Publications Gateway Reference: 02781
Download the Liaison and Diversion Bulletin: November 2014.
Welcome to the monthly Liaison and Diversion (L&D) Bulletin, bringing all news and L&D updates together in one place. Key steps on the L&D pathway are the identification, assessment and referral of service users into treatment and support services provided by partner organisations. Each month we will be looking at how a particular L&D scheme is successfully developing effective collaboration to share those experiences and to highlight the importance of good partner relationships for the service user. This month we bring you a bumper edition of the Bulletin which includes not only a report on the Leicestershire L&D trial scheme and how it integrates it with elements which are not part of the NHS England operating model, but we also look at both the L&D National Conference and profiles of the newly announced Wave 2 L&D schemes.
In this issue:
L&D news report
Leicestershire L&D – An Integrated Approach
Leicestershire L&D – A tale of two risk cultures
Leicestershire L&D – Crisis Care
Leicestershire L&D – Street Triage
Leicestershire L&D – Accelerated Learning
Leicestershire L&D – A Barometer of Community Services
Leicestershire’s Integrated Approach – A Case Study
News in brief
National Conference
Welcome to the New Wave
L&D news report:
Leicester – An Integrated Approach
Three years ago, the Crisis Mental Health team at Leicestershire Partnership NHS Trust (LPT) took on the Leicester assessment service and a joint project (set up in the wake of the Bradley report) brought the trust together with probation and Leicestershire police to create a new court service. This process became a catalyst for looking at ways to reach upstream to catch people before their arrival in court. Looking to spot mental health issues and other vulnerabilities earlier, the three partner organisations were aware that the vast majority of people detained under s.136 Mental Health Act assessments were being released without a change in their treatment and were keen to help those people who frequently come into contact with the police, sometimes 3 or 4 times in just a few days, before their problems are addressed. Initial pathfinder funding helped the partners to start to turn this vision into reality.
Since April 2014, the Leicester L&D NHS England trial scheme has a strong relationship with different commissioned programmes within the criminal justice pathway. Leicestershire has a young person’s L&D service running in parallel with the adult service. This youth service has so far covered Leicestershire and Rutland, excluding Leicester itself – but next month it extends to the city making the whole of Leicestershire fully compliant with the all-age service in the NHS England operating model. But alongside this NHS England operating model, the Leicester scheme continues to run non-model services such as the crisis and triage work.
Peter Jackson, former Leicestershire Chief Inspector and now Project Manager of Leicestershire L&D, says this integration helps everyone pull in the same direction: “By combining the NHS England L&D operating model with non-model services such as the crisis work and the triage car, we have been able to mature the relationship between mental health practitioners and the police. The culture has already changed massively from the practical learning gained by both sides when working together to deal with cases.”
A Tale of Two Risk Cultures
L&D brings together two professions, each with a very different perspective on risk-taking: mental health practitioners take action based on their detailed knowledge and understanding of someone’s particular history while police officers are traditionally seen as more risk averse, with safety their paramount concern. L&D combines these two different approaches together in one team to allow police to be more robust in their decision making and risk taking, giving police officers 24 hour access to the mental health history of individuals.
PC Mark Everest, Mental Health Triage Car Officer, says L&D makes police more confident in their actions: “We are dealing with people in crisis at the point of contact with other emergency services. Knowing more about the history of the person – possibly someone police have already seen many times before, but in a purely police role – gives us more understanding about how they have become they way they are, a sense of seeing more of the real person.”
Inspector Geoff Hughes from Leicester’s Euston Street Custody Suite said: “I have seen the ideas merge between police officers and the mental health practitioners: police can often have a clear criminal justice or victim focused objective, but a mental health practitioner will often be looking at the same situation in a more patient focused way. Mark Everest and the other police officers in the triage car team do briefings about L&D to other officers, going from station to station giving insights, explaining and helping them to understand what L&D can offer.”
Leicestershire police have already seen a big reduction in the number of s.136 Mental Health Assessments carried out, with commensurate reductions in cost, length of time dealing with people and in police time for 2 officers who would otherwise be manning the place of safety unit.
