NOTE – the Crisis Care Concordat came about due to the high variability and quality of responses when agencies are working with people in crisis. The CQC sought to ensure that local groups were focussed on 3 things (1) ensuring services are focussed in delivering quality of care that does not vary (2) that the commissioned services deliver quality in line with the concordat principles and (3) that the necessary engagement of innovative approaches to improve the experiences of those in crisis are shared within and across geographic areas. (The CCC does not discriminate between children, young people, mental illness, dementia or learning disability individuals).

Section A – access to support before a crisis
Number / Action / Priority & status / Timescale / Led by / Outcomes / Comments
Matching local need with a suitable range of services
A1 / Continue to develop the “Hub” to ensure a wider range of services is available including self-referrals (consider all groups children, adults / In place – needs development – contribute to crisis / In place 12 months (October 2016) / MH Commissioners (JRL & clinical leads) / The CCG has increased funding to the hub (NOTE – this has been delayed whilst the novation process is finalised)
A1 / Ensure the current “Hub” arrangements are appropriate effective in delivering the service / The action is firstly to review the activity and performance data. Secondly to agree a position with CCG and clinical leads on any developments and/or changes to meet core needs of the population / Commissioner, clinical leads and service / Firstly a single point will be in place for referrals and sign-posting, secondly the appropriate governance and clinical inputs will be agreed. / This will need to be in place and agreed by 1 April 2016 and an extensive marketing exercise undertaken to promote any changes or endorsse the current position going forward
A2 / My mental health well-being plan will become the focus of my well being and recovery plan and will include life-style factors / Not in place – needs development - prevention / In place 100% from April 2016 for every contact / Commissioner, Changing Lives and MH Trusts / A recovery co-produced plan is in place for every MH contact / Needs facility to share with primary care sense checking via cabinet
A2 / Ensure that all providers use a well-being and/or recovery based plan that is agreed with the person and those who matter to them / The action is firstly to review the level of use of personalised recovery plans and then in consultation with user and carer groups agree an outline and date for all persons entering services to have a completed, agreed and endorsed plan / CCCG engagement team and all user/carer organisations / A co-produced document and plan will be agreed and embedded into all services from primary care through to specialist services / A consultation and co-produiction will take place and eb mebdedd by May 2016
A3 / Ensure resilience & effectiveness of community mental health teams (driving towards primary care) and remodelling to meet “New Dawn Paradigm” / Partially in place – needs development – resilience & service redesign / Agree 12 month remodelling with associated risks identified / Commissioner, Trust and co-design with Changing Lives / A resilient set of community mental health teams that are fit for purpose and responsive to the needs of the local population / Prevention and primary driver of change
A3 / Ensure resilience & effectiveness of CMHT’s (driving towards primary care) and remodelling meet the “New Dawn Paradigm” / The action is firstly to review the directory of services (DOS) and secondly to review the existing CMHT’s to ensure they can deliver the renewed and agreed standards of care / Commissioner and BCPFT / Firstly support will wrap around the person and secondly there will be a choice (range) of community based provisions
A4 / Reconsider the respite component of acute care / Not in place – needs consultation and development – part of acute (not crisis but has influence) / Agree by April 2016 / Commissioner, Changing Lives and MH Trust / Respite care forms a part of the new integrated pathway for both acute and as a subset of crisis (multiple responses will be required across the system) / Consultation and co-produced with sense checking via cabinet
A4 / Review respite care including care packages and support / The action is to consider all viable options for respite care alternatives to admission / Commissioner and BCPFT / Firstly to review the current situation and then propose a way forward / Validate with cabinet and service users (all categories young people, mental health, learning disability and older adults)
A5 / Personality disorder (BPD and ASPD) / Partially in place – needs a reconsideration but acute focussed / 12 to 18 month project / Commissioner, LA, Public Health, MH Trust and third sectors / Redevelopment if the business case supports this and is evidence based / NOTE – much of the funds are currently in baselines and unlikely that new funds will be found
A5 / Ensure a full review of both community and third sector services as well as considering the potential for user led service integration / The action is firstly to review the personality disorder services that form part of the block contractual arrangements, then consider the literature and best practice examples as a potential way forward. / Commissioner, BCPFT and user forums / To review and propose options going forward for consideration and inclusion into future commissioning intentions (16/17) / Validate with cabinet and service user groups
A6 / Culturally appropriate services that are responsive across all sectors and groups / In place – needs reconsideration and potential development across wider spectrum (acute & crisis) / Immediate 6 month consultation and development / Commissioner, LA, Public Health, MH Trust and third / A full range of culturally appropriate services and resources / Consultation and co-produced with sense checking via cabinet
A6 / Ensure current information is captured on all ethnic groups (mental health problems are the largest single source of disability in the UK No Health Without MH 2011) / The action is firstly to review the current demographics via an updated JSNA and then to map this against use of services / Public Health (for JSNA) then commissioner and BCPFT / To review demographic based use of mental health services and ensure all services offer culturally appropriate interventions. Workforce development / To be fullly in place by June 2016
