Independent review highlights innovations in mental health crisis care in the West Midlands

Posted on 17 November 2016 (Permalink)

An independent audit of one of the innovative workstreams undertaken by the West Midlands Academic Health Science Network (WMAHSN), showing impressive benefits to mental health patients, police and the NHS, has been published.

WMAHSN commissioned GE Finnamore to undertake an independent innovation assurance audit of the RAID programme, the psychiatric liaison service for acute trusts. Originally developed by Birmingham and Solihull Mental Health NHS Foundation Trust, the WMAHSN has driven the uptake of RAID across other trusts in the West Midlands and beyond.

RAID involves rapid assessment of patients so that they can receive appropriate interventions for their physical and mental health, either in the community or in hospital. The team operates on a 24/7 basis, with the aim of assessing patients within one hour of presenting at A&E and within 24 hours if admitted to the hospital.

While a number of previous evaluations have taken place of RAID and its impact, this new report examines the benefits of the innovations arising since the original RAID implementation and which are unique to the West Midlands.

The report focuses on five key innovations: the service for Section 136 patients, which involves intentional scouting across the hospital for Section 136 patients to provide more appropriate care in a ‘place of safety’, making hospital transfers more straightforward; the Street Triage service, which provides a team comprising a police officer, a paramedic and a mental health nurse in a mobile unit operating as a ‘blue-light’ service for mental health crises; the establishment of a Psychiatric Decision Unit to assess patients away from A&E; the RAIDPlus Test Bed programme, which offers live capacity and demand modelling, a patient portal, teletriage and a focus on prevention of people getting into crisis; and education and awareness training for clinicians and nursing staff to raise the profile of mental health in the pathway.

Overall, the audit found that there was a cost-saving to the NHS of up to £5 for every £1 spent on the RAID programme, as well as a financial benefit in police time diverted to escorting A&E patients. The strong ‘intentional scouting’ function searches the hospital for Section 136 patients and takes them as soon as they are ready to be moved on from their current point of care in the hospital, and the West Midlands was the first area to include a paramedic as part of the Street Triage team, which has brought significant benefits to the operational delivery of the service.

Patient care was also improved, with support for Section 136 patients provided much quicker due to proactive approach to find such patients in the hospital system, repeat users of the Section 136 service identified and other service interventions put in place to support them, saving time and money, or avoiding Section 136 cases altogether by the Street Triage team dealing with patients early in their mental health episode. The report also found that the tele-support and mobile workforce enabled staff to move resources as required to deal with ‘hotspots’ across hospitals.

Inter-agency collaboration and support has delivered significant benefit for the patient in providing timely physical and mental assessment and care, often in the patient’s home. The Psychiatric Decision Unit has been effective in reducing A&E attendance and lengths of stay, and ensuring patients receive care in the most appropriate setting. Mental health issues are also more widely understood across NHS trusts and while some patients require to be seen by RAID teams, others are benefitting from receiving care from mainstream physical health teams trained in RAID principles.

Tony Davis, Commercial Director of WMAHSN, said: “This report includes how the introduction of innovation, combined with the transformation of clinical practice, has delivered improved healthcare outcomes and other benefits for patients through adoption and diffusion of groundbreaking best practice.

“Although RAID is now a national initiative and is repeated elsewhere, the report has found many additional innovations from the programme which are unique to our region, and which are already showing additional benefits for all of the agencies involved, as well as for patients.

“In the future, this report shows that although it is only at an early stage of development, the RAID Plus programme will further enhance the existing, well-proven RAID model of care.”

You can read the innovation audit report on RAID on the WMAHSN’s website.