Safely Reducing Avoidable Conveyance Programme

Mental Health Joint Response Car

Brief Description of Initiative

Mental Health Nurse and Paramedic dispatched as First Response to patient identified as being in a Mental Health Crisis and requiring a face to face assessment. The cars are operational 7/7 between the hours of 11.00-23.00 and the exclusion criteria is overdose and sectioned patients.

Date Initiative was introduced in Trust

November 2018. Five additional cars have been launched to cover each STP as part of Winter Resilience Funding.

Date of upload or review

Uploaded to Repository 1st January 2020.

Background Context

We know that people with Mental Ill Health are more likely to use more emergency hospital care than those without mental ill health. 3.2 x for ED attendances and 4.9 x for emergency inpatient – most of these admissions were for physical health reasons. 46% of people with a mental health condition also have long term physical health condition and patients with a serious mental health condition have a 15-20 year shorter life expectancy than the general population.

Last year we received 156,471 calls which were coded as mental health and we sent a response to 100,871.  55% were conveyed to an Emergency Department.

Since 2015 we have employed mental health professionals in our Emergency Operations Centre.

The main function of their role was to carry out telephone based assessments (Hear and Treat) and provide crew advice to staff on-scene with patients who were experiencing mental distress.

As part of the trust strategy we launched the Mental Health Pioneer Service on 26th November 2019 which sees a mental health professional paired with a paramedic, responding to patients experiencing a mental health crisis, or those requiring a specialist mental health response. The Mental Health Professional provides enhanced biopsychosocial assessment and risk assessment.

The Paramedic brings their expertise in prehospital care and physical health assessment and examination. The team completed a week’s training prior to the launch of the car and it included sessions on positive risk taking, personality disorder, the Mental Capacity and Mental Health Act, ALS scenarios, radio technique and kit familiarisation.

Combining the skill-sets of a Pre-hospital clinician and a Mental Health Professional maximises the chances of being able to safely manage the patient in the community. Brief psychological interventions can be delivered with the aim of easing emotional distress and we are able to ensure our patients access the right care, in the right place first time.

The cars are operational between the hours of 11-23 seven days a week and run from Waterloo, Wimbledon, Greenwich, Chase Farm, Ilford and Wembley ambulance stations.  The cars are dispatched by the relevant sector desk in the Emergency Operations Centre.

By joining up both mental and physical health care in a multidisciplinary setting we have been able to reduce conveyances to the Emergency Department. The original Mental Health Joint Response Car (MHJRC) which was launched in November 2018 has a conveyance rate of 18% compared to Business as Usual’s conveyance rate of 52%. The recently launched additional cars are producing similar results but are yet to be formally evaluated.

Which specific patient group or presenting need is this response targeted at?

Mental Health.

Geographical area or location covered by this response model

Urban area covering Pan-London.

Key Aims
  • Improve patient experience – Ensuring the patient accesses the right care, in the right place, first time.
  • Reducing Emergency Department Conveyance.
  • Joining up care.
Benefits for Patients
  • Assessment of both physical and mental health care needs.
  • Avoid unnecessary and often stressful trips to the Emergency Department.
Benefits for Trust or System
  • Reduction in Emergency Department Conveyance
  • Rotational model strengthens partnership with Mental Health Providers
  • Data sharing enhances ability to track patient journey.
Implementation

1.      How long has this initiative been operational?

  • November 2018 with additional cars launched in Jan 2019.

2.      Days / Hours of operation:

  • 7 days a week
  • 11-23hrs

3.      Which clinicians are involved in the response and how many WTEs (if a specific cohort)?

  • 18 WTE Band 6 Paramedics
  • 21 WTE Band 7 Mental health Professionals (also provide coverage in Emergency Operations Centre.

Team is overseen by a Consultant Nurse for Mental Health and Mental Health Paramedic Lead .

4.      Which other partners are involved in providing the response?

  • 15 of the Mental Health Professionals are provided as part of a rotational model from Mental Health Trusts.
  • Healthy London Partnerships and NHS London.

5.      What other key resources are needed for this response to work? (vehicles, specific equipment etc)

  • Skoda Fast Response Vehicle – kitted as per FRU specifications.

6.      How is the initiative funded? (level of engagement/support from CCGs etc)

  • Internally and Winter Resilence Funding

7.      What were the main facilitators / blockers / interdependencies when introducing this response?

  • New model of working for trust and staff which sees teams engaging in positive risk taking. This required leadership and role modelling – conducted PDSA cycles.
  • Involvement of key stakeholders from inception.
  • Whole system approach.
Evaluation & Monitoring

1.      What are the key success measures?

  • Reduction in Emergency Department Conveyance
  • Re-contact Rate
  • Productivity of team
  • Patient Experience – Compliments, Complaints and monitoring of SI’s

2.      How are these being measured / collated / monitored?  (frequency / who reported to etc)

  • Daily and weekly reporting of activity of cars and comparison with Business as usual responding to same coded MPDS codes in same geographical area. Shared with all key stakeholders.
  • Formal evaluation completed by data scientist.
  • Picker are undertaking patient experience surveys.

3.      Has a formal evaluation process been undertaken (independent / inhouse)?

4.      What are the current findings in terms of the success measures?

Sustainability

1.      Does the trust intend to continue with this response for the foreseeable future?

  • Yes – 3 if the Mental Health Trusts have secured 1 year funding from April 2020 to provide Mental Health Professionals to cover significant demand in their area.

2.      What long-term resourcing requirements are there?

  • Staffing

3.      What risks have been identified (for patients / Trust / system) in providing this service and how have these been mitigated?

4.      Is there potential to expand this response model?

  • Yes.
Sharing & Learning

1.      What has the Trust learnt most from introducing this process?

  • Benefits of Multidisciplinary working for patients in a Mental Health Crisis using the ambulance service.
  • Upskilling of staff.

2.      What might be done differently with the benefit of hindsight if implementing again? (in another part of the Trust for example)

  • Resources.
Additional Information

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