In 2014 we set out to reduce the number of people with mental health problems being detained in police custody under Section 136 of the Mental Health Act. We successfully applied to participate in NHS England’s Wave One evaluation trial of a national model for liaison and diversion (L&D) services.
In parallel we formed a unique local agencies’ collaboration to pilot a pioneering approach to mental health street triage, providing an effective, coordinated crisis response, directly supporting the police who were too often the first point of call for people in mental distress, crisis and emergency.
We integrated delivery of the national model and street triage service to maximise patient experience and deliver maximum financial efficiency. This meant integrating our workforce, adapting the existing service and mobilising resources. The work included:
• Recruitment, training and supervision of a new workforce
• Development of partnership alliances across criminal justice, health, social care, third sector and service user forums
• Integration through trust, effectiveness and physical co-location in police custody, safeguarding referral units, magistrates’ courts and incident command centres
• Sustained delivery by continual learning aligned to evaluation and collaboration with NHS England, Bournemouth University and The Centre for Mental Health Funding was combined to support service design.
The national model annual operating budget was £750,000 and the street triage pilot, including Dorset’s PCC, Dorset CCG, three local authorities and NHS England, had an annual budget of £160,000. It provides:
• An age-appropriate response for anyone over the age of criminal responsibility
• Enhanced service hours seven days a week (7pm to 3am)
• Service access at all points within the adult and youth justice pathway
• Coverage of a range of health issues and vulnerabilities, including mental health, physical health and learning disabilities
• Improved access to healthcare and support services for vulnerable individuals and a reduction in health inequalities
• Diversion of service users, where appropriate, out of the youth and criminal justice systems into health, social care or other supportive services
• Efficiencies within the youth and criminal justice systems
• Reduction in reoffending or escalation of offending behaviours
• Reduced number of s136s to hospital and Dorset Police custody suites.
• Support and advice for police officers leading to a reduction in the time spent dealing with members of the community who have (or appear to have) mental health issues
• Shared relevant information across agencies on service users who have high propensity for crisis, to better manage the individual’s care.
Independent evaluation of L&D by RAND Europe in 2016 found stakeholders from partner agencies and those delivering L&D services were overwhelmingly positive about the national model. Street triage outcomes in Dorset have included:
• Reduced distress to service users
• Cost savings to police, healthcare and local authority services
• Provision of the most appropriate interventions to the person
• Multiagency development of service user engagement at the earliest opportunity in support of issue resolution
• Improved wellbeing and recovery from episodes of mental health crisis.
The 2016 inspection of Dorset Police Custody by HM Inspectorate of Prisons, HM Inspectorate of Constabulary and CQC reported:
• A large reduction in the number of people brought into custody under S136 of the Mental Health Act and significant progress in improving outcomes for this vulnerable group
• Mental health provision had improved considerably and was excellent
•The service and a revised multi-agency policy had markedly reduced the number of detainees in police custody under S136 Since June 2016 police custody suites in Dorset have not been used for S136 detentions - vulnerable people are assessed in hospital-based places of safety.
The Equality and Human Rights Commission’s publication “Preventing Deaths in Detention of Adults with Mental Health Conditions” (2015, revised 2016) cites the service as a best practice example of good access to treatment and support.
We presented to the National Independent Custody Visitors’ Conference 2015 and national conference on Improving Mental Health Services in the Criminal Justice System 2016. Through NHS England’s scheme we are cited as examples of good practice, in particular for:
• Integration within health and justice settings
• The deployment of Support Time and Recovery work
• Data collation
• Measurement of health and social support outcomes