October 2009

 

Pilot Police Custody Liaison & Diversion Service for

Eastern and Coastal Kent PCT area and Medway PCT area

 

 

Service Manual

 

 

Contents

 

 

-     Introduction

-     Background information

-     Current quality gap

-     “Hub and spoke” structure

-     Resources

-     Staff organisation

-     Referral criteria

-     Exclusions

-     Proposed referral sources

-     Operating schedule

-     Quality and cost

-     Requirements for success

-     Expected benefits

-     Expected outcomes

-     Clinical targets

-     Required outcomes (defined by commissioning)

-     Measurement of service (defined by commissioning)

 

 

 

Appendices:

 

1          Assessment forms (CPA 1, 2 & 4)

2          Court report form

3          Consent form

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Service Model

 

Introduction

 

This service model describes an eight month pilot programme to scope a model for a recurrent service required for the delivery of police custody suite and court liaison/diversion mental health services in the Eastern and Coastal Kent PCT area and Medway PCT area.  Subsequently, a tender to operate a recurrent service will be submitted.  The service will be active for 6 of the 8 months allowing a one month service lead-in time and a one month service evaluation, audit and write-up time.

 

The key driver of this pilot programme is to prevent inappropriate disposal of offenders with mental health problems (including learning disability) into custody. At present, people in these areas with mental health problems who come into contact with the criminal justice system do not have access to a police custody suite or court diversion scheme.

 

This pilot programme will undertake an eight month evaluation of the mental health needs of individuals detained at Ashford, Dover, Folkestone, Swale, Canterbury, Thanet and Gillingham police custody areas and provide an assessment of the ‘added value’ of the forensic mental health service provided as part of the pilot. The pilot service will enable timely access to a dedicated forensic community psychiatric nurse, consultant forensic psychiatrist and onward referrals to other relevant statutory and voluntary agencies in the health and social care arena.  Of particular note, the service will provide a link between secondary care community mental health teams and primary health care agencies. Providing advice to courts and the probation service on the mental health needs of individuals will assist in diversion away from custody where appropriate and access to care and / or treatment through liaison.

 

Key characteristics of people within the criminal justice system include:

 

• They are often socially excluded
• They have significant health and social care needs
• They suffer from health inequalities

 

The criminal justice system can act as a gateway to health services for a population who find it hard to access appropriate mainstream health and social care services, for a number of reasons. It can present a particular opportunity to make a significant contribution to the health and well-being of an excluded proportion of our society. An offender may receive a custodial sentence when a community order with a treatment requirement or admission to hospital would be more appropriate.

 

Background information

 

Custody liaison and diversion schemes in the United Kingdom started operating in the early 1990s to meet the objectives set out by the Home Office (1990) and the Reed Report (Reed, 1992). Their aim is to provide appropriate intervention for people with mental disorder charged with a criminal offence, in the least restrictive environment according to risk assessment and the direction of a magistrates court.

 

The primary function of court diversion is the transfer of people with mental disorders from the criminal justice system to hospital, if their condition warrants it (James, 1999). Prosecution is not necessarily discontinued. The defendant may be admitted to hospital under a section of the Mental Health Act 1983. A court diversion scheme can also provide a liaison service, in which people with mental disorder facing minor summary charges who would not be incarcerated can be referred to community agencies and services, if their condition does not warrant their admission to hospital. Police custody areas provide a convenient and timely opportunity to assess defendants.  Law dictates that individuals charged with a criminal offence must appear before magistrates early in the criminal justice process, to be remanded either on bail or in custody.

 

Schemes have found high rates of alcohol and drug misuse in referred individuals, amounting to approximately a third of referrals in Glasgow (White et al, 2002) and Leeds (Greenhalgh et al, 1996). The proportion of people diagnosed with a major mental illness varies greatly between published studies, and may reflect the threshold of suspicion in the person making the referral. In a study of the East Sussex Court Assessment and Diversion Scheme (Kingham and Corfe, 2005), referring agencies generally recognised the presence of mental disorder reasonably accurately in the people they referred, so that 70% of those referred warranted a diagnosis. However, it was not known how many people with mental disorder were unrecognised as such and not referred to the scheme. A study conducted in Manchester examined whether defendants with mental disorder were reliably detected by court staff and referred to the court diversion programme (Shaw et al, 1999). Only 14 of 96 defendants from overnight custody with serious psychiatric disorder were detected and referred by court staff. Considering this low rate of detection, the authors suggested that screening questionnaires and training might increase the rate of detection.  Given this and the high rates of disorder found in a psychiatric morbidity survey of remanded prisoners (Singleton et al, 1998), it may be that although court diversion schemes are successfully identifying a proportion of people with mental disorder and diverting some away from the criminal justice system, a substantial number are not identified, and others are deemed unsuitable for diversion.