Georgina Harris, mental health practitioner with the criminal justice services of the L&D team of Leicestershire Partnership Trust: “Going out with the police on street triage helps my work in the custody suite, giving me a better understanding of how the police think and helping us to communicate. Police and nurses are very, very different, and hopefully we meet in the middle. Police get a better insight into nursing and mental health and understand that issues are not necessarily clean cut and that mental health can be a spectrum of 1,000 shades of grey.”
Kim Geary, mental health practitioner with the L&D team: “The police are a very different profession – and spending time with them in the triage team means you observe and pick up things about them. I now understand the problems they face but I also realise that they do not know all the options available – the more I understand what they don’t know, the more we can work together on those options.”
Crisis Care
Leicester’s L&D provision is closely linked to its crisis mental health work – although L&D extends this perspective to look at other vulnerabilities as well. All 13 L&D nurses in the team are crisis nurses and they work about half of their shifts in the crisis mental health team. This integration allows true 24 hour L&D provision, because one of the crisis night team is always available to act as an L&D nurse in the custody suite.
Vicki Noble, Senior Mental Health Practitioner in both the Acute Assessment Team and Criminal Justice Service, says the crisis expertise provides a more seamless service: “This crisis background means that anyone in the team can deal with emotional and mental health crises as they happen: be it a psychotic episode, acute suicidal feelings or an acute grief reaction – we can apply those skills to anyone going through the criminal justice pathway and decide whether they are presenting mental health or other vulnerabilities.
“Crisis nurses can admit an individual with their consent to an acute mental health unit (the only community based team able to do so), so only one assessment is needed making the process easier and quicker for the service user – and it is much easier for the police to deal with just one team.”
After the L&D assessment, the L&D nurse in effect becomes the crisis nurse, providing a quicker, smoother pathway for the person in need of help. This can be particularly important when someone is experiencing a crisis that is both distressing for themselves and those around them.
Street triage
The Street Triage Car scheme in Leicester sees mental health practitioners going with police officers to incidents where someone might need immediate mental health support. The team can identify and provide care or support that can potentially reduce or stop offending or self harming. Leicestershire’s Triage Car has been up and running since January 2013 and has its own dedicated office within the police custody suite: L&D practitioner and Triage Car Officer sit alongside each other, cross referring the information from their respective databases.
With four dedicated police officers, this project (run jointly by the Leicestershire Partnership NHS Trust and Leicestershire police) operates until 2am every day. The Triage Officer on duty is also the lead police officer for L&D (enhancing their expertise on L&D). L&D nurses take it in turns to work on the Triage team in order to ensure its full integration into the standard L&D work. The Triage car is able to take L&D out to connect police officers who do not work in custody, such as tactical support groups and firearms response teams. Once police officers have done a job with L&D, they can immediately see the benefits.
Street Triage services have developed across the country following the roll out of nine DH funded pilots in 2013. The funding for the pilots will be coming to an end in March 2015 but will be able to continue through local funding arrangements. Although Street Triage services and Liaison & Diversion services should work to deliver integrated care, they are distinct services from one another with separate commissioning arrangements.
Accelerated learning
Working together in this way accelerates the learning between police and mental health workers by providing more direct exposure to the mental health crisis approach and allowing those decisions to be made jointly.
Matthew Wakely, Team Manager Criminal Justice and Liaison, said: “Non-model services such as the crisis work and the triage car are complimentary to the standard operating model. They are separate services, but where you have both of them, they both work better. L&D can work without street triage, but we think it would not work as well. The combination of model and non-model services enhances the working relationship because police officers are working closely together with L&D nurses who are themselves rotating within the L&D service. The more points we have for nurses and police to interact, the more we can increase the knowledge base on both sides and give everyone a better understanding.”
A barometer of community services
L&D can shed light on the number and variety of people with mental health problems and other vulnerabilities who come into police custody – and this can show how well Leicester’s services are solving the problems of those in need of support. For example, the high thresholds and waiting times for people with personality disorders means they can often come to the attention of the criminal justice system before their condition is serious enough to receive help. About 22% of people seen by the triage team are not known to mental health services, but they are in crisis and assessed by L&D as in need of immediate assistance.
