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

1. Day 1

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. “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. “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. commissioning (verb)
Minimally adequate crisis
resolution system.
our target

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. Export
Idea

8. Export
Idea

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. Enough already… be the
change.

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. While, Kapur et al (Lancet) Madelyn Gould (Columbia)
Let’s build on the research
base.

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. “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. Day 2

17. commissioning (verb)
Crisis is one of the toughest
jobs out there.
Let’s make it one of the most
rewarding, most effective.

18. 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.

19. AnyBigCity, USA
Pop. 4m
Dimensions
Risk of Harm
Functioning
Co-Morbidity
Environment
Treatment
History
Engagement

20. 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

21. 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

22. Breakout
Session 1
DirectServices
Policy/Business
PeerIntegration
LawEnforce
Breakout
Session 2
Breakout
Session 3
Breakout
Session 4

23. Breakout
Session 1
Policy/Business

24. DirectServices
Breakout
Session 2

25. PeerIntegration
Breakout
Session 3

26. LawEnforce
Breakout
Session 4

27. 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

28. 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

29. 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

30. 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

32. Future Event Planning
•2nd Urgent & Emergency Care Summit 2019
(Washington, DC ???)
•5th Zero Suicide International Summit 2020
(United Kingdom ???)

33. 100%
Access
in a crisis
Zero
Suicide
in healthcare
&