 

Regarding short-term outcome, the success of the East Sussex Court Assessment and Diversion Scheme was demonstrated by completed diversions to either community or hospital treatment, as recommended (Kingham and Corfe, 2005).  Regarding medium and long-term success, James et al (2002) studied 214 admissions through the courts in central London, the Horseferry Road and Clerkenwell schemes, comparing them with a sample of 214 matched compulsory admissions from the community.  They examined the outcome of admission through the courts in terms of the admission episode, readmission and reconviction rates within 2 years of discharge: 81% of admissions from courts reached planned discharge, with no significant difference between court and community admissions; 86% reached satisfactory clinical outcome at discharge, again with no significant difference between court and community admissions.  There were similar readmission rates between the two groups and relatively low offending rates compared with individuals given other disposals by the court.  James (1999) found that three court diversion studies prepared for publication had admission rates of more than 25%, and indicated a wide variation of admission rates in others, with some schemes not diverting any cases to hospital. Few schemes were able to achieve admission to locked beds. The East Sussex scheme had an admission rate of 7% between 2000 and 2002, with the majority of recommendations for admission being accepted (Kingham and Corfe, 2005). Admission to secure unit beds was not uncommon.   Although James (1999) considered that courts tend to deem community disposal inappropriate, the study by Kingham and Corfe (2005) found that courts generally accepted recommendations for referral to community psychiatric or substance misuse services.

 

The Maidstone and South West Kent Custody/Court Liaison Service commenced in April 1996.  It is based at the Trevor Gibbens Unit and forms part of the directorate of the Kent Forensic Psychiatry Service.  It provides a service to Maidstone and Tonbridge police stations and input into the related magistrates’ courts.  The staff team consists of three experienced forensic community psychiatric nurses and one forensic social worker, who work within the scheme on a daily roster.  The two police custody areas are the primary source of contact.  Staff telephone each custody area every weekday morning, at around 7.30am or earlier.  Police officers appraise staff of detained persons, and staff undertake assessments as required.  In the first year of the operation of the service, staff visited each police custody suite on a daily basis to ensure a high level awareness of the service and assist police custody staff to identify and refer appropriate people.

 

After performing an assessment, the practitioner completes a standardised assessment form, a copy of which is provided to appropriate agencies to enable referral.  The practitioner is in a position to co-ordinate specific interventions from relevant agencies via locally determined resources.  Approved mental health professionals on call in Maidstone, Tonbridge, Tunbridge Wells and Sevenoaks community mental health teams co-ordinate Mental Health Act assessments following a referral.  The Trust’s crisis resolution and home treatment teams accept direct referrals for access to their service.  In cases where the detained person is likely to be remanded into custody for whom secondary mental health outpatient care is identified as appropriate, the practitioner will make a referral to the Prison In-Reach Service, a limb of the Kent Forensic Psychiatry Service Directorate.

 

A National Service Framework for Mental Mealth (Department of Health, 1999) set seven Standards in five areas.  Those five areas were: mental health promotion; primary care and access to services; effective services for people with severe mental illness; individuals who care for people with mental health problems; action necessary to achieve the target to reduce suicides.  Standard four (within the area of effective services for people with severe mental illness) states that all mental health service users on the CPA should receive care which optimises engagement, prevents or anticipates crisis and reduces risk.

 

Five years later, Standards for Better Health (Department of Health, 2004) set the following priorities:

·         Safety of patients

·         Clinical and cost effectiveness

·         Governance

·         Patient focus

·         Access and response

·         Environment

·         Public health

 

It regarded National Service Frameworks and guidance produced by the National Institute of Health and Clinical Excellence (NICE) as being integral to a standards-based system.  The document discussed giving greater scope for addressing local priorities, with an emphasis on local services allocating their resources accordingly.

 

Diversion, a better way for criminal justice and mental health (Sainsbury Centre for Mental Health, 2009), undertook to assess the costs and benefits of mental health diversion schemes by:

 

• Reviewing published evidence, including studies from other countries;
• Visiting 16 diversion schemes in England;
• Analysing value for money based on the evidence gathered.

 

The evidence collected indicated that well-designed arrangements for diversion had the potential to yield multiple benefits, including:

 

• Cost and efficiency savings within the criminal justice system;
• Reductions in re-offending
• Improvements in mental health.

 

The report notes that existing arrangements seriously under-perform in delivering these benefits.  In the absence of a clear national policy framework, diversion services have developed in a piecemeal and haphazard way.  Many schemes are insecurely funded and there is an “unacceptably wide” degree of variation in their ways of working.  The coverage of schemes is patchy and some areas have no arrangements at all.  The report notes that significant change is needed in national policy and local delivery to improve value for money and to capture more of the benefits of diversion.  The report makes 21 recommendations for the commissioning, operation and management of a diversion and liaison team for people with mental health problems who come into contact with the criminal justice system in every PCT area in England, and includes national considerations.

 

The report by Lord Bradley (2009) makes recommendations for individuals with mental health problems and learning disability who come into contact with the criminal justice system, at all stages of legal proceedings.  Tabulated here are some of the key recommendations of the Bradley Report that relate to the operation of the pilot service, and ways in which the service will meet them.