Peter Jackson said: “L&D can highlight those people who are beneath the threshold but are on their way to reaching that threshold. L&D can interact with them at an earlier stage and provide help and support, but L&D also shows where there are gaps in the current levels of services. The data which L&D can provide will allow communities to make the best decisions to ensure the necessary help and support is provided to those in need.”
Leicestershire’s Integrated Approach – A Case Study
B was a 48 year old divorced man who lived in his own property. He was a self employed builder. One evening, Leicester Police were called by a member of the public when they saw B making threats to harm himself, shouting abuse and falling in the road. He was being uncooperative and abusive to the Police and members of the public. The Mental Health Triage Car was dispatched after finding out background information about the individual and attended the scene, but B was too intoxicated to be fully assessed. B was already known to mental health services and had previously exhibited self harming behaviours.
B was arrested for being drunk and disorderly in a public place and was brought to the police custody suite at Euston Street. The Triage team passed on all the information they had gathered about B to the L&D nurses working in custody and advised them that B was still too drunk for an assessment to be carried out. B was well known to the police and this wasn’t the first time he had been arrested for this sort of offence. Whilst in police custody B presented with suicidal thoughts, saying he wanted to end his life. B was offered an assessment by the L&D nurses as soon as he was sober enough to engage with them. This assessment looked at B’s current social & domestic circumstances and his past and current risks were discussed and identified. The assessment revealed that B had ongoing relationship issues with his ex-wife and rarely saw his children. He was maintaining himself in work despite his binge drinking in response to family arguments.
B was not on any prescribed medication. B’s mental and behavioural issues appeared related to his excessive alcohol consumption and when sober he denied any suicidal thoughts or intent. B acknowledged that his alcohol consumption was increasing to a very problematic level and this was leading to regular contact with the Police. He was being arrested at least once per week. B had been involved with the Alcohol Services several years before, but he had disengaged when his marriage ended. Following the assessment, B agreed to see the Arrest Referral Worker who was able to provide some immediate ‘Here & Now’ advice on safe reduction in alcohol consumption. The L&D nurses advised B on how to access Crisis Services in the event that he might need support but be unable to access his GP.
B also agreed to a referral to his local Alcohol Advisory Service. The L&D team received Nurses were sent an update letter within 6 weeks of the referral advising of B’s positive progress at the Alcohol Advisory Service.
B was given a fixed penalty notice with a firm warning of a potential charge and subsequent court appearance if arrested again. He has not been seen in Custody since that time.
A service user voice can help to improve the delivery and development of a service. If you would like to contribute case studies on the standard service specification please complete the online case study template.
News in brief
National Conference
The third National L&D Conference took place on Tuesday 2nd December at the Queen’s Hotel in Leeds. The event was a chance to hear about Wave 1 mobilisation and look at what has been learnt from that process and was also a key opportunity for the Wave 2 schemes to understand the steps needed for implementation to ensure the delivery of consistent, quality liaison and diversion services across England.
The Care Minister, Norman Lamb, sent a video message to the conference. The main speaker in the hall was Lord Bradley who said mental health had never been higher on the agenda but stressed the need for that political goodwill to be harnessed. He spoke about the benefits of the national operating model and the importance of ensuring the Wave 2 schemes learning from the first wave.
Lord Bradley highlighted the lessons still to be learned about commissioning bringing together services, especially at a local level and said that L&D could not work unless the services to divert people into also existed.
Kate Davies OBE, Head of Public Health & Armed Forces and their Families and Health & Justice at NHS England, gave an overview of some of the key developments in Health & Justice commissioning.
Kate said the key words for L&D could be said to be “benefit, integration and equality”. Highlighting the personal journeys of service users and the importance of L&D supporting the whole person, she emphasised that this needed to be combined with a better understanding of the benefits of L&D, the collaboration of services and a better evidence base.
