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

7. Promoting Multi Agency Partnership Working

In developing this Framework, we worked with partners and stakeholders to explore existing good practice and areas of challenge. In all these engagements we heard the value of multi-agency working and regular multi agency meetings to plan care and responses.

Everyone we have worked with has stressed the importance of an everyday partnership approach which promotes cohesive collaborative working. We have set out the key components and principles that support an effective and collaborative multi-agency approach to distress below.

Local Multi-Agency Forums

Health Boards’ mental health unscheduled care (MHUC) service leads will work with local partners on formalising a forum through which the local distress pathways are developed and implemented. The multi-agency forum will also oversee the embedding of the remaining key components laid out in this chapter that underpin effective multi-agency collaborative working.

Health Boards should work with local partners and give consideration to existing groups or structures, such as local Community Planning Partnerships, prior to establishing a new forum. This will mitigate adding capacity constraints on services and support the alignment of this Framework with local needs, improvement plans and resource. Where an existing forum is being used, its membership should be reviewed to support a whole-system approach.

Where a suitable group does not exist, Health Boards will be responsible for establishing the multi-agency forum.

Membership

To support a whole-system approach, it is crucial that emergency, community, and specialist services are involved in the multi-agency forum to ensure a continuum of support around the individual. Therefore, it is essential the forum’s membership consists of the local mental health unscheduled care or out of hours service, local suicide prevention leads, Emergency Department leads, GP Out of Hours, Police Scotland, Scottish Ambulance Services, and community-based and third sector services (e.g. local Distress Brief Intervention (DBI) providers and crisis centres).

Because the local distress pathways should recognise and respond to the factors that can contribute to poor mental health and wellbeing, such as poverty, unemployment, and substance use, it is crucial that membership is wide enough, as required, to encompass all services and agencies who can provide services to support and address the underlying factors contributing to a person’s distress. This may include, but is not limited to, social work, drug and alcohol partnerships, and housing and homelessness services.

A confirmed representative to act as each service or agency’s contact point should be agreed for each member of the multi-agency forum to ensure continuity at the meetings and, more importantly, to provide fellow members with a single point of contact for any queries between meetings. It is vital that professionals designated to represent their organisation are appropriately skilled and empowered to make decisions. This doesn’t necessarily mean a single person; it could be a team that can be contacted via a single contact point.

Frequency

Multi-agency meetings are most effective when they are regular and routine, ensuring timely information sharing, progressing of actions, and review of the local pathway’s effectiveness.

Regular attendance and engagement are critical for establishing a sense of partnership as a multi-agency team.

Agreed processes

A key component to ensuring individuals in crisis receive the correct support, is having the appropriate processes in place. We have identified that the following promote a collaborative way of working and ensure a more seamless transfer of care to the correct service:

• Agreement of roles, responsibilities, and local processes. Whether this is in the context of a psychiatric emergency where a multi-agency response may be required to respond to or manage a detention, or in the context of less critical distress and crisis presentations, having a clear understanding of each service or agency’s respective roles and responsibilities will support effective multi-agency working and improve care outcomes for the individual.
• Professional-to-professional pathways for agencies to use, such as the Community Triage Pathway between Health Boards’ mental health unscheduled care service and emergency services to avoid automatic conveyances to the Emergency Department.
• Missed opportunity or conflict resolution reviews where partners come together to review instances where the local distress pathways did not work as well as they anticipated. For example, where a referral to a local crisis centre was not progressed, or police felt unable to accept the mental health clinician’s recommendation due to the perceived level of risk. These reviews provide partners with learning and inform the improvement of local pathways.
• Structuring teams in a way that enables effective communication within and between services and will in turn support building relationships and effective ways of collaborative working. An example is included in Annex C.

Behaviours

A key component to an effective multi-agency approach to distress is positive collaborative behaviours. Partners and stakeholders highlighted the following behaviours as critical to establishing and maintaining strong relationships across agencies:

• Open and direct communication between services, allowing services to have direct contact with the appropriate service or team when necessary.
• Promotion of self-management and avoiding escalation in circumstances where it is not necessary or beneficial to the individual in crisis.
• Trust between services, which promotes a positive risk-taking approach and builds confidence in decision making.

Joint Training

A key theme that emerged through engagement was the importance and effectiveness of training, and the potential for joint training to better support understanding of roles and responsibilities and to promote multi agency collaboration.

No single service can provide the support required for individuals in crisis. Joint training allows services to gain a better awareness of the processes and/or role of other services, and an understanding of how other systems work. In so doing it provides an environment where services can train together and joined up working is not something that needs to be contrived but rather becomes second nature. In Annex C, we have provided good practice examples of joint training.

Information and Data Sharing

It is recommended that, wherever possible, local partners develop and implement data sharing agreements which also include provision for psychiatric emergencies. However, regardless of whether a Data Sharing Agreement is in place, data protection laws and the Caldicott Principles allow health organisations to share personal information in an urgent or emergency situation, including to help prevent the loss of life or serious physical, emotional, or mental harm. Sometimes it can be more harmful not to share data. More guidance will be developed on this through the Review of Psychiatric Emergency Plans.

The Scottish Information Sharing Toolkit is aimed at minimising personal and non-personal information risks across organisations. It applies to all public sector organisations, voluntary sector organisations, and those private organisations contracted to deliver relevant services to the public sector and who provide services related to health, wellbeing and safety; specifically those organisations that hold health and care information about individuals and who may consider it appropriate or necessary to share that information with others.

The Toolkit enables service-providing organisations directly concerned with the safeguarding, welfare and protection of the wider public to share personal information between them in a lawful and intelligent way. It complements (rather than replaces) important guidance on sharing personal data issued by the Information Commissioner’s Office and builds on previous initiatives that have aimed to standardise personal information sharing agreements.

Health Boards should work with partners to develop and implement data sharing agreements. Wherever possible this should be done through the established multi-agency forum.

Monitoring and Continuous Improvement

The monitoring of processes and working relationships, and commitment to continuous improvement, is essential in order to ensure services are working together in the most effective way possible and providing the best care to those in crisis. This could involve a regular general review of existing processes and outcomes, or ‘missed opportunity’ reviews to review outcomes when things have not gone to plan or to undertake joint reviews as a result of adverse events. Services should be open and flexible to change in order to create and maintain a system/service that provides the best possible care for individuals.