CHARM

Wigan has its own mental health joint response car, which helps to ease pressure on other emergency services by going to people in a crisis. It was launched in 2020 by Greater Manchester Police and Greater Manchester Mental Health NHS Foundation Trust and has proved to be so successful that it is now being rolled out across Bolton, Salford, Trafford and Manchester.

Senior nurse practitioner Natalie Marland is one of the mental health staff working in the car with police officers, including PC Tom Stanford, a response officer at Wigan police station.

PC Stanford said: “The majority of the time we have a positive response. When people realise we have a mental health nurse with us, it tends to calm the situation down completely.

“What we find is people are more happy to speak to a mental health nurse than a police officer.”

When an incident is reported to the police, the call handler will consider whether it involves someone who needs mental health support.

It could be someone threatening to harm themselves, a missing person or an elderly person with dementia, for example.

Miss Marland said: “It can literally be anybody that can present in crisis. We are there to help them in that period of time and see what we can do to alleviate some stressors or concerns they are enduring at that time.”

The mental health response car is deployed to wherever it needs to go in the borough. Miss Marland can check mental health records en route to find out if the person they are going to see is already known to services and what help they are receiving. It means she has a head-start in helping the person in crisis.

Once the police officer has checked everything is safe, Miss Marland can speak to the person struggling with their mental health. Even if a crime has been committed, their mental health is addressed first.

Miss Marland can carry out an assessment and consider the right support or treatment for them.

She has worked across mental health services in her career so has a wealth of experience when speaking to people. 

She even carries a packet of cigarettes – despite being a non-smoker – in case it helps someone to feel at ease.

After the assessment, Miss Marland can look at taking them to a place of safety, helping them to access further support from community services or taking them to hospital.

She can refer people to a whole host of NHS services, but also for support with drug and alcohol problems, bereavement, PTSD, debt, housing and social care.

But sometimes it is as simple as asking a GP to review a patient’s medication.

Miss Marland said: “Any contact that we have with anybody, I would send a detailed assessment to their GP.

“It might be they are not on any medication but are asking for an anti-depressant, so I could put that in my report. 

“They will get that the next day and it will be sorted in a few days. But with the current system, it could take weeks and weeks.”

Without the mental health clinician’s attendance, police officers would be limited in the help they could offer to someone in a mental health crisis.

They may even have to detain them under section 136 of the Mental Health Act and spend several hours waiting at A&E until they are seen.

But the mental health joint response car means people can be seen quickly and get the help they need in the least restrictive way.

PC Stanford said: “It’s a better option for the person. Natalie will assess them straight away and get the assessment typed up so it’s in the system.

“But if they are taken to the hospital by police, they get more annoyed in a waiting room and then seeing doctors. It’s a very long process.”

Working alongside mental health clinicians has allowed police officers to improve their own skills when speaking to someone in a crisis, if the mental health joint response car is not available.

PC Stanford said: “From an officer’s point of view, it’s good to see how Natalie works and the type of questions she asks and to see how she does those assessments. 

“When a mental health nurse isn’t there, you can adapt your approach to people.”

The partnership eases pressure on the police and hospital, with further work being done to help frequent callers.

It also reduces demand on the ambulance service, as sometimes the mental health joint response car can attend an incident instead.

Miss Marland said: “They might be a category five call, which is about eight hours, but we can be there in an hour. We do cancel a lot of ambulances by going to see people.”

The mental health joint response car is having a big impact in Wigan, with 902 referrals made to the team between April 2022 and January this year.

This resulted in 570 A&E avoidances and 411 section 136 assessment avoidances.

A “street triage form” was filled out for 819 of these referrals, which resulted in: 30 hospital admissions; 233 already open to mental health services were handed over to their current service; 76 referrals to the mental health assessment team; 32 referrals to the home-based treatment team; 47 referrals to primary care; 177 GP referrals; and two receiving a triage car action plan.

It is hoped its success can be replicated as it is now being rolled out.

Source: Wigan Today, 4th March 2023

Inspectors found ‘disproportionate levels of restraint’, ‘care plans not being followed’, ‘people spending most of their time along in their rooms’. The Breightmet Centre for Autism in Bolton has been deemed ‘inadequate’ for a second consecutive time by health watchdog the Care Quality Commission (CQC). A damming report has now been released.

A troubled mental health hospital has been slammed by inspectors, whose ‘worrying’ visit uncovered ‘disproportionate levels of restraint’; ‘care plans not being followed’; and ‘people spending most of their time alone in their rooms’.

The Breightmet Centre for Autism in Bolton has been deemed ‘inadequate’ for a second consecutive time by health watchdog the Care Quality Commission (CQC). A damming report has now been released.

“Vulnerable people were relying on all staff members to act as their advocates, to help them live their best lives and it is unacceptable the people they relied on were treating them this way,” they wrote. 

