Compassionate triage has proven successful in Birmingham and it could be rolled out elsewhere.
The Care Quality Commission today underlined the damage caused by relying on hospital A+E wards for delivering mental health crisis care. But there are many parts of the country that have found alternative ways of supporting people.
We would perhaps all do well to look for lessons from the approach taken by the Birmingham and Solihull Mental Health Trust. Seven years ago the Trust launched a new scheme, embedded in all the city’s hospitals. It’s called RAID, which stands for Rapid Access Interface and Discharge, and has had a telling impact on the crisis care experiences of people with mental health conditions in the area.
"People are spending less time in the unsuitable surrounds of A+E."
Since it was introduced, the Trust say sectioning under the mental health act has decreased locally and police cell detentions have gone down to zero in some years. People in crisis are spending less time in the unsuitable surrounds of A+E and are being connected to appropriate mental health services far quicker than they had been previously.
Mental health experience on the front line
Mark Hillier, responsible for service user care and public engagement at Birmingham and Solihull Mental Health Trust, explains how it works. “When we launched, it was about putting a team with strong mental health experience into all the acute hospitals in Birmingham. Although it’s centred on A+E it actually works across the whole hospital. So if someone comes into A+E with a mental health problem there’s someone dedicated, a nurse or a doctor, who can help them. They will establish and understand what brought them there and the options for further treatment, then put them in touch with care that can properly help.”
“The other role the RAID representative has is to go around the hospital looking out for people who have got mental health issues. Maybe this will be people on regular wards who aren’t getting the treatment they should be getting from the Mental Health Trust. Or it could be older people, particularly people with dementia, who’ve come in from a fall or a trip, and we realise that they should be with a specialist mental health team. They can be isolated as well; so we work out how and where they can be better integrated.”
'People said it couldn't happen'
Government has a role to play, but we can all shape the mental health care models we want to see in the future. Hillier recalls the conversations he had with mental health service users when he first joined the Birmingham and Solihull Trust close to twenty years ago. “They asked us, ‘Why can’t we have a place when we’re not well, operating 24/7, that will triage us, assess us and help us get the services we need?’”
“I think back then people almost laughed at them and said ‘oh no, it couldn’t happen, we don’t have the money, it would be too difficult to provide the service, particularly at night.” It was interesting how it evolved about ten years later. Commissioners were looking at the money side of things again and they realised that actually this is a solution to some of the problems we’ve got.”
"Government has a role to play, but we can all shape the mental health care models we want to see in the future."
“One of our consultants, Professor George Tadros [a psychiatrist], was involved with the model and he’s led it along the way. I’ve become more involved recently as I’ve looked to refine the product. RAID Plus will take it a stage further; looking at people who very frequently come to A+E - even if they know there are other options - and reviewing why they keep coming back to A and E, why they find themselves in crisis on a very regular basis and why the nurses around them can’t prevent this happening.”
“People or organisations who want to emulate this model elsewhere in the country need to voice it, that’s really important. There are forums for service users, providers and commissioners alike such as the Mental Health Today event in Wales. You’ve got to talk cross-sector. It can’t just come from the acute hospital or the mental health trust, you’ve got to get talking. Charities and third sector organisations have got a big role to play too. I know that our commissioners in Birmingham are now talking to the third sector about re-establishing crisis houses. I can see those coming in again, as an alternative to hospital.”
The Samaritans can be reached 24 hours a day, seven days a week, by calling: 116 123.