A7 / Utilise and develop emotional well being and life style factors / Some components in place – reconsider and develop – community and sub-acute / Development of robust consulted plans over 12 months – to be in place October 2016 / Public health and commissioners / Full range of services in the community and enhanced by third sector / Combined with A2
A8 / Development of action plans for priority crisis hot spots / Partially in place – require further development for crisis / Development of a consultation and embedding of workforce and service development / MH commissioner, MH Trust, Police, Ambulance, Fire / Responsive set of crisis services as a priority / Liaise and consult with A&E, emergency services and MH providers
A8 / Ensure that agreed priorities are identified and an action plan developed / Consult with users and carers, mental health services and emergency services to determine the level of the issue and develop both strategic and operational plans to resolve / Commissioner / A fully integrated response to all emergencies and agreed hot spots / Endorse with MH parliament
A9 / CAMHS (universal & targeted) / In development / This forms a part of the transformation plans / Commissioners and trust (LA & health) / TBC / TBC
A9 / Ensure that the agreed transformation plans are ratified and enacted. / Consult with all children and young person’s services and user groups and endorse the agreed direction of travel from the transformation plans. / Children’s’ Commissioner / A full set of plans are in place and are being led by the C&YP Commissioner with all agencies engaged and committed / Endorse with all processes at CCG , LA and H&WB Board
A10 / Crisis beds (via P3 contract) / In place October 2015 on-going until April 2017 / A newly commissioned arrangement is in place from 2 November 2015 / MH commissioner / Confirmation that sufficient capacity is in place / Commissioner and crisis housing
A10 / The CCG has now (Nov 2014) put in place a new contract for 4 crisis beds / The new arrangements are in place and will be monitored to ensure they are appropriate / Commissioner / A full evaluation will be undertaken in year by the CCG and reported / Endorsement via usual processes
Section B – Urgent and emergency access to crisis care
Number / Action / Priority & status / Timescale / Led by / Outcomes / Comments
B1 / Review the use of Section 136 of the Mental Health Act / Review and revalidate / January 2016 / Police and mental health trust
(Note – LA for S135 & 136) / Agree use and trends, give proposed renewed priorities and principles (S135/136) if necessary
B1 / Review the use of Section 136 (initially for Sandwell & West Birmingham then give consideration to the Black Country footprint) / The action is firstly to review the number of S136 events and then determine if a critical mass exists to continue to support a unit per CCG locality / Police, Commissioner & BCPFT / Firstly to agree an action plan and then agree, in consultation with all the quality parameters for delivery / Make use of RCP standards
B2 / Build on the success of the Sandwell Triage Car / In place – needs further development and embedding / From April 2016 renewed funding must be in place / Black Country Commissioners (in conjunction with Police, Ambulance and confirmed users views) / Further developments of the Triage Car with Police, Ambulance and mental health professionals dedicated / Funding must be in place by December 2015 and an on-going agreement confirmed
B2 / Ensure that the appropriate evaluation is undertaken to inform future commissioning decisions / Consult with users and carers of the service to establish the experience of both the Triage Car and CRHT / Commissioner and Engagement Team (CCG) in collaboration with the MH Trust / A full engagement process will be undertaken to ensure the qualitative experience is determined and agreed (Feb 2016) / Endorse with MH parliament and commissioners
B3 / Review the role and function of the crisis resolution home treatment team and interventions / In place, reconsider recommendations of September 2015 unannounced visit / February 2016 / Commissioner, Black Country Trust and Changing Lives / A robust fit for purpose service that remains responsive to patients needs and wishes / Coproduced and assurance of timely responses across the pathway
B3 / See B2 / See B2 / Commissioner / See B2 / Endorse with MH parliament and commissioers
B4 / Learn from the pilot of dedicated MH nurses within the 111 services / Current pilot must be fully evaluated by the commissioner and embedded / Embed by April 2016 / 111 commissioners and leads (link with ambulance and A&E) / Fully embed within 111 and resource
B4 / Review the use of 111 mental health clinical hub / The action is to review the number of calls and the outcomes of the calls by the mental health nurse / Urgent Care Commissioner, 111 Lead (DH) and emergency service / To agree and embed the use of mental health clinical input and review in the 111 hubs / Make use of RCP standards
B5 / Ensure the continued effectiveness of place of safety (including 0 – 25 years of age) / Review current status, evaluate & redesign / Have a draft for consideration April 2016 / Police and commissioners (with MH Trusts) / Develop and agree a Black Country wide arrangement and agree milestones for embedding from July 2016 / Consultation and agreement then coproduce with Changing Lives
B5 / Review the use of place of safety / The action is to comprehensively review firstly the use of places of safety in Sandwell and then to determine how this fits into the wider remit of geographic footprint and appropriate and/or timely use of places of safety / Commissioner, and emergency services (police and ambulance) / To agree the current (and historical) use of places of safety. To then develop a paper across agencies to determine the number of places of safety across the footprint and how these are appropriately staffed / Agree a postion and mebded via processes (emergency and commissioning) then put in place with mental health and/or emergency services
B6 / Court diversion and linking to urgent care pathway