 

Bradley Report recommendation	Activity of the pilot service
Implementation of police “Safer Neighbourhood Teams” identifying and supporting people with mental health problems.	Training for police officers regarding mental disorder.   Maintaining a low threshold for assessing people before the imposition of an Anti-Social Behaviour Order or Penalty Notice for disorder.
Consistent screening for mental health problems and learning disability in police stations with access to information about detainees’ previous contact with mental health services.	Development of a screening instrument which is sensitive and specific.  Electronic patient record at Kent and Medway NHS and Social Care Partnership Trust available to CPNs during screening and assessment.
Mental health service liaison and diversion when appropriate for people with mental health problems.	Core components of service provision: -      identify and assess mental health/learning disability needs swiftly and effectively after arrest; -      assist police in risk assessment; -      identify need for the attendance of an appropriate adult; -      ensure detainees with serious mental health problems are diverted to mental health facilities, avoiding remand into custody; -      signpost people with mental health problems to mental health service, avoiding drop out.
Mental health services in police custody commissioned by NHS	Medway PCT is commissioning this service
Provide information to courts, assisting decision making regarding: -      fitness to plead; -      commissioning a psychiatric report; -      remand; -      sentence (including consideration of mental health treatment requirement in a community sentence); -      transfer to hospital.	Completed assessment proforma to be made available to the court.   Link with other services within the Trust, particularly outpatient services for community sentences, inpatient services for transfer to hospital and the Prison InReach service for remands into custody.
Specialist courts – “mental health courts”, “drug courts” and “drug and mental health courts”.	Examine the case for a specialist court.
Link between police custody mental health and prison mental health services to inform the reception screen and subsequent assessment/management.	Communication will be afforded a high priority.

This is an eight month pilot service, after which there will be a tendering process for continuing a court liaison and diversion service in the Medway and Eastern and Coastal Kent areas.  The pilot will inform and guide the future of court liaison and diversion in Kent, and is likely to highlight the need to expand service provision with greater resources.

 

Current quality gap

 

The provision of mental health services to police custody areas in Eastern and Coastal Kent and Medway is patchy.  At present, there is no dedicated commissioned police custody liaison/diversion service, leaving community mental health teams to attempt to provide this service, with wide variations in resource allocation and success.

Interested parties	Concerns about quality
Patients	Access to care and treatment Appropriate treatment Supportive intervention
Providers	Providing excellence Improving clinical outcomes Reducing untoward incidents
Commissioners	Efficiency Value for money
Fellow professional groups -      Magistrates -      Forensic nurse practitioners -      Forensic medical examiners -      Police -      Probation service	Inappropriate disposal in criminal justice system because of a lack of diversion options Lack of information about a detained person’s mental state Risks associated with continuing detention
General public	Confidence

 

 

 

 

 

 

 

 

 

 

 

 

 

 

“Hub and spoke” structure

 

The “hub” of this structure will be the KFPS base in Maidstone and the “spokes” police custody suites in each of the areas served.

 

Resources

 

Four forensic community psychiatric nurses (FCPNs) at Band 6.  They will be supported by a consultant forensic psychiatrist.  There will be a team secretary.  Office resources and interview facilities will be needed at KFPS base and in each of the police custody suites.  The ability to travel in a timely fashion between sites is essential for clinical staff.

 

 

 

This model will be commissioned according to police custody area, as follows:

 

Eastern and Coastal PCT area:

·                     One forensic community psychiatric nurse (FCPN) whole time equivalent (WTE), Canterbury and Swale

·                     One forensic community psychiatric nurse WTE, Thanet and Dover

·                     One forensic community psychiatric nurse WTE, Ashford and Folkestone

 

0.4 WTE consultant forensic psychiatrist.

 

Medway PCT area:

·                     One forensic community psychiatric nurse WTE, Gillingham

 

0.2 WTE consultant forensic psychiatrist

 

Staff organisation

 

Referral criteria

 

Any person detained in police custody who is suspected of having a mental health problem (including learning disability) that requires assessment.

 

1.   Persons aged 18 years and over that are identified by the custody sergeant or forensic nurse practitioner as requiring a mental health assessment across the spectrum of need.

 

2.   Persons detained in police custody during any point of the arrest, interview or detention period who are exhibiting evidence of mental disorder (including learning disability).

 

3.   Information obtained from the person detained that indicates the need for further investigation and enquiry.

 

4.   Persons detained in custody who indicate that they have been recently receiving a mental health service and / or learning disability support within the community.

 

5.   History of self-harm and/or attempted suicide either in the community or during a previous or current period of detention.

 

6.   Individuals who appear to have a dual diagnosis (drug/alcohol diagnosis and other mental/behavioural disorder diagnosis).

 

Exclusions

 

People aged 17 years or under

People not detained in police custody suite settings

 

 

Proposed referral sources - police custody areas

 

Custody sergeants

 

Forensic nurse practitioners

 

Forensic medical examiners

 

Defence solicitor

 

Operating schedule

 

This service will operate Monday to Friday 8am – 4pm (excluding public holidays).Last referrals are accepted for assessment at 2pm after which telephone advice will be available until 4pm. It will concentrate on providing a liaison and diversion service for recently arrested defendants detained in police custody, before their appearance in court.  The coordinating FCPN will telephone each police custody area every morning in order to prioritise work.  They will visit each custody area to make assessments and screen other detained people in order to increase the opportunity to detect mental health problems and intervene appropriately.  This may involve the provision of advice to custody staff or performing an assessment. They will have the benefit of a laptop computer with Trust intranet access, to enable examination of the electronic patient record’s using the ePEX system.

 

Following assessment, the FCPN will prepare a standardised report, a copy of which is provided to appropriate agencies to enable referral.  They will liaise with health care and social services in the statutory and non-statutory sectors to manage the health care and social needs of detained people.  They will refer detained people to inpatient and outpatient mental health services according to their clinical needs.  They will provide reports for care providers and a brief typed report for the magistrates court, where appropriate, observing usual rules of confidentiality.