Kate noted exciting trends that were bringing together L&D with other services including street triage and crisis care, but added the need to understand the varied needs of different vulnerable groups, whether they are children and young people, women, veterans – or even, she suggested with an eye to the future, victims.
Dave Burton, Liaison and Diversion Programme Director at NHS England, congratulated all 13 of the Wave 2 sites and expressed the hope that they would build on and benefit from the experiences of the roll-out of the first wave. He took delegates through some of the key L&D facts learnt over the last 12 months including:
Violence is the most common offence;
Service users are about 75% male and 25% female;
Among adults, at least 50% have comorbid conditions;
65% of adults are already known to mental health services;
45% of children are known to children’s services;
Nearly 50% of children have a mental health need;
Over 25% of children have a family conflict issue.
Dave also talked about some of the key challenges for the full roll-out of L&D:
Full business case approval by HM Treasury;
Developing a market for 100% coverage;
Co-commissioning dialogue with CCGs and others.
Dave Spurgeon from the Offender Health Collaborative hosted a discussion panel on ‘Implementing the Model’. Fiona Banes, Criminal Justice Liaison Services Area Manager for Avon and Wiltshire Mental Health Partnership Trust, welcomed the new Wave 2 providers to a very exciting area of work where no day was the same and reassured the new schemes that the L&D world was a very collegiate group where project workers have been both keen to share knowledge and eager to learn from each other.
Dr Vicky Hancock Service Manager/Clinical Lead, Coventry and Warwickshire Partnership Trust, stressed the hard but important work of building and maintaining relationships with partner organisations while Steve Brookes, Commissioning Support Manager for NHS England, echoed the importance of the national operating model and the need for more co-commissioning of services.
180 delegates attended the event – a third more than the previous annual conference in March – including representatives from government agencies (Home Office, Department of Health, NHS England, probation service, Youth Justice Board and youth offending teams), the police, local authorities and the voluntary and community sector. Among the workshops looking at how L&D responds to key vulnerabilities, the best received were those on Women and Prostitution presented by members of the London L&D trial scheme and one on Meeting the Needs of Veterans presented by the Liverpool L&D team.
Welcome to the New Wave – the Next Generation
The next 13 trial schemes to join the NHS England L&D service were announced on the day of the National Conference. These new providers will be launching the standard operating model in April 2015 and will join the existing ten areas to bring L&D coverage to 50% of the population in England. The NHS England model has already seen over 8,400 children, young people and adults come through its L&D service.
The 13 additional schemes have already been taking part in learning days with their Wave 1 colleagues and the National Conference was an opportunity for them to introduce themselves to a wider network of potential partners and colleagues.
Devon & Cornwall
The Peninsula Criminal Justice Liaison & Diversion Service (Courts & Custody) brings together two previously separate projects: Cornwall has been providing a court liaison service for 15 years while Devon has been running a custody-based L&D service since July 2013 (including Plymouth which lies outside the NHS partnership area). Devon Partnership Trust and Cornwall Foundation Trust will join to create the largest geographical NHS England L&D scheme in the country. It is a rural area covering huge distances – taking about 3 hours to travel from Penzance at one end and the Somerset border. Both projects are adult services that will be extending to youth. These popular holiday counties see a big disparity between wealthier areas and the pockets of deprivation that are under European measures.
Kent
There has been an L&D service in Kent since 1996 covering about 1.6 million people, but the Police Custody Liaison and Court Diversion Service took off in 2009 with new funding. The scheme covers the whole of Kent and Medway providing an all-age service to police custody suites Monday to Saturday, but will soon be going to 7 days a week, 12 hours a day. Magistrates Courts are also covered and there is also support in Crown Courts on request. The scheme operates under a single health trust, covers a single police force but includes the two local authorities of Medway and Kent.
Lancashire
The Lancashire Care Liaison and Diversion Scheme provides an adult service to police custody suites across the county and is looking forward to the challenges of extending that to an all-age service. The scheme already enjoys a strong working relationship with the police and other agencies which will support in delivering services.
