In response to national and local policy, patient experiences and feedback from stakeholders we developed an Acute Care Locality Service in January 2015. This is in order to improve access to acute and urgent mental health care. Our Acute Care Locality Service operates as an integrated acute service with crisis.
We have redesigned the way all acute and routine referrals are managed and have combined urgent mental health services into a coherent integrated clinical pathway, ensuring accessible and timely care for those in mental health distress. The following teams are included in the Acute Care Locality Service:
- A&E Liaison Services (Airedale & Bradford)
- The Intensive Home Treatment Services (Airedale & Bradford)
- First Response Service
- Section 136 – Health based place of safety
- Acute Care Wards; Fern, Heather, Oakburn, Maplebeck, Ashbrook
- Psychiatric Intensive Care Unit ‘Clover Ward’ based at Lynfield Mount Hospital
First Response Service (FRS)
The First Response Service (FRS) is an integrated crisis service managed and operated by the trust in partnership with City of Bradford Metropolitan District Council (CBMDC). FRS supports transformation to the current evidence based model for mental health crisis services, supporting the wider parity of esteem agenda.
This new service comes in response to feedback from people using mental health services, carers and the trust’s partners. Previously, out-of-hours support only operated during certain times and was only available to people already accessing services. Both Bradford and Airedale hospitals reported high numbers of people arriving at Accident & Emergency experiencing a crisis. West Yorkshire Police were finding people detained in custody for long lengths of time, and GPs had multiple referral routes and contact numbers into our mental health services.
We started to develop the First Response Service in February 2014 and introduced our new Acute Care Locality in January 2015. Throughout this time there has been significant national mental health guidance published including the Crisis Care Concordant. Our Acute Care Locality Service is at the heart of and central to, preventing crisis, supporting people through a crisis with specialist support, rapid assessment and interventions and ensuring a recovery and staying well focus.
This service has progressed from a week day 9–5 service to a 7 day week, to a full 24 hour service. Self-referral is encouraged.
There is one telephone number in place for self refers, service users, carers, professional referrers and agencies, with dedicated call handlers and triage staff. Tele coaches triage urgent requests and provide crisis coaching or referring on to First Responders as required.
There is an extensive collective expertise within the FRS with a range of skills and knowledge that can be drawn on. The team have received an advanced induction and training programme involving therapeutic skills, service knowledge, customer service skills and signposting training.
For those at immediate risk, tele coaches are successfully dispatching a First Responder to undertake a face-to-face crisis assessment wherever the person is situated. First Responders are providing street triage alongside Police Officers admitting to Intensive Home Treatment and on occasion to an acute ward, as well as supporting through third sector services.
This rapid and efficient response by FRS, followed by good quality interventions and support is reducing the demand on the Acute Care Pathway.
The First Response team has also had the opportunity to be involved in the development of a crisis triage tool.
In the Australian state of Victoria they have been using a state-wide triage tool since 2010. This tool supports staff to determine the need for service and the type and urgency of response required. Dr Natisha Sands, Associate Professor at Deakin University, Victoria, Australia and Dr Stephen Elsom, Director, Centre for Psychiatric Nursing at University of Melbourne, developed the scale in collaboration with the Australian Department of Health and local mental health services.
Dr Sands is already in partnership with services in Swansea, Wales to adapt the triage tool for use in their services and has offered for our services to act as a further pilot site. Dr Sands reports staff report feel much safer and more competent when armed with an evidence based tool to help support them in their practice – to guide decision-making and provide clear practice parameters.
Dr Sands and her colleague Dr Elsom visited the FRS for three days in March 2015. They provided training for the First Response staff on using the triage scale and the tele triage competency and assessment computer training programme. Dr Sands proposes that after 12 months of implementing the scale, we would be involved in research to validate the use of the scale including.
There are real positive developments in Bradford enabling us to fulfil our vision to be a national centre of excellence for Mental Health.
Evaluation and feedback
Mental Health Strategies is conducting an independent evaluation, focusing on the first six months of the Acute Care Locality Service. A report will be published in July 2015.
The response to our newly designed services has been positive. We have seen an increase in the number of calls made FRS that have required triage through telephone consultation, resulting in a number of interventions, from rapid response within an hour, to requiring medication, advice, and signposting.
Our local A&E departments have reported a reduction in waiting times and West Yorkshire Police have reported a reduction in S 136 and timely handovers of care. Officers have received immediate, round-the-clock access to health professionals, allowing for informed decisions to be made about how best to support individuals, without custody being required.
Our acute wards have seen a reduction of admissions and we have not required any out of area treatments for over two months.