 

The FCPN will refer detained people to the local AMHP and psychiatrist when detention under the Mental Health Act appears to be necessary.  They will liaise with secondary care services within Kent and Medway NHS and Social Care Partnership Trust, particularly crisis, inpatient, intake and assertive outreach clinical teams, to enable provision of high quality joined-up mental health care.  FCPNs will maintain accurate and timely clinical records using the electronic patient records.

 

FCPNs and the team secretary will maintain accurate statistical information and assist in the development of evaluation and auditing processes using a service database to ensure best practice and scoping for a recurrent service.  As well as recording outcome on the day of the assessment, the service will explore longer term outcomes.  It will implement user and partner service evaluation measures.

 

FCPNs will engage in the Trust’s supervision and appraisal procedures and participate in continuing professional development and mandatory training. They will provide training for police custody staff.

 

The FCPN will discuss individual cases with the consultant forensic psychiatrist where an assessment under the Mental Health Act appears necessary and there is a specialist need.  The consultant forensic psychiatrist will contribute to the clinical and risk assessment and management, and consider compulsory treatment under the Mental Health Act where indicated.

 

The service will not be responsible for carrying patient caseloads and will discharge its responsibility for the detained person following assessment, reporting, liaison and information sharing.  However, FCPN’s may liaise with mental health services to assist in guiding an individual’s onward care pathway.

 

Roles and responsibilities within the police custody suite

 

Key: DP - detained person

 

Forensic CPNs:

 

• CPNs will undergo a CRB check and any other verification necessary before access to police premises is granted.

 

• CPNs will, at all times, display appropriate photographic identification.

 

• CPNs must report to the custody sergeant upon arrival and must notify them before leaving the custody suite.

 

• CPNs will, at all times, comply with the instructions of the custody sergeant.

 

• CPNs may only access the areas of the building for which explicit permission has been granted - other areas remain strictly prohibited.

 

• The CPN and the custody sergeant will assess any risks involved in the assessment of the detainee. The sergeant may deem that an interview or particular form of interview is not appropriate at that time and alternative arrangements will be agreed.

 

• CPNs can access custody records (front sheets only) and consult with clients in the interview rooms or medical room (if agreement has been sought from the Forensic Nurse Practitioner). A request should be made to the custody sergeant for the client to be taken to a room. Where there is no room available, a consultation may be carried out in the cell but only in agreement with the custody sergeant and in the presence of police staff.

 

• Results of CPN assessments will be documented and added to the Detained Person’s (DP) custody record which will include further action/treatment/referral dates/risks etc.

 

• CPNs must not administer medication to any Detained Person

 

• CPNs must accept that the custody environment has inherent dangers and therefore should take all reasonable steps to protect the safety, not only of themselves, but others.

 

• Security is the responsibility of all of those working in the custody team. Particular care should be taken when leaving the custody suite to ensure that no-one else is able to leave the area before the door is closed.

 

• CPNs must disclose immediately to the custody sergeant any information that is disclosed by the detainee, or is otherwise apparent to the CPN, relating to the risk of harm to the detainee or any other individual e.g. child protection matters.

 

• CPNs will not forward information received from Kent Police custody records to other agencies or parties without the permission of Kent Police.

 

• CPNs should brief the custody sergeant about any outstanding or arising matters before leaving custody.

 

• CPNs can use mobile phones at the discretion of the custody sergeant. It may be necessary to leave the custody suite to make a call.

 

• CPNs will not supply prisoners with any items whatsoever without the permission of the custody sergeant.

 

• CPNs will not allow the DP access to mobile phones or landlines, or carry messages from one prisoner to another.

 

• CPNs are responsible for their own personal possessions whilst in the custody area.

 

• CPNs must never leave a detainee unsupervised.

 

• CPNs must provide custody staff with a telephone number whilst outside the custody suite.

 

• CPNs are expected to take part in joint training events and attend briefings where appropriate, with police officers and staff, to promote a shared understanding of this project and to focus on performance improvement.

 

 Police custody staff:

 

·         The custody sergeant will identify DPs suitable for referral using the two headings under the Genesis Risk Assessment process:

1.   ‘Do you suffer any mental health problems, nervous disorder or depression’ 

2.   ‘Have you ever tried to harm or kill yourself’

 

·        Additionally, the custody sergeant has discretion to make a referral, for example from observation of a DP’s presentation and behaviour.

 

·         The custody sergeant will place a copy of the Genesis front sheet containing the detainee details in the allocated tray in custody.

 

·         If a detainee has been arrested out-of-hours and would clearly benefit from being seen by a CPN, then a copy of the Genesis front sheet containing the detainee details should be placed in the tray for the attention of the CPN.

 

·         The custody sergeant will instruct the CPN on all safety aspects of working within the custody suite, its inherent dangers and the obligation of the CPN under PACE and health and safety.

 

·         The custody sergeant will allow the CPN access to all appropriate detainees and their custody records (front sheets only), except where the custody sergeant decides that it is inappropriate for the detainee to be seen at that time. Custody staff will make the required entries on the prisoner’s custody record.

 

·         The custody sergeant will provide the CPN with suitable accommodation for conducting consultations with detainees, wherever possible.

 

·         The custody sergeant must be aware at all times of the whereabouts of the CPN in the custody suit.

