Mental health - distress framework for collaboration: multi-agency partnership approach

Annex C

Mental Health Engagement Workshops

Police Scotland, the Scottish Police Authority and Scottish Government hosted NHS area workshops to inform this Framework and the development of the principles outlined. The sessions, which took place in Highland on 15 March, Forth Valley on 20 March, and Lanarkshire on 16 April 2024, aimed to understand current models of practice in NHS Boards and to identify good practice and learning which could be shared nationally.

The three areas were chosen specifically to draw on existing good practice and identify practical challenges and solutions which could be applied across the country. The following examples demonstrate our learning from these workshops in relation to effective partnership working, and the positive outcomes achieved as a result:

NHS Highland

• Clear definition of terminologies and concepts ensures clarity of response and responsibilities.
• Consistent approach to triage to determine the urgency for treatment and the nature of treatment required. This activity has reduced the number of patients taken to hospital for mental health assessment.
• Mental Health Unscheduled Pathway used by emergency responders and GPs, which allows consistent access to the Mental Health Assessment Unit (MHAU) who will carry out a telephone assessment and arrange for an onsite assessment if required. In more rural areas within NHS Highland where accessing the MHAU may be more difficult, Police Scotland are able to access nurses in the localities.
• Police Scotland, SAS and NHS 24 all directly accessing Distress Brief Intervention for anyone in distress but not in need of a clinical response.
• Multi-agency daily huddle allows for a proactive and person-centred discussion similar to an inter-agency referral discussion (IRD for all vulnerable person database referrals received. This is supported by a monthly review meeting.
• Mental Health Response Car deployed by Scottish Ambulance Service in Inverness area, staffed by paramedics with advanced mental health training. The paramedics have access to the unscheduled care staff at the MHAU for advice and support and if appropriate will attend in person with them.
• Joint Risk Assessment used in responding to incidents which increases confidence of all agencies in the collective decision made and action taken.
• While NHS Highland don’t have digital patient records, a system has been put in place to facilitate information sharing across agencies involved in a person’s care. Care plans are shared for high-risk people and weekly tele-conferences are held to make and record joint decisions on each agency’s system.
• Peer to Peer module aims to empower the community to offer support to those in need by providing ‘low-level first aid training’ to locals.
• Crisis Centre/community hub model is recognised as the best multiagency and person-centred model for responding to distress and/or crisis. A hub model at the centre of the community, staffed by those relevant community services (third and statutory) that are proven to break the cycle of emergency/unscheduled crisis gives a solution not currently available

NHS Lanarkshire

• Telephone based triage provision available 24/7 following a period of piloting and developing tests of change.
• Calls are filtered through the wider Flow Navigation Centre to support consistent coordination across the NHS system and referred to Psychiatric Liaison Nurses (PLNS) at all acute sites as appropriate.
• Out of hours calls are directed to the Out of Hours Hub staffed by PLNS who offer a response to requests within one hour.
• Police officers are able to call for advice while on scene with an individual in distress/ crisis, which removes the need to transport the majority of individuals to a hospital setting. Although face to face assessment can be offered if deemed necessary by all involved.
• All PLNS staff on the call have access to case records to allow fully informed advice and decision making as well as notification to other practitioners involved with the individuals.
• Clinical feedback used to update Police Scotland toolkit to support risk positive decision making based on clinical advice.
• Direct referral can be made for DBI or into out of hours social work, social prescribing, and other supports. Though some people in distress want only a clinical intervention despite clinical advice on alternatives.
• Missed Opportunity Reviews carried out jointly to identify examples where a risk averse decision was taken, this informs practice and training going forward.
• NHS Lanarkshire gather a range of metrics on the triage service and how it is used, providing useful insights for sharing practice in other areas.
• Both NHS Lanarkshire and Police Scotland have identified a single point of contact for any concerns raised by staff in either organisation. This has been instrumental in identifying further opportunities for improving/enhancing the service.
• Review model developed for high resource users of the service to ensure a response which suits individual needs.
• Multi-agency discussion model allows for a proactive and person-centred discussion like IRD for all vulnerable person database referrals.
• Recognise that Police Scotland guidelines need to be updated in relation to individuals affected by substances, as currently police officers are required to seek an ambulance or hospital response rather than leaving the person in the care of a friend of family member.
• While a community hub may be beneficial for those who need a form of support but don’t need clinical intervention, there needs to be a discussion on consistent threshold, resourcing, and sustainability of these

NHS Forth Valley

• Risk aversion continues to be a challenge across services with NHS and Police colleagues tending to take risk avoiding decisions which result in unnecessary interventions to mitigate for a ‘what if’ worry.
• Joint Risk Assessment (JAR), used in responding to incidents and making decisions on risk and responsibility, increase confidence of all agencies in the collective decision made and action taken.
• Triage line in place to a telephone assessment and advice. However intoxication and effect of substances means that many individuals are referred to ED anyway.
• Many calls through triage are referred for DBI as no face-to-face assessment is required. Looking to put in place a ‘no wrong door’ approach to referrals.
• Multi-agency meeting model to allow for a professional discission and shared, informed, judgement on appropriate responses on a case-by-case basis.
• Working to develop a protocol for responding to / reporting high risk missing persons as all agencies recognise the time demand caused by this particular client/user group.
• NHSFV and Police Scotland are working to create pathways for assessment, and alternatives to ED/place of safety such as involving family members / friends to support individuals in distress/ crisis.