London
The West, North West and Central London Police & Court Liaison and Diversion Service combines three providers: Together, which is already involved in the Wave 1 London scheme, will be working with West London Mental Health Trust and Central and North West London Mental Health Trust. The area already has an existing adult service which will be extended to youth (although there is some youth provision in a couple of London boroughs). The Wave 2 scheme means that in London, the whole of the north side of the Thames will be served by the NHS England model bringing the city’s population covered from the current 2.6million to over 5 million.
Norfolk and Suffolk
The Norfolk and Suffolk Liaison and Diversion Service will be extending their current scheme to provide 24/7 cover to 6 police custody suites, 6 magistrates courts and 2 crown courts. The scheme is looking to provide support for specific vulnerable groups including women and veterans.
Northamptonshire
The Northamptonshire Criminal Justice Team provides a countrywide service in police custody and courts and covers a population of about 700,000. The scheme was set up by Northamptonshire Healthcare NHS Foundation Trust after the Bradley report and currently employs 8 staff including two based in the Youth Offending Team and a specialist in dual diagnosis for service users with substance misuse issues.
Nottinghamshire
The Nottinghamshire Criminal Justice Liaison Service began their service with a pilot in Mansfield which concentrated on police custody and has expanded to cover all of Nottinghamshire including Nottingham itself. This is another scheme that is looking forward to the challenge of extending its provision to include children and young people.
Somerset
The Avon and Somerset Court/Custody Assessment & Advice Service will be an expansion of the current Wave 1 Avon & Wiltshire L&D trial scheme to include the whole of Somerset. The Wave 2 area is mainly rural and has been running a magistrates-based service since 2009. This Wave 2 site was historically developed along the same lines as the Avon & Wiltshire Wave 1 scheme and will fill in the rest of the Avon and Somerset constabulary, only part of which has been so far covered by the Wave 1 trial scheme. Somerset provides an adult service in custody and courts – including the crown court – and is already using Support Time Recovery Workers.
Southern Hampshire
The Hampshire Criminal Justice Liaison Diversion Service is based around two largely urban projects focused on Southampton and Portsmouth as well as South West Hampshire and covers 1.5 million people – it has one of the highest concentrations of armed forces veterans in the country. Implementing the NHS England operating model will extend the existing successful all age service in Portsmouth and develop the current provision in Southampton which is running with a single staff member.
South Yorkshire
The South Yorkshire Liaison & Diversion Service will cover the whole of the South Yorkshire police area to include Sheffield, Rotherham, Barnsley and Doncaster. It brings together 4 existing services which will be run under a single programme board and sees itself as an uplifting of existing pathfinder sites to provide the NHS England specification model. It is already providing an all age service, with Youth Offending Services working in partnership with the Clinical Commissioning Groups.
Surrey
The Surrey Criminal Justice and Liaison Diversion Service has covered all age groups across the county since April 2013 and is covered by one trust and serves a single police force. The Wave 2 scheme will be an enhancement of what is already a 7 day a week/12 hours a day service in 3 custody suites, covering all courts including youth courts.
Oxfordshire
The Thames Valley Liaison and Diversion Service Wave 2 scheme will cover the county of Oxfordshire and will serve 600,000 people in Oxford City and the rural surroundings. The existing service in fact covers Oxfordshire, Buckinghamshire and Berkshire and the Wave 2 scheme in Oxfordshire will be implemented by Berkshire Health Trust – with the youth service provided by Oxford Health.
Black Country
The Black Country Liaison and Diversion Service covers the area of the West Midlands (north and west of Birmingham) made up of Sandwell, Dudley, Walsall and Wolverhampton with a population of about 300,000 that includes areas with high levels of deprivation. The Black Country Partnership NHS Foundation Trust has had a well-established L&D service since the early 90s providing a predominantly adult court-based service that has included court assessment liaison as well as work in approved premises, prisons and probation. The Trust is now developing an all age police custody L&D service which will be fully operational when it begins implementing the NHS England operating model in April.
Next month’s bulletin…
Next month’s L&D Bulletin will look at how the Sussex L&D trial works with a variety of partner organisation to deal with issues of inequality – and how this has benefited service users
Share:
Tweet