CYPMH conference 2016 Future in Mind Vision to Implementation Developing a Successful Crisis Response Team for Young People - Clare Anderson and team (Tees, Esk and Wear Valleys NHS Foundation Trust)

1. Durham & Darlington
CAMHS Crisis & Liaison Team
Clare Anderson – Clinical Nurse Specialist

2. Rationale
 Suicide is the second most common cause of death for
young people, but globally the most common cause of
death for female adolescents aged 15–19, and yet it is
preventable.
 The UK has one of the highest rates of self-harm in
Europe (at 400 episodes per 100 000 population)
(Hawton et al, 2012a).

3. Prevalence

4. Aims of the service
 The service is for Children & Young People including those with a
learning disability, up until their 18th birthday and presenting with
an acute mental health need that requires an urgent mental health
assessment and plan of care
 Develop a flexible & responsive service to meet the needs of
Young People experiencing a mental health crisis.
 Reduce waiting time for Psychiatric assessment when young
people are in crisis.

5. To provide high quality Nurse led mental health care
which includes:
 Open access
 Initial assessment appointment – which we will aim to commence
within 1 hour of referral being received by our service. (4 hours
max)
 Comprehensive mental health and risk assessments
 Intensive support within the home/appropriate setting for up 72
hours post assessment or until the risks are contained.
 Telephone support 8am-10pm
 Liaison and consultation with other professionals and members of
the children’s workforce
 Training to other services and professionals

6. What it looks like:
 Nursing team - 7 staff
 In operation since May 2014
 8am – 10pm 7 days per week
 Area covered is all of Durham and Darlington*
 Service available to any young person under 18 years
 Only referral criteria is that the presenting issue must
be mental health crisis

7. Locality – May 2014 – February 2016

8. Referrer – May 2014 – February 2016

9. Wait times – May 2014 – February 2016

10. Reduction in use of Paediatric beds
 From a total of 1176 assessments conducted by the Crisis
Team, 711 were assessed within County Durham &
Darlington foundation Trust sites of Darlington Memorial
Hospital and University Hospital North Durham.
 Of these, 50% (356) were assessed on the paediatric wards
due to admission to hospital outside of crisis team working
hours or unable to be assessed in A&E due to medical
needs. (24 hour service would reduce bed use further).

11. Reduction in use of Paediatric beds
 The remaining 50% (355) were assessed in the A&E
department. Of the 355 assessed in A&E by the CAMHS
crisis team, 54 young people were subsequently admitted to
a ward.
 Between 21.5.14 and 29.02.16, the crisis team were able to
free up 301 overnight beds that would otherwise have been
used whilst young people awaited a duty mental health
assessment the following day

12. Increase in crisis assessments in the
community
 In addition, of the 465 presentations assessed outside
of acute hospital settings, 352 individuals presented
with suicidal ideation, panic attacks or threats of self-
harm. Traditionally, presentations such as these would
be directed to A&E, so the presence of the crisis team
has alleviated pressure on A&E departments within the
county by an additional 352 presentations.

13. Case Examples
 Young person attended GP with low mood and suicidal thoughts –
crisis assessment in GP surgery within hour of referral
 School teacher concerned about self harming behaviour of pupil –
concerned about deteriorating mental state – crisis assessment within
school
 Adolescent girl involved in near hanging – assessed in A&E and
followed up on ward.
 Young girl who had disposed of stillborn baby in bin – assessed on
ante-natal ward.
 Police concerned about mental state of young person after being
called to domestic incident – assessment with police at home.
All young people offered follow up visit next day after assessment to
forward plan.

14. Emerging outcomes/benefits
 Reduction in 653 overnight beds
 Reduction in time waited for young people and families
 Increase in service user & partner agency participation to
shape service
 Increase in community assessments
 Identifying risks earlier
 Increase in multi agency working
 Developing new practice
 Empowering partner agencies by support and training

15. Training & Development
 Police training
 GP’s
 Local authority care home staff training
 Independent Reviewing Officers
 Supported lodging providers
 Foster carers and fostering officers
 Work with ‘hard to reach’ groups

16. Service Developments
 Crisis care plan work
 Post suicide support
 Targeting ‘hard to reach’ young people
 Joint work with police & schools
 Awareness raising for support available
 Supervision and support to professionals affected by suicide

17. Young people’s feedback and
participation
 Investing in Children Agenda days involved in helping
develop service – including ‘hard to reach’ vulnerable
groups
 Every young person/family receives feedback form and
suggestions are acted upon
 Young person and parent have been involved in
recruitment and presentations to award judges

18. (Nearly) 2 years on….
 Winner of 3 awards:
• Positive Practice in Mental Health
• Nursing Times Awards
• Contribution to Medical Development
 Shortlisted for 3 more:
• National Patient Safety Awards
• Trust Award for Developing Excellent Services

19. Future plans: 111 developments
 Working with 111 commissioners
 Enhance the current service to include call transfer to
CAMHS crisis service
 Potential reduction in ambulance use
 Potential reduction in A&E attendance
 Increase in early CAMHS support
 Extension to 24/7 working

20. Thank you.
Any Questions?
clare.anderson1@nhs.net