B6 / Review the use of court diversion and link to all parts of emergency and crisis services / The action is to review the current provision of services via courts and then agree for those in crisis an appropriate pathway. This pathway will then be embedded / Commissioner, courts (via justice system) and probation in conjunction with police / To agree and embed the most appropriate and timely services for those in crisis into the court services
B7 / Review and reconsider the RAID model / In place, needs a review and formal reconsideration including financial envelope / Formal review must be undertaken by July 2016 and consideration to finding greater efficiencies / Urgent care and MH commissioners and trust / Consideration of the wider psychiatric liaison principles and consult and liaise with users and carers
B7 / Review the current arrangements formally with commissioners and other interested parties to determine the use of the model and its efficacy for mental health / The action is to review the current use of the RAID model, to benchmark and consider the wider remits of its place in both crisis and emergency settings and relationship, or not, to the wider psychiatric liaison services / Commissioner, providers and users of services. Also there will be need for a wider engagement using the CCG engagement team and third sector / To agree appropriate terms of reference (commissioner) and then engage and undertake; measurements, outputs, success and a way forward / Make use of RCP standards and others and then endorse and challenge via parliament
B8 / That age appropriate services are in place covering the range of services (older adults, mental health, learning disability and young people) / Review and redesign if needed / In place and confirmed from April 2016 / Commissioners / Confirmation that all services are age appropriate and afford an equality if access for all / Coproduction and consultation with users and carers
B8 / Review the pathways and routes into and out of services across all ages and all services / The action is to undertake a full engagement and review of all services over the next 12 months and agree these into commissioning intentions and future directions (considering geography and regional developments) / Commissioner led, but to include all interested parties / To agree and embed the use of all pathways in mental health and endorse where appropriate or alter and amend as necessary / To consider, develop and then embed locally and regionally (12 months maximum)
B9 / Ensure that all multi-agency arrangements relating to crisis are reviewed and re-affirmed / In place – needs review and reconfirmation / In place for February 2016 / All agencies (ambulance, police, commissioners and services) / Confirm with co-production
B9 / Review the use of multi-agency sharing protocols specifically relating to mental health crisis / The action is firstly to review the protocols in place and then agree a strategic way forward / Police, Ambulance, Commissioner & MH Trust / Firstly to agree a sharing protocol and then embed this in practice / Make use of RCP and RCN standards (consult then co-produce)
Needs specific children and LD components to be captured
B10 / Ensure appropriate use of A&E by those presenting in crisis / Arrangements are in place – review and consider coproduction / Review in first quarter of 2016 / Commissioner and mental health trust / Ensure that a comprehensive service is in place then validate by user/carer engagement
B10 / Review the use of A&E in Sandwell for those presenting with mental health issues / The action is to review the use of A&E by those presenting with mental health issues, to understand the drivers, to better see where both appropriate and inappropriate contacts take place and resolve for both efficiency and effectiveness for MH / MH Commissioner supported by Urgent Care Commissioner, 111 Lead and all providers / To agree and embed the use of mental health clinical input and review in the 111 hubs over the next 8 to 12 months / Reference to standards with approporiate and sensitive services to be developed and embedded
Section C – Quality treatment when in crisis
Number / Action / Priority & status / Timescale / Led by / Outcomes / Comments
C1 / Development of competent workforce across all services including specifically for mental health, LD & children’s services;
1.1police
1.2ambulance
1.3GP
1.4Mental health trust
1.5Third sector
1.6User voices / Review as no assurance this is in place, consult and agree / Full review by April 2016 and embed thereafter for crisis component specifically / Commissioners, providers and user voices / A fully competent workforce will be in place. / Undertake a TNA (training needs analysis) and embed all results
C1 / A full review by each service will be undertaken that will ensure that all workforce is fit for purpose / The action is for every service to review its own workforce and develop a 3 year strategy to have all staff appropriately skilled and trained to meet the needs of the population / The mental health commissioner will coordinate the outputs but responsibility will be held by each organisation to develop a plan and put this in place (this will be monitored by the strategic mental health group) / To agree that all services have a workforce that is able to meet the needs of the population and is fit for purpose going forward.
C2 / All services and service providers will adhere to and monitor best practice for restraint (including vulnerable individuals children, LD and dementia) related groups / Review current practices and policies / January 2015 complete review and report to CQRM (clinical quality review forum) / MH Trust and police / Report to include
C2 / Review the use of restraint (providers and emergency services) will undertake a comprehensive review of the last 12 months and report to a developed task and finish group who will make recommendations / The action is to review the current use of restraint and develop a strategy and action plan going forward / Led by the mental health commissioner in conjunction with providers / To agree and embed the best practice principles for every service and to align these and embed going forward over the next 6 months (July 2016 completion) / Develop a task and finish oversight group to moonitor and advise