Background
Method
Design
Participants
Location 1 | Location 2a | |
---|---|---|
Population | 138,400 | 1,759,800 |
Location size (sq mi) | 146.8 | 1,622 |
Estimated % of population 16–74 with severe mental illness (national comparison 1.1 %)2 | 0.8 % | 0.6 % |
% of people living in 20 % most deprived locations (national comparison 20.3 %)c | 5.7 % | 3.7 % |
Number of S136 detentions by MH provider 2013/2014 b,c | 60 | 250 |
Number of S136 detentions by police force boundary in 2013/2014c | 805 | |
% of all S136 detentions that result in individual being taken to a health based place of safetyc | 57.8 % |
Unique identifier | Gender | Organisation | Job title | Managerial role in street triage | Location |
---|---|---|---|---|---|
01 | Male | Mental Health Services | Register Mental Health Nurse- Crisis team | No | 1 |
02 | Male | Police | Police Constable | No | 1 |
03 | Male | Mental Health Services | Inpatient Modern Matron | Yes | 1 |
04 | Male | Police | Police Constable | No | 1 |
05 | Male | Police | Police Sergeant | Yes | 1 |
06 | Female | Police | Police Constable | Yes | 1 |
07 | Male | Mental Health Services | AMHP Manager | Yes | 2 |
08 | Male | Police | MH inspector | Yes | 1 & 2 |
09 | Male | Police | Police Sergeant | Yes | 2 |
10 | Female | Police | Police Constable | No | 2 |
11 | Female | Mental Health Services | Community Psychiatric nurse | No | 2 |
12 | Male | Police | Police Constable | No | 2 |
13 | Female | Mental Health Services | Crisis worker | No | 2 |
14 | Female | Police | Police Constable | No | 1 |
Data collection
Analysis
Results
Overview of themes
Key aspects of a street triage service
Street triage operating models
Components of the service | Description | Location 1 | Location 2 |
---|---|---|---|
Joint Response Car | Mental health worker and police officer visit to the individual in MH crisis by travelling in the same vehicle | x | x |
Mental health presence in police Control Room | Mental health worker handles incoming calls from individuals who need mental health support, as well as providing advice to police colleagues | x | |
Integrated Recovery Programme | Multi-agency intervention for service users who create a high demand on police and mental health services | x | |
Street Triage Briefing sessions | Educational sessions for police and mental health staff directly involved in the implementation and management of the service, as well as staff from wider organisations which work alongside police and mental health services e.g. social care | x | x |
Tailored service for local need
“It’s too big a location and you’d take half an hour to get from one to the other. And that’s just not reasonable or realistic. So if I had a magic wand and an unlimited budget, I would get the worker back in the control room. I’d get the car back on the streets of [City] and I would get one in the east. But you know with all the will in the world it would not be worth putting one in the north. It just wouldn’t be worth it” (08, police, manager, location 2)
“I always find it difficult to get in touch with my own service to get that information… we have got a little mobile phone but because of the location…there are dead spots you know and the other thing is we are always very busy and when I am phoning I get engaged… so I am out there with a patient with the police trying to sort things out so it’s very difficult you know to get my own service sometimes” (03, mental health worker, manager, location 1)
Referrals to mental health services
“Actually in the north of [Location 2] we are covered by [NHS Trust #1]… It gets very complex up there but in the south you know you have got [NHS trust #2], [NHS Trust #3], you have got [NHS trust #4]. You have got almost… I don’t know actually how many there are but you have got a lot” (09, police, manager, location 2)
“I can refer them back to their care co-ordinator, I can refer them back to their GPs for possible referral to mental health services. Or it may be the fact that they are just feeling depressed and they need some antidepressants so refer them back to their GP, and I can refer them onto < Place > which is our community mental health service” (03, mental health worker, manager, location 1)
“I worked within that team and understood the process, it was obviously probably much easier for us. So I would be able to write up my notes and the plan and then put, add on to the schedule for the next day that person to be called or contacted” (13, mental health worker, front-line, location 2)
“It was always at the very least it would be telephone contact. That would be the only bit that I would guarantee because I couldn’t always guarantee a visit. I could always say to my colleagues I think that would be appropriate and that’s needed and put my rationale but that would be at the discretion of the team the next day to kind of look at their workload and how manageable it was” (13, mental health worker, front-line, location 2)
Appropriate staff and rostering
“You need to have it that people want to do it, I don’t think it should be rota’d [rostered for all staff]…as I said before you know it’s better to have people want to do it than are forced to do it or told they have got to do it, so I think that’s the other thing that other locations need to look at… I think the other thing is that you need to have people, mental health practitioners who have quite a good knowledge of mental health issues, got some experience behind them as well. I don’t think that somebody who has just come out of finishing their training would in my opinion have that knowledge to go out” (03, mental health worker, manager, location 1)
