This report is for information and provides the Health and Wellbeing Board with an update on the commitments made in the Crisis Care Concordat across Kent and Medway to undertake a Deep Dive analysis of Section 136. It provides an overview of the Deep Dive report that has been completed and recommendations from the findings.
The Mental Health Programme Director introduced the report which provided details of the findings and recommendations of the Deep Dive analysis of Section 136 (S136). Quantitative data was collected in addition to qualitative data obtained by surveying professionals, and individuals detained under S136 of the Mental Health Act.
Members then raised several comments and questions, which included:
· Professional views – in response to a concern about comments made by professionals who had responded to the Deep Dive questionnaire, the Mental Health Programme Manager explained that the personal views expressed had changed since the Deep Dive was undertaken. The views stemmed from a lack of a shared understanding between organisations about what constituted a crisis. This was reflected in the recommendations. Going forward it was important to develop a shared understanding so that all organisations involved worked from the same definition and understood how each other experienced a S136.
In response to several questions and a concern about the length of time it had taken to implement protocols and develop a shared understanding, the Mental Health Programme Director explained that although the institutions and organisations involved had been in place for a considerable time, presenting need and understanding of best practice had changed. So had the workforce. The challenge was to keep up with these changes and develop shared views and solutions. Attention was drawn to the S136 Pathway Standards document set out at Appendix C to the report which was in place but as highlighted by the Deep Dive, was not always consistently applied. As a result, it was clarified that the findings from the Deep Dive would help to reinforce better practice.
· Response rate – in response to a question about how many professionals had been asked to answer the Deep Dive questionnaire, the Mental Health Programme Manager explained that the number of Police personnel engaged with the survey was not known. However, the number of participants within smaller professional cohorts was known. The importance of knowing this figure to determine the weight to attribute to the findings was recognised by the Mental Health Programme Director. Nonetheless, she considered that feedback was important.
· Health-Based Place of Safety (HBPoS) – comments and concerns were expressed about the need for a HBPoS in Medway, particularly as Medway was one of the three highest areas in the County for S136 detentions.
In response, the Mental Health Programme Director confirmed that the three HBPoSs were in Kent (Canterbury, Maidstone, and Dartford) and these needed to be located adjacent to Acute Inpatient Mental Health Care services. However, she explained that several developments were taking place in Medway to address the rise in S136, including opening a Safe Haven. It was later added that the CCG’s investment in Mental Health services exceeded the Mental Health Investment Standard and she referred to Appendix D to the report which set details of current mental health provision in Medway.
· Mental Health Services in Medway – concerns were also expressed in relation to the loss of Mental Health Services in Medway and the involvement of KMPT in this regard. Concern was also expressed in relation to the absence of KMPT at the meeting. It was noted that owing to technical difficulties, a representative of KMPT had not been able to attend.
· Recommendation 18, private addresses as alternative places of safety – it was clarified that this could be the individuals own home.
· Children and young people – in response to a question about self-harm, the Mental Health Programme Manager advised that in the event a child or young person presented at A&E, they would be admitted to a ward overnight until a full assessment was carried out. If they needed mental health hospital care, this would be provided by NELFT at a facility located in South West Kent. The preference was, however, to have an alternative to hospitalisation. With the support of the Crisis team, children and young people would, wherever possible, be supported to stay at home, come through the crisis and receive treatment within community mental health services.
During the Deep Dive period, a small number of children and young people were detained under S136 and all had safety and crisis plans in place. In response to a question, it was confirmed that a protocol was in place and children and young people were considered within the S136 pathway. The Mental health Programme Director recognised that there was no dedicated S136 suite for children and young people, they were accommodated in the three HBPoS. However, a dedicated suite would soon be provided adjacent to the existing acute inpatient mental health beds for children and young people in South West Kent.
· Medway Safeguarding Children Partnership - an invite was extended for the S136 Deep Dive to be presented to the Medway Safeguarding Children Partnership.
· 18-25 year olds - with reference to the 18-25 year old cohort, a comment was made that the number of detentions during the Deep Dive period was high given the small interval between the banding. In response to a query in relation to the proportion of individuals in this banding who were care experienced, the Mental Health Programme Manager explained that data collection in the past had been ad hoc. Going forward, agreement would be made about what and how data would be collected.
· Young women – in response to a question, the Mental Health Programme Director explained that national evidence showed more care needed to be taken regarding the mental health of young women aged 25 and under owing to the clinical complexity in which those women present.
· Support available for frontline staff – asked what support was available to help a first responder, the Mental Health Programme Director explained that advice for Police personnel could be obtained from the ‘836 line’. This was a 24/7 telephone service provided by KMPT, which if called would connect the attending officer to a Mental Health professional. Feedback about the accessibility and quality of the clinical advice provided by this service was positive. Discussions were ongoing in relation to broadening the support available to all first responders utilising forthcoming transformation funding. One proposal being considered was to provide digital support though a mobile app.
· Missing support at home - in response to a question about missing support at home, it was explained that this would be considered when recommending treatment. Attention was drawn to Appendix D of the report which provided details of current mental health provision in Medway. It was explained by the Mental Health Programme Manager that several options were available including support provided by the Crisis Resolution Home Treatment teams or Community Mental Health teams.
· Support for the voluntary sector – in response to a question about support for the voluntary sector, the Head of Mental Health Commissioning gave assurances that the organisations funded by the Kent and Medway CCG would continue to receive funding and support. Attention was drawn to an upcoming kaizen event to review and improve the crisis mental health pathway for Medway and Swale.
· Magistrates warrant for S136 – it was confirmed that a magistrate’s warrant was not required.
· Identification of partners – the Mental Health Programme Director apologised for the inadvertent oversight and clarified that that the Medway Council logo should have been included within the S136 Pathway Standards document.
· Racial equality – the Mental Health Programme Director assured the Board that the NHS was strengthening its approach to advancing equalities, especially around mental health.
· Section 135 – in response to a question about S135, the Mental Health Programme Manager confirmed that there were fewer S135 cases.
· Recommendations – a comment was made that that many recommendations had been made and that a lot of work had been done. This was a positive step forward. A view was also expressed that it was important to develop a system wide organisation memory. It was believed that the recommendations provided an opportunity to tackle this.
· Support from the Health and Wellbeing Board – in response to a question on further action the Board could take to help improve services in Medway, the Mental Health Programme Director asked the Board to support the implementation of the recommendations of the S136 Deep Dive, note Medway specific services set out in Appendix D to the report and safeguard the needs of Medway Residents. Critical to this was working collectively to prevent ill health and promote good mental health.
The Health and Wellbeing Board:
a) noted progress and supported planned work across agencies to address the recommendations of the Deep Dive report.
b) requested a briefing note on the treatment and care for children and young people, including support available within the community.
c) requested attendance of a representative of KMPT at future Board meetings.