 

·         Custody staff must respect the confidentiality of any conversation between the CPN and the detainee – the CPN is expected to disclose information that may relate to the risk of harm to the DP or any other individual (eg child protection matters)

 

·         Where risks are highlighted by the CPN the custody sergeant must ensure Genesis markers and information section are updated as soon as practicable.

 

·         Custody staff are expected to facilitate joint training between police, detention officers and the CPN.

 

       Complaints

 

In the event of a formal complaint being made against a specific member of staff operating within the framework of this protocol, the procedures to be followed will be those of their employing agency or organisation of the member of staff being complained about.

 

If a general complaint is made in respect of any of the working practices or procedures highlighted within this agreement it should be referred immediately to a line manager from any of the stakeholder agencies who will then be responsible for meeting the initial needs of the complainant. If necessary the complaint can then be discussed with line managers from each agency to determine the most effective course of action.

 

Compliance and management

 

Any problems encountered in operational delivery should, in the first instance, be brought to the immediate attention of the custody manager of that BCU. Out of hours they should be referred to the officer in charge of the relevant custody suite, who will seek to resolve the matter and then, if necessary, refer it, at the first opportunity, to the custody manager.

 

Quality and cost

 

The provision of this service will increase costs in the short term, as new resources are needed.  However, it is likely to reduce cost in the longer term for the health economy, by putting patients in contact with appropriate services at an earlier stage, and diverting patients to hospital sooner.  There may also be reduced cost in avoiding SUIs. There may be external cost savings in terms of prosecuting offenders and imprisonment (approximately £50000 per prisoner annually).  A successful service will also prevent erosion of public confidence in the reputation of the Trust.  It will improve clinical and personal outcomes.

 

This is entirely consistent with the “prevention-appraisal-failure” model, in which prevention costs rise and failure costs fall.  This service will improve dimensions of quality described by Berry et al (1985) in terms of improving reliability, responsiveness, competence, and credibility.

 

Requirements for success

 

The service will need to have the following components:

·         Adequate resourcing by commissioners and support by top management at the Trust.

·         An organisation-wide commitment to quality, working to meet Standards for Better Health.

·         A patient focus, with equity in access and care.

·         Approval by, and engagement from, CMHTs in Kent and Medway.

·         Co-operation between the police custody liaison and diversion service and CHMTs.

·         Ensuring that the service provided meets the requirements of all interested parties.

·         Pursuit of continuous improvement through evaluating clinical management.

 

Expected benefits to service users and local health economy

 

• Diversion of  people with Mental Health problems, away from prison custody into appropriate care and treatment.

 

• Early identification and support for people, reducing the risk of them committing a serious offence and/or deterioration in their mental state.

 

• Early detection of psychosis, to enable early intervention.

 

• Improved partnership working between local mental health services and criminal justice services.

 

• Information for magistrates for their decision making.

 

• Reduction in the rate of re-offending as individual’s health and social care needs are better met.

 

• Improved public protection and risk management of dangerous offenders.

 

• Reduction in the number of people transferred from prison to hospital under the Mental Health Act 1983.

 

• Reduction in barriers, stigma and myths surrounding mental health problems.

 

• Engagement of family members where there has been a breakdown in relationships.

 

Expected outcomes

 

• Increase in number of people referred to mental health services from police custody areas.

 

• Timely availability of specialist assessment and liaison/diversion for detained people.

 

• Improved health outcomes for offenders with mental health problems.

 

• Improved access to services for hard to reach communities and promotion of the social inclusion agenda.

 

• Availability of mental health professional assessment, triage and information about offenders’ mental health before their appearance in court.

 

• Services will be accessible for people with a learning disability.

 

• Early intervention and mental health promotion.

 

• A mental health aware police staff team via training.

 

• Reduction in chaotic repeated minor offending by people with mental disorder by facilitating their engagement in health and social care interventions.

 

 

 

 

 

Clinical targets

 

The key clinical targets for the service are provided here with measurable outcomes. 

 

Target	Outcome measure
Demonstrate patient satisfaction with the service provided to them	Patient satisfaction survey; survey of compliments and complaints
Improve the mental health of secondary care patients and promote recovery                   Improve access to and outcomes from other services for patients not provided ongoing secondary care	Assess clinical progress and apply clinical instruments at first contact and after six months for individuals provided aftercare by Trust services:   Compulsory: Health of the Nation Outcome Scale (HoNOS – adult working age)   Optional: Brief Psychiatric Rating Scale   Obtain feedback from services to whom patients are referred.
Improve secondary care patients’ clinical risk profiles	Examine CPA4 “Mental Health Risk Assessment” at first contact and after six months for existing patients of the Trust.
Reduce SUIs, other incidents and “near misses”	Obtain information regarding incidents and “near misses” from Trust reporting mechanisms
Reduce arrests	Explore arrest data by liaison with Kent Police

 

 

 

 

 

 

 

 

 

Required outcomes (defined by commissioning)

 

      

The service must, on request, provide evidence to demonstrate compliance with all statutory requirements including:-

 

§  Mental Health Act  1983 and any amendments thereof

§  NHS Community Care Act 1990 and associated guidance

§  Health and Safety requirements

§  Care Programme Approach

§  NHS Complaints Procedure

 

Measurement of service (defined by commissioning)

 

Activity

 

The following activity dataset must be made available to the Secure Services Commissioner in the final Pilot Programme Evaluation Report in April 2010:

 

