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#ProjectA - Mental Health Accelerated Design Event - Report of Day


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The report that captures the outcomes and spirit of the #ProjectA Accelerated Design Event (February 14th 2019). Improving the ambulance service response to mental ill health and emotional distress.

Published in: Healthcare
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#ProjectA - Mental Health Accelerated Design Event - Report of Day

  1. 1. 14th February 2018 Twitter hashtag #ProjectA Report of the #ProjectA Mental Health Collaborative Accelerated Design Event Responding to people in mental health crisis and emotional distress
  2. 2. The purpose of this report What this report seeks to do: • Provide a record of the inputs and outputs from the day • Show what happened on the day and the energy in the room • Document the wealth of information and experience that the attendees brought to the day What this report does NOT seek to do: • Make verbatim notes • Analyse, synthesise or prioritise ideas • Develop a decision document or action plan Report compiled by Lynsey Oates and Ian Baines NHS Horizons
  3. 3. Showcase table and wall area Share and show materials from mental health initiatives around the country – learn and share from one another!
  4. 4. Welcome by Will Hancock CEO of South Central Ambulance Service. Why today is important… There was a request for a Mental Health collaborative right from the initial #ProjectA launch. There is a lack of confidence at present in how to treat people with mental ill health and frustration in front line staff so this work is critical. Thank you for your continued leadership in this area. We want to support and nurture you, so you have a voice to bring this agenda to the fore. This is a chance to share the great work we are doing today, and a safe environment to do so.
  5. 5. In the room are people who aren't ambulance staff - these are critical friends, and who are here to help us – embrace them! Helen Bevan Chief Transformation Officer NHS Horizons set the context for the day This is not your usual conference or workshop, it is a specially designed process which enables a depth and quality of output that would usually be unachievable in such a short timeframe...we’ll do three months’ worth of work today.
  6. 6. Valentine’s Day Some people had sacrificed their Valentines Day to be here; it was a worthy sacrifice as everyone is here to design a response to people in mental health crisis or emotional distress. Avedis Donabedian was one of the founding fathers of healthcare quality improvement; his ethos was about love. Let’s channel the spirit of Donabedian and St Valentine today - to focus on love.
  7. 7. The activity: On your own, look through the magazines and find two pictures that symbolise for you: •How the midwifery profession is now (sometimesalways) •How things could be different in the future People travelled to London from as far afield as Northern Ireland and Scotland to attend the event. Every ambulance service in the UK was represented.
  8. 8. The aims for the day To: • Build connections and collaboration between people across the country who are passionate about improving the ambulance service response to people experiencing mental health crisis • Share existing knowledge and good practice • Contribute to the emerging national mental health workplan being developed by the Association of Ambulance Chief Executives and NHS Clinical Commissioners stakeholder group • Build a commitment to translating the knowledge gained into practical action in local settings whilst providing high level actions for the national workplan • Test out ideas and identify our next steps
  9. 9. Talking about our lived experience of mental ill health #ProjectA Leigh Kendall – NHS Horizons @leighakendall David Morgan – North East Ambulance Service @djmtees Elle Todd – Service user by experience @elletodd8
  10. 10. Where is your biggest interest ? Lived Experience I have walked in patients’ shoes. I was too mad for some services and not mad enough for other services. Let’s work together today to share good practice and work together to provide a better service for people living with mental ill health, crisis and emotional distress. Kindness, compassion, empathy and dignity is needed when treating those in crisis.
  11. 11. What unites us? 3. They were then requested to introduce themselves to other people at the table and use the card to tell a story in relation to the card they chose, disclosing as much or little as they were comfortable doing 4. Each table was asked to create a sentence about what unites all the personal stories 1. Attendees were asked to reflect on their own lived experience of mental health 2. To then choose a card that represents that reflection #ProjectA
  12. 12. What unites us? Collaboration and shared experiences in action Reflect on your own lived experience of mental health, then choose a card that represents that reflection.
  13. 13. Sharing stories with others on their table.
  14. 14. There is a person behind the story Mental health can unite or divide us Frustration Creating a sentence about what unites our personal stories Everyone is on a journey
  15. 15. The feedback
  16. 16. What unites us: table feedback from the transformation cards 1 - Everyone is on a journey and our personal journeys have helped us to grow and to develop and have influenced our practice to become more responsive than reactive 2 - Frustration 3 - We are all aware of personal, system and societal challenges which need to be balanced and expectations changed, to enable us all to survive and thrive 4 - There is a person behind the mental health story and experience 5 - Metamorphosis through difficult experiences helps us to become better people 6 - There are blurred lines, between life experiences coping strategies and our mental health. Mental health can unite or divide us 7 - Your response can influence my response by seeing the person behind the call 8 -We have all seen dark places and can tell the tale of experience with the desire to open doors
  17. 17. TRIZ Step 1: Devise a list in response to the question. Be creative!
  18. 18. Where is your biggest interest ? Step 1
  19. 19. Where is your biggest interest ? Step 2 - Is there anything that we are currently doing that in any way, shape or form resembles any of the items on list one
  20. 20. Step 3 what are the first steps that will help us stop getting undesirable results?” Identify one big idea for action
  21. 21. Step 3 what are the first steps that will help us stop getting undesirable results?” Identify one big idea for action
  22. 22. Each table identified one “big idea” as a result of the TRIZ exercise 1 – Training - high quality across the board improve understanding and allow continual improvement 2 - Education and training, national plan that is coordinated 3 - Digital road maps, interoperability between ambulances, trusts and mental health services 4 - Right response to the right person, frequent caller management and transportation, look at a whole system approach that provides the right response - Blue light hubs 5 - Access to crisis care plans 6- National mental health response training that is agreed for all staff and also potential resilience training 7 - Sign Post patients at 999 at the first point of contact as it is likely to impact on their journey 8 - Challenge culture through standardised training and awareness campaigns
