Remote delivery of services brings with it specific safety issues, which London MHSTs have been addressing in a variety of ways.
A ‘safe online’ protocol has been developed by Hounslow. This involved the establishment of a new model, and dedicated EHMP. Processes were adapted to support safe remote working in line with local information governance guidance such as accepting e-referrals via email or phone.
Islington developed a pathway script to encourage access to a Social, Emotional and Mental Health (SEMH) central point of access through a Covid helpline. MHSTs in this area liaised with an Emotional Wellbeing Service to develop protocol for a ‘call-back’ service for parents.
Central London MHST also developed a new protocol for the remote delivery of sessions, and telephone check in sessions have been established in Hammersmith & Fulham. Hammersmith & Fulham have also developed organisational and individual risk assessment processes.
A number of risks were cited by MHSTs, such as knowledge of clinical risk and safeguarding among EHMPs. Others cited risks associated with EMHPs who are not yet qualified but are practising in the mental health field under pressure (Central London). New starters have faced specific challenges of not being able to meet colleagues in person, build rapport, and integrate themselves in the way they would usually. Hounslow has mitigated this risk by developing first month induction schedules, a new starter buddy system, local induction pack and additional remote Facetime sessions to ensure new starters have access to colleagues and feel well orientated in their new setting and role.
EMHPs and CWPs make up a sizeable portion of many MHST workforces. The EMHP and CWP training programmes are one year duration and it is unlikely that all core mental health knowledge can be included within this time frame. Supervision is essential to support this workforce but this may not be widely understood and risks being eroded over time. Some areas commented that the wider knowledge and understanding of the remit of EMHPs and CWPs may not be present. Camden have been working with stakeholders to ensure there is sufficient supervision time for less experienced clinicians working with young people and families with mental health concerns and within complex school systems. There is a recognition of the importance and benefit of experienced senior clinicians working in schools and supporting less experienced staff. Camden have raised with stakeholders and commissioners that there needs to be substantial levels of supervision for EMHPs and CWPs in their post trainee year.
A further good example of positive practice to mitigate these issues is in Hounslow, which has run additional training sessions and provided reflective space for staff regarding ‘managing risk’, as well as a dedicated supervision group for online group working.
Risks associated with returning to face to face sessions, and returning to school generally, were mentioned by several areas. This is echoed by the Oxford study.
It was reported that some schools in Ealing have not been able to fully engage with the MHSTs, leading to a reduction in appropriate referrals as both parents/carers and young people would prefer to see practitioners face to face. To mitigate this, risk assessments have been completed and a format to be used within each school agreed. These risk assessments now need to take place with schools who wish for practitioners to return and practise onsite.