Improving mental health pathways

Objectives

• Undertake diagnostic of mental health pathways across the health system, including bottlenecks in local ED where issues most visibly manifested
• Co-create transformation initiatives targeting service delivery to expedite MH patient flow
• Synthesise initiatives with existing plans to create single transformation plan
• Establish delivery mechanism for transformation, including building the capability to do so

Diagnostic to understand root causes and create “one version of the truth”

• Combined previously unlinked datasets and performed analysis:
• • Mental Health in-patient admission
  • Mental Health Liaison Team (MHLT) referrals
  • MHA assessment
• • Acute hospital Trust A&E and in-patient
• Complemented analysis with operational immersion
• • Worked side-by-side with MHLT to map assessment process and experience bottlenecks (exhibit 1)
• Grouped MH patients into four cohorts based on the which mental health team managed the patient and the referral/discharge location (exhibit 2)
• • Admitted to in-patient MH bed, referred to GP, etc.
• Developed insights on bottlenecks and root causes. Established common narrative, busted-myths, and built a case for change
• • E.g., long waits to be seen (12+ months) by one community mental health team (CMHT) led to false perception that all CMHTs had long waits to be seen. Therefore, MHLT avoided referrals to any CMHT, despite other teams having no wait time at all

Co-create transformation initiatives in four areas

• Systems and processes
• • Improve MHLT rota, creating overlap and avoiding service gaps during handover
  • Streamline MHLT paperwork process:
  • • Adopt ‘triage and referral’ form for ‘simple’ cases
    • Utilise technology e.g., mobile working, voice dictation, etc
    • Reduce repetition for MH ‘frequent flyers’
    • Utilise admin staff rather than clinicians
  • Improve interface with other MH Trust’s to expedite ‘out-of-area’ admissions/discharges
  • Improve referral system efficiency
  • Adopt ‘Early MH triage’ – faster assessment for patient-cohorts likely discharged home, GP, or already under CMHT team.
  • Improve ED triage and prioritisation of MH referrals
• Resources
• • Recruit AMHP nurse in response to increasing MHA assessment referrals
  • Train ED consultants to complete MHA assessment alongside MHA certified consultant
• KPIs and reporting identified and established to track performance and progress of transformation initiatives e.g., (Exhibit 3)
• • Average time from MHLT referral to MHA assessment
  • % of patients assessed by MHLT within 1h of referral
• Mindsets
• • Establish culture of effective communication and information sharing between teams (MHLT, Rapid, CAMHS and older-people crisis teams, Acute Trust ED & IP teams, etc.)

Synthesising pre-existing and new initiatives into one transformation plan

• Across meeting series, worked with stakeholders in mental health Trust plus external stakeholders:
• • Captured detail of ongoing projects
  • Assessed the maturity of each project (e.g., were objectives, KPIs, and milestones defined)
  • Identified interdependencies and understood potential adverse risks
• Facilitated prioritisation exercise with mental health Trust leadership team, focusing on impact and ease of implementation
• Codified prioritisation output into a single transformation plan including detailed workplans, milestones, and responsible individuals/teams

Defining a delivery mechanism

• Governance: Agreed and set up forums to manage programme delivery
• Reporting: Defined KPIs, including when and how they will be tracked
• Accountability: Established incentives for delivery and consequences for not delivering

Building capability

• Workshops with leadership, operational, and clinical teams across mental health Trust to:
• • Clarify ownership of transformation plan objectives, priorities, and deliverables
  • Build capability within Trust teams to deliver, and how to monitor delivery including reporting, governance, and accountability as above