The document describes improvements made to mental health crisis services in Bradford, UK. Key changes included establishing a 24/7 first response crisis service, integrating intensive home treatment and A&E liaison teams, opening crisis centers like the Sanctuary and Haven, and strengthening partnerships between health, social care, police and third sector groups. These changes resulted in fewer acute out of area placements, reduced A&E attendance and police detentions, and better outcomes for patients.

1. You & Your Care
www.bdct.nhs.uk

2. You & Your Care
www.bdct.nhs.uk
Case for change – 2014
• OOH services only to known MH patients at restricted hours
• IHTT high number of crisis calls
• Inpatient bed base over capacity and regular use of OOA area
acute treatments
• A+E’s reporting patients presenting in health and SC crisis
• Police detaining people in cells for long periods
• GPs reported multiple referral routes and poor access
• AMHP’s overstretched
• Rates of stay in acute care too long
• Negative feedback from patients

3. You & Your Care
www.bdct.nhs.uk
How the whole system developed
• BDCFT set up FRS & redeveloped Acute Care
• LA redesigned Social Care, AMHP + DTOC
• Police support services + training developed
• Third sector partners set up alternatives
• Housing options redeveloped
• Criminal Justice brought into FRS
• Crisis care Concordat driver for change and
accountable for actions

4. You & Your Care
www.bdct.nhs.uk
Partnership with the Police
• MH training for all officers
• Joint planning and mtgs
• Criminal Justice Liaison
• ASB & community links
• Health & Social Care staff in
Police Control room
• NHS Community constables

5. You & Your Care
www.bdct.nhs.uk
Summary of benefits – 2016
• First Response 24hr Crisis service
• NHS & Social Care Intensive Home Treatment
• Integrated A and E Liaison team linked to ‘Haven’
• Police Hub team & Police Triage response
• MIND Sanctuary Project & The Haven
• Social care respite and housing integrated into service
• MH & PH parity with the Bradford Tool

6. You & Your Care
www.bdct.nhs.uk
Sanctuary
• The Sanctuary is operated by Mind in Bradford, in partnership with
‘Sharing Voices’ and ‘First Response’. This service is open 365 days a
year from 7pm – 1am
• The Sanctuary is open to people 18 years and over
• Experience anxiety or panic attacks
• Suicidal thoughts and feel unsafe, but do not intend to end their life
• Have self-harmed but do not require medical attention
• Are disassociating
• Are intensely depressed
• Hear voices but know that the voices are not real
• Experience Post Traumatic Stress Disorder
• Feel overwhelmed and unable to cope
• www.crisiscareconcordat.org.uk/.../the-sanctuary-at-mind-in-bradford/

7. You & Your Care
www.bdct.nhs.uk
Haven
• Haven is a new 365 day a year service at the Cellar Trust
• Opens 10am – 6pm
• Aim: A&E diversion
• Gate kept by FRS
• IHT Duty sit within the service
• Emphasis on peer support from people with lived expertise
• Aim is to support people in distress and work with them to
develop their plans to stay well and cope better with distress
in the future
• www.thecellartrust.org/client-services/haven

8. You & Your Care
www.bdct.nhs.uk
Safer Spaces
• Safer Space CYP service plan to stay for one
night
• Available seven days a week, 365 days a year,
from 10pm to 10am
• Offers support for young people under 18 years of
age, in crisis and struggling with emotional
distress living in Bradford, Airedale, Wharfedale or
Craven
• Gate kept by FRS
• http://www.bdct.nhs.uk/ss

9. You & Your Care
www.bdct.nhs.uk
Outcomes and Improvements
• No Acute OOA placements 22 months
• Reduction in MH attendance at A and E
• Reduction in use of s136
• Reduced average length of stay
• DTOC to zero for 7 months
• Diversion from custody + reduced use of cells

10. You & Your Care
www.bdct.nhs.uk
Lessons Learnt
• Relationships and trust are vital
• Communication and Involvement
• Having a clear agreed vision underpinned by partnership
agreement
• Integrated services are key to success
• Shared ownership and responsibility when things go wrong.
• Shared ownership and responsibility when things go right.
• Constant reflection, evaluation and planning.

11. You & Your Care
www.bdct.nhs.uk
Mental Health Liaison
• Core 24
• Integrated and partnership approach
• Expansion on In reach into Acute Hospital
• Training for ED Clinical Staff
• Front door triage