it also appears to be significantly reducing the amount of people detained by police under Sections 135 and 136, who are then taken to Police Custody Suites.

Whilst we still await formal evaluation of both the Government funded pilots, and the “other” evolving pilots, everyone seems to agree that the model works to some degree. Our model in Dorset has attracted superb feedback from agencies. Crucially, the schemes have aided huge learning and multi-agency working across the piece.

Various people involved at a strategic level, including Ministers, can see the benefits of “joining up” the street triage with other schemes which are either in operation, or being piloted currently. For example, arguably the street triage could blend with the Custody Healthcare provision, which is currently transferring over to NHS England by April 2016. Equally triage could be absorbed into the Liaison and Diversion scheme for offenders with mental health issues, which is currently being piloted across various sites at the moment, including here in Dorset.

Imagine one wrap around service that intervenes when a person with mental health issues reaches crisis point or commits a crime. A scheme that could also embrace victims of crime who are vulnerable as repeat victims through their mental health illness.

But that’s the future, watch this space!

So what can we do right now, as a “quick win”? What can we do now to spread the success of multi-agency working, the knowledge sharing and the improved service to people who are mentally ill?

Well, we could expand street triage, in its current form, to include 999 bluelight agencies.

We know that mentally ill people like everyone else, either cause fires or suffer from accidental fires and often, police are not called to those incidents.  Why can’t we extend the street triage concept to the Fire Service? 

Equally, we know the ambulance service is regularly called to injuries, potential injuries or attempted suicides, involving the mentally ill. We also know that some ambulance trusts do not have immediate access to Care Plans.

Why can’t we extend the street triage concept to the Ambulance Service? Well the simple answer is we can. And we can do this relatively easily.

This idea came from Simon Thorneycroft, the Mental Health Champion employed by myself and the Chief Constable to “join up” the dots for policing and mental health provision in Dorset. And as Police and Crime Commissioner, it is my job to facilitate such an excellent idea and get partners talking.

So here in Dorset, Fire, Police and Ambulance will shortly sit down to discuss this exciting approach, an approach that will hopefully improve outcomes for the mentally ill, and along the way, improve multi agency working.

I am looking forward to working with partners to explore launching the first 999 Street Triage in the UK.

Martyn Underhill
Dorset Police and Crime Commissioner 

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