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

Annex D

Good Practice Examples

1. NHS Ayrshire and Arran Joint Training Good Practice Example

Since creation of the original Police pathway in 2017 attempts had been made to engage in a process of training and improved awareness between partnership services with limited success. In 2019, a further scoping exercise was undertaken within the Scottish ambulance Service (SAS) to widen access and service remit. This led to a small team being created with the dedicated purpose of managing Police and SAS generated unscheduled mental health activity. The dedicated resource allowed for the development of more regular and stable relations with partners within both Police and SAS.

Within Ayrshire and Arran, police are separated across three primary stations, each with multiple shifts, making full engagement a significant difficulty. Similarly, SAS have primary bases within the three localities but multiple satellite stations, again with multiple shift groups.

The first stage of improving input was identifying key stakeholders within both organisations. For Police Scotland, this was the liaison Sergeant operating as part of the Partnerships and Community Wellbeing team. He was able to create links with the Operational Learning and Development Unit who worked to create a schedule of inputs, initially for the purpose of revisiting overview and service purpose but also offering wider ability to identify learning and development themes. The goal for these sessions is to create an avenue for the officers to gain awareness of the regular presenting problems, why these present that way, how best to approach these situations and importantly, why mental health services make, what can often be perceived as higher-risk management decisions.

So far, inputs have primarily targeted the “boots on the ground” officers however additional input has been provided to the Inspector’s forum to allow communication of future plans and developments to improve engagement and create hierarchy sponsorship. These include joint development of individualised and bespoke management plans for people identified as presenting frequently across services, as well as the anticipated improvements brought by the Mental Health Unscheduled Care Assessment HUB, such as providing an alternative location for section 297/298 assessment and streamlining of process for admission or clinical setting assessments.

The connection with the liaison sergeant has also provided an avenue for direct escalation of any issues, concerns or requests between the two services.

Within SAS, identification of key stakeholder has been slower, due to management structure changes, however, have now been stabilised with the introduction of the Clinical Effectiveness Lead for Mental Health. Although behind developments with police, it is anticipated a similar initial process of offering refresher on service remit and referral process would be followed by more presentation and management specific training.

Feedback from Partners on benefits of dedicated ESMPH

For me this process is win, win, win. The person in crisis wins as they are getting the support they need at the time they need it, by professionals and they are not being put under more stress by police escorting them to A&E, or arrested which has also happened in the past. We also have better understanding of what is happening for the person. The police win as we can be there providing initial support, handing the person over to professionals and standing down far quicker than in the past, which allows us to be there for our community. NHS win, as police are not clogging up the A&E department. It’s been really useful to get training and advice directly from specialists. We’re getting to know the team better now which makes it easier to ask questions and get an understanding of what they’re doing and why. Understanding their decision making and the way people are behaving helps us deal with things in a better way.

Police Scotland

Working for the Ambulance service we regularly attend Mental Health Calls within the community and the pathway has been a great help to ensure that these patients are receiving the right care at the right time. Prior to the introduction of this pathway many of our patients living with mental health and in crisis required to be transported to hospital emergency departments for support. Even just the ability to phone someone who specialises in mental health to ask their advice and guidance when treating a patient is

The Scottish Ambulance Service

It’s been great for us and the patients. A busy ED isn’t the place for someone in mental health crisis; it’s busy, clinical and everything moves at pace, meaning people just don’t get the help they need. Before the pathway, we’d have police in almost every day, waiting hours to be seen and getting in the way. Now they get people the help they need quickly, without all the extra steps.

Emergency Department Clinician

2. Composite Examples of Local Distress Pathways

The scenarios provided below are composites based on the good practice examples provided to us by partners. They are not designed to designate what services can and should be available in each locality; they simply illustrate a multi-agency approach to responding to distress following a collaborative approach to the development and implementation of local distress pathways.

Example 1

The Scottish Ambulance Service attend an incident at a private residence concerning an individual complaining of chest pain and shortness of breath. Following an examination and discussion with the individual and the family present at the time, they attribute the symptoms to distress resulting from recent challenging life experiences, such as financial troubles, a recent bereavement, and a stressful work environment. The paramedics provide the individual with a compassionate response and listen to their story while they identify an appropriate way forward. The paramedics are trained in level 1 DBI, however they are uncertain whether the person would benefit from a mental health assessment too.

The paramedics use the community triage pathway to get the mental health clinician’s advice. They provide the clinician with an overview of the individual’s situation before providing the individual with the opportunity to speak to the mental health clinician directly. Following a discussion, it is agreed that a referral to level 2 DBI would be the most appropriate way forward for the individual’s need. The paramedics explain to the individual what DBI is, including that they will receive a phone call from the service within 24 hours. They also instruct the individual to call NHS 24’s Mental Health Hub or their GP should their distress worsen before they receive the call.

The individual receives a call the following afternoon, and after going over the individual’s recent experiences the impact it has had on their wellbeing, the DBI provider suggests a plan to support the individual to manage their distress as well as address some of the underlying issues. The individual continues to receive support from their local DBI provider over a 14-day period, following which, the individual’s GP is notified of the outcome.

Example 2

Police are called to an incident of erratic behaviour at a community park. The individual presents as confused and is displaying signs of crisis. The individual does not recognise the impact their actions has had on others, including children at the park.

There is mixed corroboration on what happened at the park from witnesses. Police Scotland check the vulnerable persons database but see they are not listed. The police determine that the person’s behaviour is likely a result of their alcohol consumption rather than a specific mental health concern, so the police seek the individual’s consent to take bring them to a crisis service. Once consent is received, the police escort the individual to the service and provide them with a verbal handover.

The staff at the crisis service offer the individual a compassionate response and once the crisis has subsided, they work with the individual on developing a plan, including safely signposting to other community services that provide alcohol treatment. The crisis service staff offer support with making an appointment with the relevant service and, with the individual’s consent, offer to write to the GP with the outcome of the referral.