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Urgent and Emergency Care Summit 2018 London IIMHL


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Urgent and Emergency Care Summit co-hosted by East of England NHS Trust and Dr. Caroline Dollery and RI International and David Covington

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Urgent and Emergency Care Summit 2018 London IIMHL

  1. 1. Day 1
  2. 2. “Keep pushing!” The key word is building… Momentum Dr. Caroline Dollery 30%of calls to hospital service and law enforcement in UK are psychiatric crises “Jeremy Hunt announces Zero Suicide ambition for the NHS.” Top public goals for the UK NHS: #1 Urgent Care #2 Mental Healthcare
  3. 3. “Why do we tolerate this?” Shunting people around, waiting in search of a crisis support… PsychBoarding Build a sense of a moral imperative. Audacious commitment “Social movement of change. Prideand excitement.” Crisis care concordant contains a set of consensus principles. Now, we need a significant investment of resources crisis and support Equal Access to Treatment and Support
  4. 4. “Resolution is the goal” From agitation and crisis to a state of … Comfort Dr. Michael Hogan “I’ve led policy for three years and I sometimes don’t know where? someone in crisis is supposed to go.” Bobby Pratap “People want services that are simple, kind, Human.” Vicki Nash, MIND UK It’s time to raise expectations, through Political Activation and Systems Leadership Where are we now?
  5. 5. commissioning (verb) Minimally adequate crisis resolution system. our target
  6. 6. “We’re using the word recovery much more often.” Dr. Caroline Dollery “We Standardize care for an MI, time for MH.” Dr. Charles Browning “We need to collaborate with Community Assets and partners.” Dr. Caroline Dollery “Crisis is Hard Work. How do we resource and support our teams?” Dr. Charles Browning
  7. 7. Export Idea
  8. 8. Export Idea
  9. 9. “bona fide social movement… ready to roll” Theory of change in complex systems… “Speed and time matter” “Frankly, it’s unstoppable.” Steve Mallen, Founder and Father
  10. 10. Enough already… be the change.
  11. 11. “So distressing” The description of seeking crisis services… A&E Caroline Meiser-Stedman Ultimately, it’s about hopeand connection. Shari Sinwelski “Like Zero Suicide, the solutions must be , Baked In.” Becky Stoll People in crisis need a safe place… a Sanctuary Aly Anderson
  12. 12. While, Kapur et al (Lancet) Madelyn Gould (Columbia) Let’s build on the research base.
  13. 13. 14 hours in a police custody cell changed his perspective on MH crisis Sergeant Paul Jennings “Thank you ma’am may I have another?” Detective Sabrina Taylor “We need more triage destinations than ambulance and hospital EDs” Dave Partlow, Ambulance Service Rural issues require creativity. To gain real partners, MH’s answer must simply be “yes.”
  14. 14. “What people need is a commonsense approach to wellness” Steve Miccio “This is a proper role that needs valueand respect” Aly Anderson “Deliberate and strategic intervention worked for me, TrevorLifeline, a friend & 48 hours of safety.” Misha Kessler “ Two crisis experiences: the first provider kept me alive… the second helped me become Well” Sarah Blanka
  15. 15. Day 2
  16. 16. commissioning (verb) Crisis is one of the toughest jobs out there. Let’s make it one of the most rewarding, most effective.
  17. 17. Business Case for Crisis Continuum 1. Why do we have to make a business case? Does medical? Cost of suicide is immense. 2. Reality: We must do as RAID for consultant liaison (invest $1, save $4, net $3) 3. Bobby and Brian began crunching the numbers, with tens of millions in savings for hospitals and law enforcement in UK & US.
  18. 18. AnyBigCity, USA Pop. 4m Dimensions Risk of Harm Functioning Co-Morbidity Environment Treatment History Engagement
  19. 19. 200 persons in crisis per 100,000 persons in your community on a monthly basis. Total Pop. Divide by 100k and multiply by 200 What do they look like clinically? Monthly Crisis FlowCommunity Individual, Friends, Family Walk-In Primary Care & Social Services Police Crisis Line & Mobile Community Crisis Flow STEP Most all community crisis referrals flow through the hospital ED. Compute your crisis system flow. Greater Phoenix 4m 8,000 LOCUS Levels of Care STEP What do they look like clinically? Stratified Crisis Need STEP The typical LOCUS distribution for community crisis flow. Clinically Matched Care STEP Do you have the crisis continuum capacity to meet the need? % whose assessed need matched their linked crisis service Hospital ED
  20. 20. Clinicians are Human. We must review the process after a loss, but also support (just culture). Jamie Sellar The important thing following a loss: Society caresand resources are provided. Steve Mallen “These are the words in my vocabulary: Courage, speak out, action, belief.” Dr Sharon McDonnell Suicide Postvention
  21. 21. Breakout Session 1 DirectServices Policy/Business PeerIntegration LawEnforce Breakout Session 2 Breakout Session 3 Breakout Session 4
  22. 22. Breakout Session 1 Policy/Business
  23. 23. DirectServices Breakout Session 2
  24. 24. PeerIntegration Breakout Session 3
  25. 25. LawEnforce Breakout Session 4
  26. 26. Report Title: Be the Change: Ensuring a Minimally Adequate Crisis Resolution System Key Themes/Elements: 1. Integrated, systematic approach at the national level (END FRAGMENTATION) 2. Includes a single national 3 digit crisis hub #, which drives easy access A. Where all callers are welcome and the crisis is defined by the caller, whether the user, family, friend or professional B. And, includes promotion and intelligent social media to get the word out Summit Product Development
  27. 27. Key Themes/Elements (con’t): 3. Includes crisis services alternatives to formal mechanisms and/or psychiatric inpatient, including: A. Shorter stay crisis facility services (e.g., Crisis Stabilization, Temporary Observation, Living Room, Crisis Houses) B. Community Crisis Response (e.g., Mobile Crisis Teams) 4. Requires a significant investment 5. Special consideration to veteran population 6. Requires an integrated HIE-capable technology (we can track a parcel worldwide but lose people locally) Summit Product Development
  28. 28. Key Themes/Elements (con’t): 7. Meaningful data/outcomes which are displayed through balanced scorecard dashboards and leveraged for CQI 8. Include users/peers and carers in the design/leadership of crisis systems 9. Better integration of peer supports staff in crisis services delivery 10.Own Zero Suicide Model/Aspiration 11.Engage “family”/friends in crisis care (don’t hide behind privacy) Summit Product Development
  29. 29. Let’s disrupt the status quo. Focus on saying yes. Mission: Crisis includes triage and referral/linkage to supportive ongoing services. But, it’s far more. Kindness with emotional intelligence at the moment of crisis reduces distress. A “ministry of presence” that focuses on engagement and collaboration increases comfort and strengthens autonomy and recovery. Summit Product Development
  30. 30. Future Event Planning •2nd Urgent & Emergency Care Summit 2019 (Washington, DC ???) •5th Zero Suicide International Summit 2020 (United Kingdom ???)
  31. 31. 100% Access in a crisis Zero Suicide in healthcare &