Closure of mental health facility will 'add pressure to A&E'

The Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) wants to move the place of safety at Fountain Way to Devizes, meaning patients detained under Section 136 of the Mental Health Act will have to be driven 45 minutes to the planned new suite at Green Lane psychiatric hospital.

But Christine Blanshard, medical director at Salisbury District Hospital (SDH), fears police who have detained someone they believe has a mental disorder, and is a risk to either themselves or another, will just take them to A&E rather than driving all the way to Devizes.

Speaking at a consultation meeting held by AWP on Monday in Salisbury, Dr Blanshard said: “At the moment 40 to 50 people a year are detained under Section 136 at Fountain Way and probably about five or ten in SDH’s accident and emergency.

“Now they are small numbers of patients but they have a huge impact on our ability to function in A&E because of the resource entailed in looking after these individuals.

“My worry is if the suite closes at Fountain Way, then those 50 people will end up in our A&E because, with all due respect to my colleagues in the police force, when the choice is between bringing somebody to a place they perceive as safe for the patients, i.e. A&E or making a one-and-a-half hour round trip to Devizes, I know if I was a police driver which I would prefer to do.”

AWP, which also wants to close Swindon’s place of safety, plans to centralise the service in Wiltshire, in Devizes, but says it will increase the county’s provision from three rooms to four and provide a dedicated team of professionals to staff the suite.

Toby Sutcliffe, clinical director of AWP for Wiltshire, said it would enable mental health assessments to be carried out more quickly, adding it would be an incentive for police to take them to Devizes rather than having to wait hours in A&E for the right professionals to arrive.

However Dr Blanshard told him: “The police very often leave the patient with us and our security so that won’t necessarily be an incentive.”

She also raised concerns over the inability of staff at the new suite to assess a patient’s physical health and warned the place of safety service needed to be seen as part of the wider review currently going on with Section 136.

She said: “Until the system is designed properly, A&E will become the default place that everybody ends up, because it always does.”

Newlands Anning, AWP’s managing director for Swindon, said the transport of people to places of safety should be done by the South Western Ambulance Service NHS Foundation Trust (SWAST) but “nine times out of ten” it was done by the police.

He said: “We are in conversations with SWAST about that - if they were doing the conveyancing, they would do those physical assessments and see whether people needed to go to A&E or not.”
 

Proposal to move dividing opinions

THE proposed move of Salisbury’s place of safety to Devizes has divided opinion among those involved with people detained under the Mental Health Act.

While police officers say the new suite would be “much better prepared and staffed”, mental health professionals say it will result in longer waiting times for people in Salisbury requiring assessment.

Avon and Wiltshire Mental Health Partnership NHS Trust’s managing director for Swindon, Newlands Anning, says the aim of the relocation is to reduce the time it takes to assess people.

He said: “At the moment it’s all clogging up as we’ve got one assessment centre in Salisbury, one in Swindon and one in Devizes which are reliant on the same people for some of it - if we’re able to consolidate the centres, we can increase the flow through the system.”

But Mike Macdonagh, a social worker and an approved mental health professional (AMP) based at Fountain Way, said in Salisbury people were currently seen “pretty quickly” and that the move to Devizes was likely to mean longer waiting times for them.

He added: “It’s not seeing local people locally, they are not likely to be assessed by doctors and AMPs that know them.”

And Julian Bowerman, a social worker and AMP also based at Fountain Way, said: “From our perspective we think the Section 136 works well in the daytime - we have doctors who will respond, AMPs who are on the ball - you can’t mend something that’s not broken, it’s not a good move.”

However Wiltshire Police mental health liaison officer Mike Hughes said the new place of safety suite would be better equipped to deal with “more challenging people”.

He said: “Last month we had seven Section 136s and the month before we had four.

“The issue we have had over the last couple of years has not been about the number of spaces but the quality.

“If somebody is a bit aggressive, the current facilities are not set up in a way to accommodate that individual.”

He added: “What I would like to see, and it seems to be gaining momentum, is safe assessment areas.

“If we come across somebody in crisis, it seems we either go to a place of safety under a Section 136 or we go to A&E, what’s missing is somewhere in between.”

Patients feel ‘rushed through care system’

MENTAL health patients say they are being “rushed through the system” in an attempt to “drive down statistics”.

Speaking at a consultation meeting at St Paul’s Church Centre in Salisbury on Monday, one patient said: “I have been in mental health care for over 20 years. I have seen a lot of changes sold to staff and sold to patients that ‘this is the modern way’ and ‘this is an improvement’, and it’s caused no end of problems.

“There is a lot of concern among patients about being in the community rather than in hospital.”

She added: “Patients are feeling very lost in all of this. There’s this feeling we are being rushed through the system because you are driving down statistics.”

City councillor Tom Corbin said: “It’s really quite heartfelt by a number of Salisbury residents that they’re being pushed along the system at great speed.

“This impacts on their family’s lives because they’re the ones often picking up the pieces.”

AWP clinical director for Wiltshire Toby Sutcliffe told those present at the meeting that the choice was between providing a “really high quality” place of safety assessment centre in Devizes or having a facility which was “very close but not good enough”.

He said running the three separate suites which see an average of around four people each a month was not an efficient use of money.

He said: “We are trying to drive down the number of Section 136s - ideally there would be none and everybody would be able to access care through their GPs or presenting to the appropriate services.

“It’s not stopping Section 136s at all costs, we just need to reduce the need for them.”

He opened the consultation meeting by saying: “We know there are concerns that this is a done deal and there are also concerns the details haven’t been worked out. There are truths in both of that.

“This is something AWP would really like to do because we think it makes sense, the details aren’t completely worked out.

“The provision we have at the moment isn’t good enough, something has to change.”

A consultation on the plans runs until Friday.

To complete the survey visit AWP’s website or call 01249 468261 or 0800 073 1778.

What is a Section 136?

SECTION 136 under the Mental Health Act allows a police officer to remove a person from a public place so they can be assessed in a stable environment.

• Currently people may be detained in a place of safety for a maximum of 72 hours but under the incoming Policing and Crime Act 2017, the period of detention will reduce from 72 to 24 hours.
• A police officer must, if practically possible, consult a mental health professional prior to using Section 136. Since the recent introduction of psychiatric nurses in the police control room, the number of Section 136s have fallen.
• Long term, AWP is looking to reduce the number of people detained under Section 136 and reduce the usage and need of places of safety.
• For those people detained under Section 136, it aims to assess, discharge and transfer patients within six hours.
• It will provide transport from Devizes to Salisbury for people being discharged.
• In Fountain Way, the place of safety contains an assessment room with table and chairs, and an adjoining room with a bed and ensuite toilet.
• A review by the Care Quality Commission found the place of safety’s environment and staffing inadequate.