Service Development Initiatives,Adult Mental Health & Learning Disabilities Division:Acute & low secure (crisis services)

February 2015

Box Tree Farm5 Main Street, Ratby

Population coveredPeople 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

CriteriaAcceptance criteriaService users aged 18 years or over who are suffering from significant mental health distressReferrals deemed appropriate by the Crisis Resolution Team

Exclusion criteriaService users who are currently detained under the Mental Health ActService users who are actively suicidal, or presenting at significant risk of life-threatening harm to themselvesService 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.

People must be able and willing to engage with their recovery in order to be accepted into the serviceAnyone 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.

Proposed Referral ProcessCRT 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.

CRT will make decision to admitOn 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.

6 en-suite bedrooms Residents will have keys to their own roomTwo communal areas (one with TV and one quiet) One communal kitchen Short stay (24 hours to 7 nights)Residents: what to expect

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.

Service specific outcomesReduced levels of mental health distress for service users in crisisIncreased coping strategies developed by service users and carers to support management of future crisesService users being empowered to take control of their own careAvoidance of acute hospital admissionsReduced reliance on emergency health care services as a consequence of mental distressIncreased levels of service user and carer satisfaction with their experience of mental health crisis services

Telephone support line

2pm 1.30am7 days per week

0808 800 3302

.

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 crisisCalls 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

0808 numbers are free on these networksSome other mobile networks also offer free calls to numbers with the 0808 80xx prefix however these are not guaranteed and users are recommended to check with their provider.

Email addressWhen the phone line is closed, there will be an email address, which will be replied to within the hour.

Leicestershire.Helpline@RichmondFellowship.org.uk

Face-to-face support

Ratby appointment based service (referred from helpline)8am 8pm 7 days per week

Leicester CityThursday & Friday: 10am 5pm Apex House, Charles StreetSaturday, Sunday & Monday: 10am 10pm The Centre Project, Granby Street

Changes to Crisis Resolution Team (CRT)

The role of the CRT

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?

If the answer is noIf 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 daysRoutine cases will continue to be faxed to the CMHTs as usual.

Contacting a clinicianIf 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.

Locality CMHT Fax Numbers

LocalityFax numberCity (Referral Management Service)0116 295 3280East Leicestershire:Melton Rutland Market Harborough 01664 50422501572 72446001858 445459West Leicestershire 01455 443944North West Leicestershire01530 453845Charnwood01509 553907South Leicestershire0116 225 5650

Community Mental Health Team Contacts City

Team NameConsultantsTeam ManagerTeam Contact DetailsCity West Dr AkhtarDr JhinganDr VannTim ColmanBraunstone Health & Social Care Centre39 Hockley Farm RoadLeicesterLE3 1HNTel: 0116 295 3322City CentralDr TannerDr KhokharTim ColmanMaidstone Centrec/o St Peters Health & Social Care CentreSparkenhoe StreetLeicesterLE2 0TATel: 0116 295 7070City East Dr MuhammadDr RaoDr SharmaElaine JohnsonMerlyn Vaz Health & Social Care Centre1 Spinney Hill RoadLeicesterLE5 3GHTel: 0116 294 3167

Community Mental Health Team Contacts East Leicestershire

Team NameConsultantsTeam ManagerTeam Contact DetailsEast LeicestershireDr VilanovaDr AroraFran BaileyThe Welland Centre1 Fernie RoadMarket HarboroughLeics LE16 7PHTel: 01858 445450East Leicestershire (Melton)Dr AroraDr VilanovaFran BaileyParksideStation ApproachBurton StreetMelton MowbrayLeics LE13 1SJTel: 01664 504202South LeicestershireDr PingiliDr KestelmanDr SmithFran BaileyThe Cedars CentreCedar AvenueWigstonLeicester LE18 1PETel: 0116 225 5700

Community Mental Health Team Contacts West Leicestershire

Team NameConsultantsTeam ManagerTeam Contact DetailsWest Leicestershire Dr ArifDr SwamyElaine JohnsonOrchard Resource CentreHill StreetHinckleyLeics LE10 1DSTel: 01455 443950North WestDr RatanDr KunigiriJanine HammersleyHawthorne CentreBroom Leys RoadCoalvilleLeics LE67 4DETel: 01530 453800Charnwood Dr KinnairDr VazeDr MinajagiJanine HammersleyTown Hall ChambersTown Hall PassageMarket PlaceLoughboroughLeics LE11 3EBTel: 01509 553900

Liaison & Perinatal Services

ConsultantsManagerContact detailsDr LazarusDr SolomonsMarie McGranaghanFarm Lodge, c/o Bradgate Mental Health UnitGlenfield HospitalGroby RoadLeicester LE3 9EJTel: 0116 22568779

CRT targets

This briefing is produced to support managers within adult mental health community to cascade updates on the Service Development Initiative to their staff. *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.

*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

*LPT will receive quarterly monitoring reports from Richmond Fellowship which contains a wide-range of metrics, including service user experience.*The 0808 800 3302 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 timesa.The response time should all operators be busy (during hours of operation) and the caller leaves a voicemail (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 email address will be available, which will have a response time of one hour from time of receipt.

Once the crisis house is open (23.2.2015) we will respond to answer phone messages from 8am, 7 days a week; until then we will respond to the voicemail messages when the help line is opened at 2pm but will respond to out of hours emails 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 Fellowships 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 0808 80xx 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 0808 80xx 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.

*Richmond Fellowship has contact with other helplines and that indicates that whilst phonecalls remain the preferred method increasingly people are using email, texting and web chat. *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 werent 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 somepeople, we will use the Big White Walls interactive support tool to support them back at home.*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.

*GPs (mostly) will refer those people whom they are considering admitting within 24 hours to 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.

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).

*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.*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. *