• Total Number of referrals to liaison service by Police Custody Suite
• Number of inappropriate referrals by Police Custody Suite
• Number of referrals by ethnicity
• Number of patients assessed by Forensic CPN
• Number of patients assessed by Consultant Forensic Psychiatrist
• Number of onward referrals made (following assessment) by service type: e.g. PICU, MSU, primary mental healthcare, housing, GP for physical health, Drug Intervention Programme, Intake team, voluntary sector (i.e. Mind, Domestic Violence Intervention Programme for Perpetrators, Anger Management Programmes).
• Number of individual assessments distributed by type of key stakeholder (i.e. to Magistrates, Probation, CMHTs)
• Evidence that describes how assessments were used by key stakeholders and impact on individuals (i.e. custodial sentence, released without charge, conditional discharge, community treatment order).
• Description and outcomes of training provided
• Service User and Key stakeholder pre and post outcome measure reports
• Report on number of people still in contact with services after assessment and onward referral and liaison
• Number of people diverted away from custody as a result of mental health / learning disability assessment and liaison
• Waiting times to see practitioner from receipt of referral to initial assessment
• Number of people already under CPA  management at time of assessment
• Number of people referred for transfer to hospital under the Mental Health Act 1983

 

 

 

 

Quality standards

 

National policy and directives provide details with regards quality standards and must be adhered to. Examples of good practice should also be adopted when developing and delivering the service

 

The service must have in place the following policies and procedures that are regularly reviewed:

 

Policy and Procedure Documents	Date last reviewed
Adult Protection
Care Programme Approach
Clinical governance
Complaints
Confidentiality
Corporate governance
Diversity and Equality
Gender
Patient / carer experience
Referrals
Risk assessment / management
Untoward incidents (SUI’s)
Violence and aggression

 

 

 

Suzy Bailey, Bernard Brady, Joseph Kent, Lars Rasmussen

Forensic Community Psychiatric Nurses

 

Michael Kingham, Consultant Forensic Psychiatrist

 

Alan Stewart, Manager, Community Services

 

 

 

References

 

Berry L, Zeithaml V & Parasuraman A (1985) A Practical Approach to Quality.  Joiner Associates Inc.

 

The Bradley Report - Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system (2009).  Department of Health; London: Stationery Office.

 

Department of Health (1999) A National Service Framework for Mental Health: Modern standards and service models.  London: Stationery Office.

 

Department of Health (2004) Standards for Better Health.  London: Stationery Office.

 

Department of Health and Home Office (1992) Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services.  London, Stationery Office. (The Reed Report).

 

Diversion.  A better way for criminal justice and mental health (2009).  London: Sainsbury Centre for Mental Health.

 

Greenhalgh N ,Wyhe K, Rix K , et al (1996) Pilot mental health assessment and diversion scheme for an English metropolitan petty sessional division.  Medicine, Science and the Law, 36, 52-58.

 

Home Office (1990) Provision for Mentally Disordered Offenders; Home Office Circular 66/90 (MNP/90  1/55/8, 1990).

 

James D (1999) Court diversion at 10 years: can it work, does it work and has it a future? Journal of Forensic Psychiatry, 10, 507-524.

 

James D., Farnham F, Moorey H et al (2002) Outcome of Psychiatric Admission through the Courts. Home Office RDS Occasional Paper No.79. London: Stationery Office.

 

Kingham M and Corfe M. (2005) Experiences of a mixed court liaison and diversion scheme.  Psychiatric Bulletin, 29, 137 – 140.

 

Shaw J, Tomenson B, Creed F and Perry A. (1999)  Prevalence and detection of serious psychiatric disorder in defendants attending court.  The Lancet, 353, 1053 – 1056.

 

                 Singleton N, Meltzer H and Gatward R (1998) Psychiatric morbidity among prisoners in England and Wales; Office for National Statistics, London, Stationery Office

 

White T,  Ramsay L & Morisson R (2002) Audit of the forensic psychiatry liaison service to Glasgow Sheriff Court 1994 to1998. Medicine, Science and the Law, 42, 64-70.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kent & Medway Care Programme Approach                                                      CPA 1

 

REGISTRATION/SCREENING/ADMISSION/CHANGE OF DETAILS FORM *

*delete as appropriate

 

Ward/Team:                 Date and time of receipt of referral: Date:     Time:                (24hrclock)               

 

Previously known:       Yes          No      Method of Referral: Post         Fax      Email     Phone     Caller/Office    Care Group receiving referral: AMH       OPMH        LD         CAMHS       Other  Specify First seen by MH services (anywhere) date:
NHS number:						Social Services ID number:
Title:	Forename(s):			Surname:				Alternative names(s):
Present address:   Postcode:   Contact number:						Usual place of residence:   Postcode:   Contact number:
DoB:		Estimated:			Gender:    M       F			Lives alone:    Y        N
Religion:			Employment status: School attended:				Marital status:

Ethnic group (Tick one box only)

White British                                 Irish                                     Any other white background    (Tick and specify)	Asian or British Asian Indian                                Pakistani                            Bangladeshi                       Any other Asian background   (Tick and specify)			Black or Black British Caribbean                            African                                 Any other black background    (Tick and specify)
Other ethnic groups Chinese                               Any other ethnic group       (Tick and specify) Not stated	Mixed White and Black Caribbean White and Black African      White and Asian                  Any other mixed background  (Tick and specify)			Main language:     Interpreter required:   Y                  N
Registered GP: Address:     Contact number:			Consultant/RMO: Address:     Contact number:
Referred by: if not GP above:                               Contact Number:
Allocated to:                                 Profession:                             Worker ID:   Allocated date:                              Assessed date:
Form completed by:   Signature:		Supervisors name:   Supervisors signature:                                     Closure date:

