Category Archives: Street triage

PhD studentship on street triage

The International Centre for Mental Health Social Research is offering a PhD studentship on street triage to start in September 2015. With North Yorkshire Police and Tees, Esk & Wear Valleys NHS Foundation Trust we have obtained an ESRC studentship from the White Rose Social Science Doctoral Training Centre to conduct an evaluation of street triage in North Yorkshire.

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The project

Police officers report that a disproportionate amount of their time (anecdotally reported to us as 50 per cent) is spent in responding to incidents involving people with mental health problems. This is common throughout England and Wales, and the Government recognises that the police are not always best placed to respond to mental health crises.

In February 2014 the Government published the Mental Health Crisis Care Concordat to improve the care provided to people in a mental health crisis. In York and North Yorkshire, many agencies including NHS Mental Health Trusts, North Yorkshire Police, and Clinical Commissioning Groups have declared their commitment to implement the Concordat.

One initiative which has been introduced to improve mental health crisis care is street triage. This involves mental health professionals advising police officers on, or accompanying them to, incidents where police believe people require immediate mental health care and support. The Government has invested £25m to pilot street triage in locations across the country and in North Yorkshire schemes are currently in operation in Scarborough, York and Selby. Street triage in Leeds, for example, is producing early evidence that the use of police powers under s.136 Mental Health Act 1983 to remove someone who appears to be suffering from a mental disorder to a place of safety has been reduced by 22 per cent.

Street triage is yet to be thoroughly evaluated, though pilot sites are collecting and reporting data to the Department of Health. This project builds upon our evaluation of the Scarborough street triage service to extend our knowledge of the process and outcomes of street triage to inform its development both locally and nationally. It has three specific objectives:

  1. To calculate the proportion of police time spent with people with mental health problems and to understand the nature of these incidents.
  2. To evaluate three, six and twelve month outcomes of people who have used street triage services in terms of their contact with police, criminal justice system and mental health services.
  3. To understand the processes and mechanisms of street triage which contribute to both short and long term outcomes.

Apply

If you are interested in making an application for this studentship, further information is available here. The deadline for applications is Friday 20th March.

Two new studies for 2015

The International Centre for Mental Health Social Research has been successful in obtaining funding for two new studies starting in February 2015. Both studies are evaluations of innovative mental health services to help build the evidence base for practice and to inform future commissioning decisions.

Peer support service

The peer support service provided by South London & Maudsley NHS Foundation Trust in the London Borough of Southwark matches people with psychosis with a peer to support their recovery.

The service started in June 2011 initially to help individuals who had accessed the crisis services and had opted for home treatment rather than a hospital admission. From September 2012 the service was extended to people in hospital. The aim was to match individuals just before their discharge, as this was the point that clinicians perceived them to be most at risk of relapse, anxiety and encountering other difficulties due to the sudden reduction in support. Individuals were entitled to six to nine months of peer support which was deemed to be sufficient time to support them through discharge and for any initial problems experienced post-discharge to be resolved.

The Southwark peer support scheme can be defined as a ‘peer delivered service’ whereby the frontline support is delivered by peers, and clinical and non clinical staff provide aid for the peer supporters.

The evidence for the effectiveness of peer suppport is not strong. A recent systematic review found little or no evidence that peer support helped to reduce hospitalisation,  reduce symptoms or improve satisfaction with services (Lloyd-Evans et al, 2014). However, there was some evidence that peer support was associated with improvements on measures of hope, recovery and empowerment.

In 2013 we published an interim evaluation of the Southwark peer support service. The initial evaluation examined routinely collected data, but there was insufficient to make any firm conclusions.

South London & Maudsley NHS Foundation Trust have now funded us to return and undertake a further analysis of outcome data which the service has collected. This will be supplemented by qualitative semi-structured interviews to explore individuals’ experiences of the service. It is a small evaluation and will be completed by late spring by our researcher Samantha Treacy.

Street triage evaluation

The Department of Health is funding pilots of street triage across England to help reduce use of s.136 Mental Health Act 1983. Street triage sees mental health professionals advise local police forces about their response to calls involving people with mental health problems. The aim is to divert people from police custody where this is not required and facilitate access to mental health treatment. In Leicestershire, for example, an early street triage pilot has seen a 33% reduction in s.136 detentions.

The Scarborough street triage pilot has been running for over 9 months and is a partnership between Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) and North Yorkshire Police (NYP). We have been working with them to design an evaluation which will help both services understand if, and how, street triage works in the first year of its operation.

We have been successful in obtaining funding from the N8 partnership of eight northern universities co-production programme (which is funded by the Economic and Social Research Council). This research programme aims to learn how co-produced research between academics and non-academics might help to shape the future of social science research.

Embedding research findings into policy and practice is the ultimate aim of applied social science. While projects frequently include knowledge exchange as part of their funded activities to increase the impact of their findings, few have the opportunity to reflect on whether this process achieves its desired outcome. This small evaluation includes reflective learning on the co-produced process of embedding research findings in practice to investigate how jointly agreed and delivered messages are received and acted upon by mental health practitioners and police officers.

This project will utilise multiple methods including the analysis of routinely recorded information on police and NHS databases, qualitative interviews, participant observations and reflective diaries to achieve the following objectives:
1) To evaluate the impact of street triage on rates of s.136 Mental Health Act 1983 in Scarborough and district
2) To evaluate the short-term outcomes of people seen by street triage in terms of their
contact with the police and mental health services in Scarborough and district
3) To understand how the co-design and co-delivery of street triage contributes to its
outcomes
4) To co-design and co-deliver briefing sessions to police officers and street triage
practitioners to discuss research findings
5) To reflect on the immediate impact of the co-produced evaluation on policy and practice in the police and NHS

This evaluation will be conducted by Annie Irvine in the Social Policy Research Unit, supervised by ICMHSR Director Dr Martin Webber. Annie will work in partnership with data analysts in NYP and TEWV to undertake some aspects of the evaluation. We also look forward to working closely with NYP and TEWV to learn how co-produced research can produce insights lacking in traditional academic research. The evaluation will be completed by summer 2015.