This document discusses mental health (MH) related unscheduled care attendances in Scotland from 2014/15 to 2018/19. It notes that the proportion and numbers of emergency department (ED) attendances related to MH issues have been increasing each year. People with MH presentations are more likely to live in deprived areas and be conveyed by ambulance or police. They are also twice as likely to breach the 4 hour waiting time standard in ED compared to other patients. The document proposes several actions to improve the MH unscheduled care pathway such as developing distress intervention groups for collaborative multi-agency crisis response and linking unscheduled and MH care leads to analyze local data and service use.

1. Scotland’s Mental Health Strategy
& Unscheduled Care
J Kerr
Senior Medical Officer
Scottish Government

2. MH Attendances
Financial Year
ED Attendances
(All Sites)
ED Attendances
(Episode Level
Data1
)
MH Attendances1
Proportion of
Attendances with
MH Diagnosis1
2014/15 1,639,991 1,535,934 37,944 2.5%
2015/16 1,606,682 1,505,042 42,089 2.8%
2016/17 1,622,272 1,522,477 45,878 3.0%
2017/18 1,645,849 1,551,190 55,456 3.6%
2018/19 1,691,952 1,598,651 63,891 4.0%

3. Continuous Unscheduled Care Pathway
(CUP)
• N NHS24
• O OOH Primary Care
• S SAS
• E Emergency Department
• A Acute Medicine I/P
• M Mental Health I/P

5. More likely to live in the most deprived areas in Scotland at 42%
(compare to non-MH-related attendances at 29% in most deprived areas)

6. • Half of the pathways for people
attending ED with MH problem
involve an ambulance (28% attending
for other reasons)
• For those pathways that involve an
ambulance, 12% involve a police
officer on scene

7. Attendance numbers & 4 hour standard
ED
Attendances
(Episode
level data)
Breaches
(Episode
level data)
Breaches
(%)
MH
Attendances
Breaches
(number)
Breaches
(%)
1,598,651 147,977 9.3% 63,891 12,473 19.5%
Financial Year 2018/19

8. MH Unscheduled Care Performance
• MH presentations are approx. twice
as likely to breach the standard as any
other patient
• MH presentations are more likely to
breach overnight, irrespective of the
lower numbers of attendances OOH
• MH presentations breach waiting for
specialty assessment or for first (ED)
assessment rather than waiting for a
bed (the most frequent breach reason
for all other conditions)

9. 0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017 Q4 2017 Q1 2018 Q2 2018 Q3 2018 Q4 2018 Q1 2019
CAMHS seen PT seen CAMHS seen <18wks PT seen <18wks

13. Action 15

14. Action 15

15. Next steps
• Whole system approach to MH services
• Analyse local data
–NOSEAM
–nature of presentations
–in-hours vs OOH
–?distress
• Link UC leads with MH leads
• Action Effect Diagram

17. Distress Intervention Group

18. Distress Intervention Group
• Collaborative multi-agency response to distress
• Non-medicalised response; right individual, right time, right place
• Focus on effective triage; ACPs; Community distress response
• Sustainably link individuals to appropriate service
• Complements DBI work
• Reduce unnecessary police and ambulance conveyance
• Reduce ED attendances
• Improve individual and staff experience

19. Individual
in
CRISIS Police
Ambulance
Access to Mental Health Services
People and Places of Safety
ED
Fire and Rescue
MH Unit InpatientPolice—Custody
Suite
OOH Primary Care
Acute Care
Triage
111
101
NHS
24
Crisis Prevention
Community
Services
Rescue
Community
Services
Rescue
Home
Relapse Prevention

20. Individual
in
CRISIS
Police
Ambulance
Access to Mental Health Services
People and Places of Safety
ED
Fire and Rescue
MH Unit InpatientPolice—Custody
Suite
OOH Primary Care
Acute Care
Triage
111
101
NHS
24
Crisis Prevention
Community
Services
Rescue
Community
Services
Rescue
Home
Relapse Prevention
Community
Hub

21. Thank you