 

Named significant other/carer:   Relationship: Address:     Contact number:

Duty Room only: Ongoing: Action completed Code:   Responsibility code:   Referral requested by Code (SSD)

Referral data input Initials:            Date: Allocation data input Initials:            Date: All data input to computer Initials:            Date:

 

 

Drug Sensitivities/Allergies         Signed:                                                       Date:

Psychosocial Sensitivities (eg: not informing or contacting certain persons)       Signed:                                                  Date:

 

                                                   

SCREENING INFORMATION

Client Name:

Information from referral:

Is named significant other/carer aware of referral/admission?                       Yes               No              Is client aware of referral?                                                                    Yes               No

Risk factors: (include homelessness)                                                               Yes                 No            Comment:

Provisional diagnosis:                                                                                Yes         No        Comment:

Medication (Including length of time prescribed):                                  Yes              No        Comment:

Duration of current difficulties: Comment:

Psychological factors (emotional, interpersonal, cognitive, behavioural) which may require Psychological assessment:                                                                           Yes                  No            Comment:

If previously known to the service give details here:

Summary of screening evidence:

Further information required?                                                                    Yes         No        Comment:

 

 

 

Client Name:
Client status: Eligibility criteria met:                         Yes               No          Which level:                       A        B        C       D        E        X
CPA level – Standard                              CPA level – Enhanced                            Supervised Discharge                            Other Mental Health Act Section		Section 117                                              Supervision Register                                Guardianship/Section 7
Referral:     Accepted                                  Declined	Comment:
Immediate action:
Contact as: Emergency               Response within 4 hours Urgent                      Response within 24 hours Routine                                Proceed to allocation –                                     Response within 7 days,                                     Seen within 3 weeks			Fast track to: CRHT/MIST                                          Enhanced Team/Assertive Outreach    Tertiary/Rehabilitation Services                       Specialist Psychotherapy Services          Initiate Mental Health Act assessment

 

For Psychiatrist only: Diagnosis (ICD 10): Primary                                                            1st ° secondary                                          Subsidiary                                                       2nd ° secondary

 

Informed of outcome:	Verbally	In writing	By whom	Date
Client
Referrer (if appropriate)

 

Nearest Relative (as defined under the Mental Health Act):    Relationship:   Address:   Contact number:

 

Care Co-ordinator:   Profession:   Contact number:

Covering worker:   Profession:   Contact number:

 

Other professionals involved (including named nurse for In-patients):
Name	Profession	Contact number

 

Kent & Medway Care Programme Approach                                            CPA 2

 

Mental Health/Needs Assessment Form

 

Police Custody Liaison and Diversion Service

 

Client name:                     NHS No:                                        SSD No

People present at assessment:	Date of assessment:   Place of assessment:
IDENTIFY ANY RISKS ASSOCIATED WITH CLIENTS’ NEEDS IN EACH CATEGORY – ALSO STATE CLIENT’S STRENGTHS AND OWN COPING STRATEGIES
Major recent events: time of referral, reason for referral, time of assessment, current alleged offence, custody area, circumstances, note info from custody records if any)
Mental health problems, include:   Mood (dsh etc):   Sleep:   Diet:   Cognition:   Past Psychiatric History:(previous/current contact with health services)   Psychological Factors:   Treatment:   Admissions:   Possible Precipitating Factors:
General health, include: Physical Illness:   Allergies:   Use of Alcohol/Drugs( type, frequency, amount, duration, effect, withdrawal, maintenance medication):   Baseline Observations:
Medication:    Details:   Compliance:   Dependence:   Side Effects & Sensitivities:
Personal and family relationships and history: (Including social networks, dependants/children.  State ages of children and caring arrangements, names of schools attended)   Dependent children:   Social Networks:
Children:  Is this a “Child in Need” of an assessment for Children’s services?    Yes/No Is this child a Carer?      Yes/No   Are there issues of risk or Protection?    Yes/No (NB – you can call the local Children’s Duty Team and request a Telephone Consultation to help you decide how to proceed)   Referred to:                                                      Date: Alert complete?    Yes/No   N/A                       Date completed Details:
Adult Protection: Issues:  Yes/No/  N/A         Reported to:                                    Date: Alert complete?    Yes/No/  N/A                       Date completed Details:   Appropriate adult needed: Yes No?

 

 

Forensic history: (Probation details, mappp, conviction record, history of offences, disposals)

Housing and environment: (include social agencies record/ contact) Housing Issue? Being Addressed?

Occupation, training, leisure and education: Are there issues? Are they being addressed?

Financial, Advocacy, Legal: Full benefit entitlement?