“We also saw staff laughing at the people they were supposed to be looking after.”

The hospital was previously rated ‘inadequate’ and placed in special measures following an inspection in March 2022. The latest review in December saw officials ‘witnessing incidents that gave them real concerns about people’s dignity and their experience of using this service’.

The Breightmet Centre for Autism is an independent hospital run by ASC Healthcare Limited. It provides support to adults with a learning disabilities and people with autism. At the time of the inspection, there were 12 people using the service.

Inspectors found ‘disproportionate levels of restraint’; ‘care plans not being followed’; and ‘people spending most of their time alone in their rooms’. Inspectors said they were left ‘worried’ by the inspection. 

The latest inspection was carried out to follow up on the warning notices issued at the 2021 inspection and assess whether improvements had been made. CQC did not find enough improvement had been made. 

The facility remains ‘inadequate’ overall and ‘inadequate’ in the ‘safe’, ‘effective’, ‘caring’ and ‘well-led’ categories. 

CQC is now taking further enforcement action, and if there is not rapid, widespread improvement, will start the process of preventing the provider from operating the service.

Debbie Ivanova, CQC’s director for people with a learning disability and autistic people, said: “Much like the findings from our previous inspection, we still didn’t see enough significant improvement to reassure us that leaders at Breightmet had turned things around. More worryingly, we witnessed incidents that gave us real concerns about people’s dignity and their experience of using this service. 

“We witnessed staff using a disproportionate level of restraint, and care plans weren’t followed in ways such as helping people who needed it to eat and drink.

“We also saw staff laughing at the people they were supposed to be looking after, and that people spent most of their time alone in their rooms. People also told us staff could be loud at night time and disrupt their sleep, and their preferences such as to be supported by carers of a specific gender wasn’t always being respected. 

“Vulnerable people were relying on all staff members to act as their advocates, to help them live their best lives and it is unacceptable the people they relied on were treating them this way.”

Inspectors also found that people’s risks were not assessed regularly and managed safely and people were not involved in managing their own risks whenever possible.

People’s care, treatment and support plans did not reflect their sensory, cognitive and functioning needs. “Staff did not follow the requirements of the Mental Capacity Act 2005 in relation to assessing capacity and making decisions in people’s best interests,” added the inspector. 

“People did not receive care, support and treatment that met their needs and aspirations. Care did not focus on people’s quality of life and did not follow best practice. Staff did not use clinical and quality audits to evaluate the quality of care.

“Staff did not support people through recognised models of care and treatment for people with a learning disability or autistic people. Governance processes did not help the service to keep people safe, protect their human rights and provide good care, support and treatment.”

The service had, however, improved from ‘inadequate’ to ‘requires improvement’ for being’ responsive to people’s needs’. “We did see some small improvements since the previous inspection in how the service was handling complaints and working well with services that provide aftercare to ensure people received the right care and support when they went home,” the CQC director continued. 

“We have told the provider that it must make urgent improvements and we won’t hesitate to take further action and use our legal powers to keep people safe, which could include closing the service. It is not acceptable to keep people waiting for improvements much longer in a service which is not meeting their needs.”

‘Improvements have been made’

A spokesperson for The Breightment Centre for Autism said: “We are passionate about delivering high quality care to our service users and their safety and wellbeing is our number one priority. The Breightmet Centre for Autism is a small community hospital for adults with Autism and/or Learning Disability and has an ethos of least restrictive practice and enabling community care for our patients with positive outcomes.

“The new management team at The Breightmet Centre for Autism are working constructively with the CQC and other external stakeholders such as NHSE and our focus is on making ongoing sustained improvements for our service users and families.

“The CQC have acknowledged that improvements had been made at the time of inspection in December 2022 and we are further confident that further sustained improvements continue to be made as we continue to work collaboratively with all external stakeholders.”

Full story here

Source: Manchester Evening News, 3rd March 2023

The police are dealing with increasing demands to intervene with people suffering mental health crises, freedom of information requests have revealed. Some forces across England and Wales have experienced a tripling in mental health requests between 2019 and 2021, data shows.

The findings come as Sir Stephen House, a former deputy Met commissioner, leads a productivity review of policing ordered by the home secretary, Suella Braverman, which is initially focused on mental health pressures on police forces.

Several forces are implementing schemes to reduce the number of interventions they make in cases that could be referred to health services instead.

Under the Mental Health Act, the police are called out to help deal with a situation because someone having a mental health emergency may pose a risk to themselves or others.

Officers usually take the person to hospital for treatment.

Senior officers say the increase highlights the erosion of services for people with conditions such as depression and schizophrenia who end up in crisis.

Labour obtained the data by asking forces to provide the number of 999 calls received that were logged as a mental health-related incident between 2019 and 2021.

