Following an investigation of a homicide case in London concerning a mentally ill patient absconding from ED, several recommendations were made including the need for ‘an appropriate handover of the patient’ when police attend with any mental health (MH) patient, voluntary or detained.
The handover process was developed to help ED staff identify those MH patients brought in voluntarily by the police and to improve information sharing, partnership working and safety through the effective handover of risks and care needs. Prior to this initiative, the absence of formal processes left voluntary MH patients vulnerable in the department, led to frequent AWOLs and increased time spent by police in the department.
In light of the recommendations and discussion with stakeholders from London’s Urgent and Emergency Care (UEC) system, it was agreed that Healthy London Partnership would work in partnership with the Metropolitan police and EDs to pilot a handover process for officers and ED staff to use when an officer attends an ED with a voluntary mental health (MH) patient in crisis.
The initiative was supported by London’s UEC clinical leadership group, together with the Crisis Care Implementation Steering Group formed from health and social care professionals across London, police and service users. The process was co-designed, piloted and evaluated by ED clinical leads and the Metropolitan police.
The pilot ran in four of London’s EDs over a four month period, with handover forms completed for approximately 70% of occasions where officers attended with a voluntary MH patient.The process includes a handover form and a simple procedure (refer to ‘Handover Process’) designed tosupport its use. The form details information including use of alcohol or illegal drugs, reason for attendance and any suicidal ideation.
This allows ED staff to understand the circumstances of the attendance and risks identified by officers. The process includes a verbal handover allowing further clarification, and calls for discussion regarding the support needed (e.g. additional staff to monitor the patient). This supports a collaborative and holistic approach to determining the needs of patients thus leading to higher quality care.
Police upload the original form to their database therefore ensuring that use can be monitored and learning needs identified. The ED also keeps a copy in the patient notes so that this important information can follow the patient. Development of the handover process has required no new investment; ongoing costs will be largely limited to minimal printing costs.
Though the financial value of this initiative was not the evaluation focus, it can be surmised that system benefits would result through a decrease in handover time, a reduction inpatients absconding, and fewer clinical complications secondary to incomplete handover.
Whilst winning support for implementing this change wasn’t always straightforward in the early stages, both police and healthcare staff appreciated that having the right information was vital for safe decision making. The handover process was designed as a simple and effective mechanism for achieving this.
Its ultimate success demonstrates the strong, collaborative relationship that has been built between police and healthcare professionals in London. This relationship will facilitate future collaborative work crossing boundaries between the NHS and other public services.
• 82% reduction in missing person reports from the EDs taking part (see ‘Summary’); this is a huge stepforward for ensuring that vulnerable people remain in an environment where they can get help and support.
• Police and ED staff agreed that formalising the handover process is crucial and this process effectively captures information for safe care, including an understanding of vulnerability and risks (refer to’Feedback’ document).
• ED staff report that the information on the use of restraint is especially helpful for ensuring appropriate care in hospital.
• Police report a reduction in the time spent waiting to handover, thereby freeing them up for other duties.
Following the successful pilot, London’s Urgent and Emergency Care Transformation and Delivery Board approved a pan-London roll out of the form in March 2018. The pilot also led to buy-in with London’s otherpolice forces and the wider roll-out will include the City of London (CoL) and British Transport police(BTP).
The Metropolitan police, Healthy London Partnership, BTP and CoL are working in partnership to co-design and distribute communications and training for the roll-out. The Metropolitan Police Medical Director has shared the form with colleagues nationally and recommended the initiative for national adoption.