Social skills: (Communication skills and interaction)

Self care, mobility and daily living:

Culture: (Consider gender, diet)                                                         1st Language:

 

Spiritual needs :

Early warning signs of relapse:

Summary of key events:

Summary of assessed need:

Appropriate to refer for assessment for AOT.  Yes/No (Referral to CMHC/T, Referral for Mental Health Act assessment, Referral for hospital admission,  Referral to other service, referral to crisis intervention, )

 

Form completed by: (Please print name)   Profession:

Signature:     Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kent & Medway Care Programme Approach                                            CPA 4

 

Mental Health Risk Assessment

To be completed at the point of assessment following referral to the Mental Health Service and at other times as indicated

 

Name of client:                                    DoB: CPA level:                                                      NHS Number          Date of assessment:       Location of assessment:

 

1.       Risk of suicide or self-harm?:                                                             ANSWERS
Past/ Past & Present/Present/None
Minor self-harm without significant risk to life or health
Suicide threats or gestures
Serious contemplation/planning of suicide
Attempted suicide
Comments:

 

2.       Risk of harm to others?: (Including children, staff, and the public)
	Past/ Past & Present/Present/None
Violence towards others
Aggression without violence eg threats, verbal aggression
Fantasies of violence expressed
Known to possess dangerous weapon(s) eg firearms, combat knife
Arson/fire setting
Comments:

 

3.       Risk of self-neglect/exploitation/abuse by others?:
	Past/ Past & Present/Present/None
Self -neglect
Inability to recognise hazards
Difficulties with activities of daily living
Vulnerable to exploitation or abuse (financial/sexual/physical)
Comments:

 

4.       Sexual risks?:
	Past/ Past & Present/Present/None
Rape, indecent or sexual assault committed
Sexual behaviour towards children
Non-violent sexual offences eg inappropriate sexual behaviour
Fantasies of engaging in any of the above expressed
Comments:

 

5.       Substance/alcohol misuse?:
		Past/ Past & Present/Present/None
Intravenous use
Multi-drug/chaotic use, including prescribed medication
Psychiatric risks are seriously exacerbated by abuse of drugs or alcohol
Other:
Comments:
6.         Forensic Information:
7.         Children – if risks to children identified please answer the following:   Is this a “Child in Need” of assessment for Children’s services?  YES/ NO Is this child a Carer? YES/NO Are there issues of risk or Protection?  YES/NO (NB you can call the local Children’s Duty Team and request a Telephone Consultation to help you decide how to proceed.)         Referred to:       Date:       Alert complete?          Date completed:         Details:
CONSIDER THE IMPACT OF THE FOLLOWING FACTORS IN RELATION TO RISK BEHAVIOUR:
YES/NO	The client has a diagnosis or history of severe mental illness
YES/NO	The client is experiencing major life stresses (consider debt, isolation, bereavement, feelings of guilt or hopelessness, physical illness)
YES/NO	A recent discharge from a mental health unit
YES/NO	Client is refusing medication/relapsing/disengaging with Mental Health Services
YES/NO	Client is currently homeless or in major housing need
YES/NO	Impaired driving
YES/NO	There are other factors indicating the need for repeated risk assessment eg discrepancies or gaps in information - or specialised risk assessment
COMMENTS:

 

Analysis/summary of risk assessment: West Kent staff refer to CLIN.GOV.35.01 Policy on Communicating Risk to Other Agencies)

 

Immediate action to manage risk: (To be reflected in the care plan. If client’s children are in need or at risk, contact SSD)

 

Who notified	How	Date

 

 

Name(s) of assessor(s):

Profession of assessor(s):

Signature(s) of assessor(s):

 

 

 

 

 

 

Is client aware of the above action plan?     

 

If no, give reasons why:

 

 

Date of review:                                      Reviewer’s Signature:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kent Forensic Psychiatry Service

Pilot Police Custody Liaison and Diversion Service

Eastern and Coastal Kent and Medway

 

COURT REPORT

 

This Report is prepared by a Forensic Community Psychiatric Nurse and is based on an interview with the detained person in Police Custody with access to limited background information.  It is CONFIDENTIAL and its contents should not be disclosed to a third party beyond Officers of the Court without reference to the author.  Unless otherwise indicated, the information in this report is derived from the detained person at interview.

 

Name of D.P:	D.O.B
Address:	Time/Date:
Police Custody Area:	Court:
Assessed By/Designation:	Where Assessed:
Reason for Referral and Alleged Offence:
Presentation:
Relevant Psychiatric History:
Clinical Opinion:
Clinical Recommendation: (Referrals, Signposting, Risk, Management Plan):
Signature:………………………………………….	Print Name:………………………………………
Consent Given by Detained Person                  Please provide a copy of this report to Officers of the Court present at Hearing: Clerk, Magistrates, Probation, Defence, Prosecution, Defendant.

 

 

 

 

 

 

 

 

 

 

 

Kent Forensic Psychiatry Service

 

Pilot Police Custody Liaison and Diversion Service

 

Eastern and Coastal Kent and Medway

 

RECORD OF CONSENT

 

 

 

I the undersigned give consent to ……………………………………… (FCPN Name) preparing a report on my mental condition.  I understand that the purpose of this report is to assist the Police/Court and treatment providers in meeting my mental health needs.

 

I understand and confirm that the usual rules of medical confidentiality do not apply, and the contents of this report will be available and shared with the relevant professionals, verbally/electronically and data may be used anonymously for service and capacity planning.

 

 

 

 

Dated ……………………………………

 

 

 

Name………………………………………Signed……………………………………………

 

 

Dated……………………………………

 

 

 

Witnessed by…………………………… Signed……………………………………………