Twenty-six forces provided figures showing the number of logged mental health incidents. Forces that provided figures included Gwent, Lancashire, Leicestershire, Merseyside, the Met and North Wales.

Twenty-three of the 26 forces recorded an increase over the two years. In 2019, there were 247,336 cases across the forces that responded, which jumped to 281,598 two years later – a 13.9% increase.

The shadow policing minister, Sarah Jones, said: “It is a damning indictment of this government that they’ve abandoned the police to spend hours dealing with people who should be getting mental health support.”

Some forces have introduced radical interventions to free up officers from dealing with people suffering mental health problems.

The chief constable of Humberside police, Lee Freeman, drew up the “Right Care Right Person” scheme to cut the amount of mental health work for officers.

He has given the health services a year’s notice that police would no longer routinely spend hours sitting with patients in a mental health crisis, or ferry people to hospital.

Several other forces, including the Metropolitan police, are studying it, with its commissioner, Sir Mark Rowley, wanting to reduce the time lost by officers dealing with work that other services should be doing.

Other forces that have introduced a version of the scheme include North Yorkshire and Lincolnshire.

In 2018 Her Majesty’s Inspectorate of Constabulary and Fire & Rescue Services voiced “grave concerns” that officers were being called out to deal with mental health-related incidents. It blamed “a broken mental health system” and said the problem constituted a national crisis.

Ten forces provided data to Labour that showed significant jumps in mental health interventions by the police between 2010 and 2021.

Derbyshire police said the number of mental health calls had risen by 1,784% over 11 years, North Yorkshire said theirs had risen by 485%, and Merseyside police’s figures had risen by 463%.

A National Police Chiefs’ Council spokesperson said non-crime incidents such as significant mental health crises and vulnerabilities had a significant impact on available resources.

“Policing is often seen as the service of last resort, but chiefs must make decisions balancing ever-growing demands. The demands on policing are significant and it is vital that we deliver our own priorities to protect the public and catch criminals first,” the spokesperson said.

A government spokesperson said: “We are investing at least £2.3bn of additional funding a year by April 2024 to expand and transform mental health services in England so that 2 million more people will be able to get the mental health support they need.

“The government is committed to helping the police do their primary job – fighting crime and keeping people safe.”

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Source: The Guardian, 21st February 2023

Lauren Bridges was “left alone, far from home with no treatment”, her mother said. Lauren who was autistic, died while she was detained at Priory psychiatric hospital in Stockport, 250 miles (400 km) from her home. She was “massively failed by the mental health system”, an inquest jury has heard.

Lauren Bridges, 20, from Bournemouth, died after an incident at Priory Hospital Cheadle Royal in Stockport, Greater Manchester, in February 2022.

Her mother Lindsey Bridges said her environment “did more harm than good”.

She said Lauren was “left alone, far from home with no treatment”.

The 20-year-old begged to be let out of hospital two days before she died
Ms Bridges died at Wythenshawe Hospital, two days after she was found unresponsive in a Priory Hospital bathroom on 24 February.

Giving evidence at the hearing in Stockport, her mother said Lauren rang her earlier that evening “begging me to get her out”.

She said her daughter was “hysterical” when she was given an hour to pack before being transferred to the hospital in July 2021.

She said she had “significant concerns” about Lauren’s treatment, which showed a “lack of compassion and care”.

Her “brave, beautiful” daughter was afraid of the other patients and “nothing was being progressed quickly enough”, Lindsey Bridges said.

The inquest heard Lauren was a “straight-A student” despite suffering from mental health problems from the age of 15.

She had panic attacks and obsessive compulsive disorder (OCD) and struggled to leave the house, her mother said.

Lauren was first admitted to a psychiatric unit at the age of 17 and was transferred to a number of different hospitals a significant distance from her home, Lindsey Bridges told the hearing.

At the Priory hospital she was diagnosed as being autistic, the coroner heard.

Full story here

Source: BBC News, 21st February 2023

Almost 2,000 people waited more than three months for a second mental health treatment in Manchester last year, figures show. As of November, around 4,315 people were waiting for a first treatment in Manchester.

The findings come as a leading staff body for the profession says it is “unacceptable” so many are suffering delays for vital treatment across England.

The NHS’ talking therapy service treats patients for common mental health problems like stress, anxiety and depression.

In the year to November 2022, around 9,240 patients received a second treatment in the former NHS Manchester CCG area – but 1,975 (21.4%) had to wait more than 90 days from their first one.

This was a rise from 9.1% in the year to November 2019.

The Royal College of Psychiatrists, a staff body, said delaying treatment could “put patients’ wellbeing at risk”.

Dr Adrian James, the organisation’s president, said: “Some patients’ mental health may deteriorate if left untreated, which can have a detrimental impact on their quality of life and have potentially life-altering consequences.