“…three practitioners were taken from our normal team so we weren’t extra resources. So we were three full time practitioners that would normally do nights and weekends. That pulled us out of an already stretched team. So I think that [project] was given a lot of priority …but I know that it put huge strain on our colleagues and at times, because we would have been on the night shift” (13, mental health worker, front- line location 2)
“I think because we have had our shift numbers cut, officers on shift, I think there needs to be some sort of provision put in place because we are just so short. You know it’s a job for an officer to get time off on leave, let alone you know then we have to support [project name] as well” (14, police, front-line, location 1)
Perceived benefits of street triage
Helping people with mental health problems
“I’ve seen it work, and I’ve seen it help people”(12, mental health worker, front-line, location 2)
“…projects like this have got so much potential value in them”(01, mental health worker, front-line, location 1)
“It was a very worthwhile piece of work” (06, police, manager, location 1)
“I don’t want to put them all into one category I mean there’s a mixed feeling of officers on the ground. I can’t be as optimistic about all of their points of view and their opinions. Some of them are very much, I’m a police officer, this is mental health. But just because there is a cultural way of thinking, doesn’t mean it’s the right way of thinking. And I’d say for as many people as think it’s not part of their job, there is probably a lot more that think actually if this is going to help me do my job better…then I’ll give it a go” (06, police officer, manager, location 1)
Shared decision making
I think the police in general have a habit of being reasonably risk averse. And have a habit of perhaps not taking decisions. It’s maybe not been the police entirely but I think in any large organisation if you don’t take a decision you can’t be criticised for the decision you have taken (12, police, front-line, location 2)
“So there’s a huge number of people who are coming into hospital who don’t need to be there…that’s got a huge impact on an individual and actually if they don’t need to be part of that service… From a health management point of view, I’d say that- you know generally the Health service is fairly slim resources and our resources were being called to be used in a way that wasn’t necessary” (01, mental health worker, front-line, location 1)
Improving understanding between organisations
“It just allowed us to understand what each role involved and how we could help that person. It was interesting in that respect and also if things did go a bit wrong then we were there to support the mental health workers if they needed it. So it’s definitely helpful in that respect, and understanding each other’s roles, it’s like oh right I didn’t realise you did that. So it was a huge learning curve” (10, police, front-line, location 2)
“I did go to the police station because I think it was really useful in terms of networking… breaking down some barriers because I think, you know, the police historically perhaps some attitudes towards mental health, there were perhaps some misunderstandings” (13, mental health worker, front-line, location 2)
Improving information sharing policies
`"Information sharing is the key, before [project name] I could have never have phoned them up and said I’ve this person here can I have some information to let me make a decision about what to do, I couldn’t have done that. But now I can make a phone call and say hi its < NAME > can I talk to you about this person and they can give me some information… before you know I have limited information I might have had to 136 them but now… they might give me more information to make an informed decision” (04, police, front-line, location 1)
“I think it was something that we very early on thought about, the information sharing agreement… I would often get complaints that the police had rung, they’re at a situation, and they’d rung to try get some information about somebody…And after that, you know, I don’t hear that, I think that’s had knock-on effects outside of [project name], that people can potentially more freely talk to each other without fear of being called to book about being confidential” (01, mental health worker, front-line, location 1)
“They use different IT, completely different IT. At the moment they use two different versions of [computer system] but [city 2] have now moved away from [computer system] altogether. So it will be very, very difficult, even though the AMHPS [Approved Mental Health Practitioners] will regularly cross borders… That’s not the issue and the trust boundary isn’t the issue, it’s the IT” (08, police, manager, location 2)
Service development and future directions
Focus on frequent service users
“…we’ve seen, if you have a good partnership that focuses on the street triage, you then automatically start talking about well actually we could do with a nurse there, or a mental health professional there….. So street triage is a vital first response tool, but without those mental health pathways, those critical points in the pathway, you are just going to have response, because you will be scooping up the same people. And it will be the same people coming round into the street triage again” (05, police, manager, location 1)
Reducing police involvement in mental health crises
“So one of the objectives of [project name], is the long term, almost a generational piece of work, to actually place mental health risk, mental health responsibility, back into the NHS, because it has never been in the NHS, because culturally the wider thing is the police in the UK scoop up everything.” (05, police, manager, location 1)