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A Model of Urgent and Emergency Mental Health Care

Kate Chartres Nurse Consultant Sunderland PLT and Senior Nurse Community Access Services at Sunderland Royal Hospital spoke at today’s Improving Mental Health Crisis Care conference on:

  • the key elements of the Mental Health Crisis Care Model ‘ a whole systems approach’

  • metrics including baseline and progress

  • how we are setting measurable standards for care and outcomes in crisis care

  • what have we learned in along the way

  • the future

Kate discussed 2011- Access Phase 1: The case for change

  • A new urgent access model was developed following extensive engagement and co-design with service users, carers, GPs and commissioners.

  • Like a lot of areas:

  • Problems getting through to Crisis Team by phone as Triage saturated++

  • Overnight and at peak demand times callers could wait hours for a return call from a clinician- even longer for face to face contact

  • Too many exclusion criteria- Too much bouncing

  • No ready point of access for Older People or People with a significant Learning Disability seeking Urgent Advice/ Intervention

  • Fewer than 35% of referrals needed admission/ home treatment

  • Most of the non-crisis referrals required advice/ signposting but at low risk/ acuity

2012- Phase 1: The Model

  • The Principles:

    • 24/7 Universal telephone access for requests for urgent help.

    • No restrictions on who can refer

    • Triage and Routing over the phone- No bouncing

    • Face to Face Triage (Rapid Response) if clear plan cannot be determined over the phone

    • Patient defined crisis- response agreed and negotiated through the service

  • Achieved with:

    • Investment in staff for enhanced telephone and face-to-face response

    • Use of digital dictation and 3G laptops for clinical documentation

    • Flexible interchangeable roles and rotation between Crisis Team and IRT roles dependant on demand.

  • Culture change

In her presentation Kate stated:

  • Urgent Access has had very positive performance and feedback evaluation.

  • Evidence of marked reduced bed-usage across all three SoT areas since launch of IRS- saving real money.

  • 7-day Psychiatric Liaison, Consultant Working, Street Triage- all impacting on the wider Urgent and Emergency Care System positively.

  • This is an ambitious systems-based model- how can it be integrated into new urgent-care health service developments?

Kate Chartre’s full presentation is available for download at the end of this page.

Kate Chartre’s Biography

Kate Chartres is a Nurse Consultant in Psychiatric Liaison.  The Sunderland Team has just received news of successful accreditation by the RCP with excellence (PLAN). My previous experience has included extensive time within Crisis Services, work in Primary Care, EIP and the Clinical Management of a range of diverse Psychiatric Liaison Teams across Northumberland Tyne and Wear. I have undertaken further development in a variety of therapeutic modalities which enables me to develop innovative treatment packages for people presenting with complex clinical difficulties utilising an eclectic approach which I believe is necessary within this specialist field.  My interests include developing truly integrated services, engagement and developing the body of evidence to underpin future Psychiatric Liaison practice and developing staff.

I also have a leadership role for NTW which allows me to represent nursing at a senior and strategic level; I have professional responsibility for the initial response service’s trust wide, psychiatric liaison teams trust wide, street triage, CRHT teams, and the personality disorder hub and specialist psychological therapies.

Future conferences of interest:

Implementing the NEW NICE Quality Standard for Domestic Violence & Improving the effectiveness of MARACs
Wednesday 2 March 2016 , ICO Conference Centre, London

Towards Zero Suicide: Preventing Suicide, Saving Lives
Tuesday 15 March 2016, Hallam Conference Centre, London

Deprivation of Liberty Safeguards: Ensuring Compliance & Moving towards a new system of 'Protective Care'
Tuesday 19 April 2016, Hallam Conference Centre, London

Smoking Cessation in Mental Health
Friday 22 April 2016 , Hallam Conference Centre, London

Improving the Quality of Perinatal Mental Health Services
Wednesday 4 May 2016, Hallam Conference Centre, London

Download: kate-chartes_1319.pdf

3 February 2016


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