Oxleas Police Custody Liaison SchemeSuzanne Ahlers & Marie BarkerOxleas Forensic Community Psychiatric Nurse (FCPN)

Background• Oxleas NHS Foundation Trust provides mental

health services in the boroughs of Bexley, Bromley and Greenwich.

• Have been providing a Court Diversion service for approximately 20 years.

• Suzanne: Forensic Community Psychiatric Nurse (FCPN) for over 13 years with experience in the Court Diversion service.

• Marie: FCPN for a year and a half, 13 years of forensic psychiatric nursing experience.

• Secondment opportunity following the Bradley report to pilot a police custody liaison scheme in the stations.

Scoping exercise – process•1 person, full time: visited 3 Metropolitan

Police Service (MPS) custody suites for a total of 4 weeks.

•Gathered information about 349 detained people seen.

•Used tool as used in Court Diversion service to carry out an assessment.

Scoping exercise – findingsMental Illness

19%

Personality difficulties

6%

Learning Disability1%

Alcohol11%

Drugs17%Dual diagnosis

1%

Social8%

Others4%

No problem identified

33%

Scoping exercise – outcomes•Excellent opportunity to confirm and

understand the need.•Allowed the service and process to be

further developed.•Identified resources.•Amended assessment form, database.•Provided evidence to justify the jointly

funded pilot scheme for 6 months initially, now a further 6 months until March 2013.

The pilot scheme – process & barriers•2 FCPN’s servicing 3 police stations•Flexible approach has allowed the service

and process to evolve during the 6 month period to the process which is discussed later

Barriers•Access to clinical system outside of Trust

buildings•Acceptance from MPS staff•Suitable resources/cover

The pilot scheme – findings at 5 months•Approximately 600 detained persons are

triaged per month. An average of 13% of these required further assessment.

The pilot scheme – findingsMHA assessment

5% Hospital admission5%

Referred to Oxleas services

28%

Referred to court diversion (bailed or RIC)

13%

Prison In-reach Liaison/Referral

3%

Advice/signpost39%

Discharge no further intervention

7%

The pilot scheme – agreed process

The pilot scheme – outcomes•Flexible approach has allowed for the process to

develop naturally to take forward to the next jointly funded phase

•Developed stronger working relationships/barriers

•Developed more detailed assessment form and database to better capture activity and outcomes

•Recognition of the value by MPS – dedicated office being prepared, posters

•Positive outcomes for the detained person. Safer custody environment.

•Discuss examples…

Example – no MH contact prior to arrestBackground• Repeated visits to GP who increased dose of Fluoxetine. Felt he had nowhere to

turn.• Arrested for common assault.

Alert• I noticed custody nurse seeing detained person with a large dose of Fluoxetine.

My action• Carried out assessment and found he had very low mood, suicidal thoughts and

paranoia.• Informed custody sergeants of assessment and risk. • Arranged for Mental Health Act assessment.

Outcome• MHA assessment carried out in custody which led to a hospital admission under

Section 2.• Now linking in with a community mental health team and stabilised on the right

medication.

Barriers• Custody staff thought he may have been “trying to pull the wool over your eyes”.

Example• Background 16 year old male arrested for theft

• Triaged with the front sheet

• Well known to CAMHS

• Presenting as agitated and difficult in custody

• Recent self harm and suicide attempts by hanging, not disclosed by the male to custody staff.

• Notified custody of relevant risks, risk assessment changed put on continuous observation. Possible ligatures removed and referred back to CAMHS

The future•2x FCPN’s•Part-time administrator•Review 6 month outcomes for those

previously assessed. Mental health and criminal?

•Still to develop…▫Joined up service with Court Diversion team▫Support/cover for service

Feedback“I want to thank you for referring me to the …………….. Centre. I had an assessment and I am pleased to be getting some help at long last. I went to court and ended up with 1 year probation, 100 hours community service (unpaid work) and a £50 fine. So I am glad I did not get sent to prison. I am also glad that you were at the police station when I was arrested. Thank you so much for your help. I hope I will get better with this help – I think I needed it for a long time. It is so good that you visit police stations in your job – it helped me. Thank you.”