Findings from the first 24/7 staffed ‘place of safety’ to implement London’s section 136 pathway and Health Based Place of Safety specification have received overwhelmingly positive feedback from users of mental health crisis services and has shown significant improvement in the pressure often experienced by the police, paramedics, A&E departments and the sites themselves.
The London guidance, developed by Healthy London Partnership bringing together partners across the health, care and justice system, was launched last year by the Mayor of London, Sadiq Khan. The guidance intended to bring in consistent standards of care for the most vulnerable people in our city to make sure they are treated by the right people, in the right place, at the right time. The guidance was supported by London’s service users, the NHS (ambulance services, acute and mental health trusts), London’s three police forces and social services.
The pilot site at South London and Maudsley Trust is the first of its kind in London to fully implement the guidance and provide a 24/7 staffed place of safety for adults and children detained under section 136 of the Mental Health Act (2017).
Key findings from the pilot evaluation include:
- The site accepts on average 15 % more admissions than previously across the four sites in that area. The activity increase represents the amount of patients turned away at previous single occupancy sites located in Croydon, Lambeth, Lewisham and Southwark.
- Having a dedicated team at the centralised site has meant that it has only been closed once over the past year – a stark improvement – sites were closed 279 times previously over a 12 month period.
- The number of individuals detained under section 136 that have had to be taken to A&E before going to the centralised site has fallen – partly due to the fact that the staff based at the pilot site are better trained to address physical health issues.
- Individuals detained under section 136 are being admitted to the sites quicker, with 96 % of cases being admitted within 30 minutes of arrival.
- The physical environment has been transformed through the new purpose built facility which is much more conducive to recovery.
- Service user’s satisfaction with the centralised site has significantly improved with 76 % of service users providing positive feedback.
- The rate of admission to an inpatient bed has fallen by 13% under the new model following comprehensive assessment by dedicated staff.
- Improving flow will be important to reduce the time patients are detained at the suite in light of new legislation.
The feedback from service users is that they received a more respectful, more responsive and less fragmented experience from all agencies involved; from the police and ambulance services, to NHS A&E departments, and social and mental health services.
Vincent Kirchner, Healthy London Partnership Mental Health Clinical Lead, says; “We are delighted that the pilot at the South London and Maudsley Trust has demonstrated many positives of providing a dedicated place of safety for those in mental health crisis; from better user experience, improved clinical efficiencies to reduced pressure on the police, paramedics, HBPoS staff and the A&E department. This pilot and the evaluation findings support a wider roll out of this model of care across London and the importance of consolidating health based places of safety sites into centres of excellence with specialist 24/7 staffing. We will be incorporating these findings and the impacts of the new model into a pan-London business case for decision makers to take forward.”
Dr Matthew Patrick, Chief Executive, South London and Maudsley NHS Foundation Trust, says; “Having a mental health crisis can be an extremely frightening and distressing experience for patients. The feedback from those using this new model of care has been extremely positive and highlights the importance of having dedicated places of safety with professionals available around the clock; making the experience more respectful and tailored to individual’s needs.
“The findings also show that this model of care also makes the process more efficient and less fragmented for those involved in the care pathway.”
Briony Sloper, Deputy Director of Nursing and Quality, London Ambulance Service says; “Working with Healthy London Partnership has been instrumental in improving communication, relationships and patient experience. Staff from London Ambulance Service have embraced this new model of working and we have seen local networks develop. The new pilot site has seen an improvement in handovers and patient care. It has set the benchmark for other places of safety across London creating better pathways for patients.”
Superintendent Mark Lawrence, Metropolitan Police Service Lead for Mental Health, Drug and Alcohol Abuse and Suicide Prevention says; “As the lead for mental health, I am genuinely excited by the findings of the evaluation into South London and the Maudsley Trust’s centralised health based place of safety pilot. Supported by a fantastic facility, this is a model which puts the needs of people in crisis at the forefront of services and one which other trusts across London would do well to replicate. The reductions in waiting times and ready access to advice from mental health professionals have been embraced by our officers and helped improve the way the police local to SLaM support people in mental health crisis.”
Healthy London Partnership and South London and the Maudsley Trust have worked together to evaluate the new model of care in South East London.
The guidance was developed with the support of over 300 Londoners who gave vivid first-hand accounts of their experience of London’s mental health crisis care services. The guidance was a significant achievement in multi-agency partnership working with input from over 70 police officers from London’s three police forces and over 350 front line staff in mental health and emergency services.
The pilot site acts as a good example of how despite tight fiscal constraints surrounding mental health, innovative models of care can provide excellent solutions, respond to service user needs and lead to significant benefits to the wider urgent and emergency and mental health landscape.
The ambition is to have this model of care rolled out across London and transform care for those in mental health crisis. This has been compared to other developments in physical health care in London’s Urgent and Emergency Care system which have seen the set-up of centres of excellence in stroke, heart attack and major trauma services. This demonstrates a track record of London delivering significant transformational change to build on and achieve parity of esteem.
The success of the model is particularly significant in light of legislative changes in effect from Monday, 11 December, made within the Police and Crime Act 2017 that include:
- Section 136 powers may be exercised anywhere other than in a private dwelling.
- It is unlawful to use a police station as a place of safety for anyone under the age of 18 in any circumstances.
- A police station can only be used as a place of safety for adults in specific circumstances, which are set out in regulations.
- The previous maximum detention period of up to 72 hours will be reduced to 24 hours (unless a doctor certifies that an extension of up to 12 hours is necessary).
- Before exercising a section 136 power police officers must, where practicable, consult a health professional.
Notes for editors:
- Healthy London Partnership formed in April 2015. It has been working across health and social care, and with the Mayor of London, Public Health England, NHS England, London’s councils, clinical commissioning groups, and Health Education England. We have united to amplify the efforts of a growing community of people and organisations that believe it is possible to achieve a healthier, more liveable global city by 2020.
- ‘Crisis care for Londoners: London Section 136 pathway and Health Based Place of Safety Specification’ has been endorsed by NHS England, London’s NHS commissioners, London’s Mental Health Trust Chief Executives, London Adult Directors of Social Services, Metropolitan Police, City of London Police, British Transport Police, London Ambulance Service, Royal College of Psychiatry, Mind charity and the National Crisis Care Concordat Initiative.
- The pilot is the first ‘Health Based Place of Safety’ in the country to provide a dedicated 24/7 staffed service for those detained under s136, this new model has been compared to other pan-London service reconfigurations such as stroke and trauma models where consolidated sites to create centres of excellence has significantly improved patient care and outcomes. The important factor this time round is focus on parity of esteem and ensuring effective, high quality care for those in a mental health crisis.
- The site provides an all-age service ensuring children and young people are not refused access to a place of safety and therefore mental health services.
- The pilot has led to other improvements across London’s mental health crisis care system including the voluntary handover form which has shown an 82% reduction in missing persons from A&Es at the four pilot sites and builds on the significant success of London having some of the lowest rates in the country of children and adults taken to policy custody when detained under s136.