  23. 23. Learn and share • What do we do well? • Our biggest challenges • Our current improvement ideas/initiatives • What needs to happen?
  24. 24. Mental health - learn and share
  25. 25. Mental health - learn and share
  26. 26. Analysing data from people who have engaged in the process. Helping to get rid of the stigma and helping people to open up. Focus now on distress brief intervention in children Hearing from the room - Julie Fletcher Scottish Ambulance Service Distress Brief Interventions originated from the suicide prevention strategy 2016, it was a challenge for the Scottish Government and Ambulance Service. Aligned our policy to the strategy and the actions that were important to us. I am passionate about mental health and fought to get the Scottish Ambulance Service involved including first responders along with accident and emergency departments. All have different challenges. The level of engagement in terms of response needed is determined by level of distress. This gave us an alternative to A&E. A&E is not the right place for people in distress. Sterling University researched this. It was found that 14 people brought to A&E went on to take their own lives.
  27. 27. Next steps include having drop down boxes on the e-form rather than having to input manually. The pilot finishes in March, with the evaluation to take place in April. Darren Early, North West Ambulance I want to share my work to combat the complexity and lack of education and training in terms of mental health response. JRCalc guidelines are very long, hard to remember and not user friendly. We’ve developed something that’s usable and simple. Components of mental health assessment on A5 card - based on risk factors not a risk assessment. Risk factors do not generate a score but a conversation as to next steps and treatment. We also made an A4 version that is on the ambulances.
  28. 28. Will Hancock - Mental health stakeholder group As Chair of AACE and Clinical Commissioners Mental Health Stakeholders group I would like you to help us develop the workplan. Co-creation is important in helping the group have a workplan to address the ambulance services concerns in relation to mental health. We are developing five workstreams: What good looks like Integrated urgent and emergency care Face to face work Expanding capacity, capability and resilience Education Take a look at the workplan on your table and take this big opportunity to contribute to shaping the work from the start.
  29. 29. World Café A different table then looked at each element of the five workstreams of the AACE and NACN stakeholder group
  30. 30. World Café Session
  31. 31. The Feedback from World Café
  32. 32. World Café – Feedback for National Working Group 1 – What Good Looks Like Right care – right people - at the right time is foundation and principal for what good looks like. Quality indicators – 80% resistance to having a timed target, needs to shift to the patient experience of quality. Systems – to the person in crisis it is confusing and challenging e.g. 8 different triages in one time, putting mental health professionals into control rooms may be another layer of complexity. It needs simplifying. Cannot just be ambulance service it needs system partners to be more engaged. 3 - Integrated Urgent and Emergency Care Third sector clinical assessments model - 111 999 extending primary care and 24 hours services to mental health. Need an up to date directory of service. Accelerate consistency of services eg street cars not in all ambulance services. Fragmentation is huge, particularly issues with technology – eg not being able to see people’s care plans. Support worker roles can support us as there are not enough across the services. 5 - Face to Face Accelerate the concise interpretation to support practice, make every intervention count. We need to stop ‘Pilotitis’, 136 targets for the ambulance service and an approach that thinks one size fits all. We need to collaborate on multi agency basis around significant incidents. Better care plan access and national bank of good ideas. 6 - Expanding Capability, Capacity and Resilience We need dedicated 24/7 resource and speciality roles - take the care to the patients and use technology better to help to stop duplication. Stop silos and default conveyance, do not just go with the default. If it was working we would not be sat here looking for alternatives. Collaborate and start working with partners and sharing the evidence 7 - Education Need to consider if education can then lead to specialist roles. National repository for information would be good. Whoever picks the phone (111-999) needs the skills - usually these people are non clinicians (give these people the skills they need and desire). We need to rethink, hear and treat, see and treat, differently. Not all have the key skills that we need for patients with mentalill health. Involve patients and carers as it is important. Simulation for existing staff and understanding for student paramedics what training they need NHS Horizons will compile full feedback report for National Working Group
  33. 33. What’s my offer? • There is huge value in sharing and connections • We asked people to think - What can I offer the room? – As a result of my knowledge and experience? – As a result of my experience? – As a result of my conversations today? • Also does anyone in the room want some help from others? NHS Horizons will compile the offers of services and individual support with regard to Mental Health and share these across the attendees.
  34. 34. What's My Offer?
  35. 35. Action planning We asked attendees to move to their ambulance service teams with critical friends and do some action planning. Questions that were asked included: • What are the implications from today for our service? • Who do we need to engage? • What are our next steps? The teams captured actions in real time – local and collaborative
  36. 36. Service action plans Individual action plans were drawn up by each ambulance service. These will be shared to ensure learnings and connections are implemented
  37. 37. All our power together, now is the time to make some amazing things happen. Our commitments will take us forward. Thank you all for your fantastic contribution. Lived experience, let’s stick with the essence of that to motivate us, to connect people together and keep the conversation going. Helen Bevan Thinking through next steps
  38. 38. Commitment line
  39. 39. Today has been amazing - a really good day sharing and learning. Great to see the passion for mental health support. It’s easy to become siloed – we need to stop that. Lets work on moving forward to break down the barriers, share the learning. Thanks everyone for a great day. Final thoughts Carl Betts, Paramedic and Quality Improvement Fellow Yorkshire Ambulance
  40. 40. Twitter stats