“There is also a danger that long waiting lists will undermine people’s faith in mental health services and discourage them from seeking the support they need.”

He added staff are “working as hard as they can” but are struggling with limited resources and problems with retention and recruitment.

Across England patients are facing lengthy waits for mental health treatment.

The figures show 154,000 people (22.5%) were waiting more than three months between their first and second treatment in the year to November 2022, up from 120,000 (19.2%) over the same period in 2018-19.

Mark Rowland, chief executive of the Mental Health Foundation charity, said these statistics should come as “no surprise” given the “huge pressures” mental health services are facing.

He urged the Government to prioritise preventative approaches – focused on tackling mental health problems before professional help is needed.

Standards set by the National Institute for Health and Care Excellence state 75% of patients should get a first treatment within six weeks.

The figures show services in the former NHS Manchester CCG area were meeting that target in the year to November – with 83% of 24,670 patients receiving treatment within six weeks.

As of November, around 4,315 people were waiting for a first treatment in Manchester – up from 4,245 in November 2019.

An NHS England spokesperson said: “The NHS is committed to increasing support for patients through its world-leading talking therapy services, and in November there were 60,000 more appointments completed compared to the previous month.

“The NHS is also increasing the number of trainee places for more people to join the workforce, so if you are struggling with your mental health, you can either refer yourself to your local NHS talking therapies service online or contact your GP,” they added.

The Department of Health and Social Care said it was already taking a preventative approach to tackling mental health issues and expanding access to the talking therapies service.

Source: Manchester World, 17th February 2023

However the A&E received praised for having competent staff, an effective leadership team, and treated patients with respect and kindness. The rating for safe in the emergency department has moved down from good to requires improvement amid concerns that people attending with mental ill health often experienced long delays in being assessed.

The Royal Bolton Hospital’s emergency department has been praised by a watchdog but warned that it needs to be safer according as inspectors downgrade the A&E’s safety rating.

The Care Quality Commission (CQC) has published a report this morning (February 17) following an inspection of the emergency department and medical services at The Royal Bolton Hospital in November. The rating for safe in the emergency department has moved down from good to requires improvement amid concerns that people attending with mental ill health often experienced long delays in being assessed.

However, the emergency services remain rated good overall. The overall rating for Bolton NHS Foundation Trust remains as good.

READ MORE: Scandal-hit mental health services branded unsafe and ordered to change amid patient abuse allegations

Karen Knapton, CQC deputy director of operations in the north, said: “When we inspected the emergency department and medical services at The Royal Bolton Hospital, we saw a good level of care across most areas, but some improvements were needed in the emergency department to ensure people are safe.

“We were impressed that emergency department staff not only knew how to identify and treat sepsis; they were also supported by an electronic reporting system to record symptoms. This is important when staff are busy when it’s easy to miss or misjudge symptoms. This supported patients with suspected sepsis to successfully receive treatment in line with national standards.

“However, people attending with mental ill health often experienced long delays in being assessed. The service had recognised this and updated its procedure to include hourly checks with people to ensure they were safely cared for and their nutrition and hydration needs were met.”

Accident and Emergency at Royal Bolton Hospital (Image: ABNM Photography)
“Medical services were run by an effective leadership team, with staff who were clear about their roles and responsibilities and treated people with respect and kindness.

“Doctors reported that nurses were competent and quick at recognising deteriorating patients and that consultants were responsive to any requests to review patients.

“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people can continue to receive a good standard of care.”

Royal Bolton Hospital’s emergency department (Image: Daily Mirror/Andy Stenning)
The inspectors found the following during this inspection that in the emergency department leaders ran services well using reliable information systems and supported staff to develop their skills; the service had enough staff to care for patients and keep them safe; staff felt respected, supported and valued and were focused on the needs of patients receiving care; and the service managed safety incidents well and learned lessons from them.

But staff did not always have training in key skills such as safeguarding children. Patients experiencing mental health illness could wait extended periods of time in the waiting room and not all areas where patients waited were ligature free, added the CQC.

Meanwhile, in medical services staff treated patients with compassion and kindness, respected their privacy and dignity and took account of their individual needs; managers monitored the effectiveness of the service and made sure staff were competent; staff assessed risks to patients and acted on them; the service engaged well with patients and the community to plan and manage services; and staff provided emotional support to patients, families and carers.

However, in some of the paper “do not resuscitate” records we saw there was not enough detail around the clinical decision with reasoning and clinical information. There was more appropriate detail in the electronic records.

Tyrone Roberts, Chief Nursing Officer at Bolton NHS Foundation Trust, said: “We welcome today’s report from the CQC, and we will use these findings to focus our attention on areas where we know we can improve and make an even greater difference to what our staff and patients experience.

Full story here

Source: Manchester Evening News, 17th February 2022