konabunny - Member
Okay, so if more money were available, what would be the answer? Some sort of secure custody/place of safety facility inside hospitals? A kind of mental health A&E?
[professional hat on] Absolutely this. But at/on same site as the mental health unit rather than A&E. ^^
I have a good friend who is a police custody nurse and we often discuss this as TBF I think he gets dumped on with patients that are seen as too dangerous or drunk for the local mental health unit's Section 136/Place of Safety suite and go to custody instead.
Barriers to improvments are 1) money, 2) economies of scale and 3) the institutional intolerance, in fact horror on the part of middle managers that there might be some times of the day where people run out of things to do and just sit there waiting for a call/admission.
1) Money: space, setup costs and ease/guarantee of access. The care quality commission and mental health act commission's standards for that sort of place, and the impact it (or rather its patients, the chaos/disturbance than can come with them and the needs they pace on the staff) have on the other patients already properly admitted to mental health units are understandably high. Given the size and layout of mental health units it is often a huge undertaking to provide a Place Of Safety Suite. There is also an ongoing debate about how to staff it and with what type/grade of staff. In an ideal world I would say Band 6 Mental health nurse plus helpers of some description but realistically you are talking £120k just for a b6 nurse 24/7. Unless they are shared with another service in the same building, which brings me to...
2) Economies of scale. Most mental health units are reducing their bed numbers and consequently their overall staffing numbers, and going, going gone are the days of massive hospitals or units with loads of wards all of whom could send a pager-equipped member of staff to assist with emergencies and so when the alarms went off on a general adult mental health unit, you would have 6 extra people to help. (secure units and hospitals have far better responses to emergencies but are also not often on same site or indeed run by same hospital trusts/companies as general adult acute units where 136 suites are the most usefully placed) Obviously if you had one switched on member of staff at all times in your POS suite who had access (reasonably within 30 seconds of pressing alarm) to a few extra staff who were guaranteed to be available (much like you do in a police custody suite but for diferent resaons!). But to be abe to guarantee this, you need to have a large enough body of staff to draw from (if your response team is 4 people but there are only 8 on duty in the whole 2-ward unit then you are pretty much bound to get a situation where everyone has their hands full with one crisis or another and one person turns up to help when the alarms go off. But this brings me to:
3) Middle management are horrified by the notion that you might not always be busy or indeed just be sat on your arse waiting for something to happen. I order to guarantee a timely response to any emergency you need to accept that your expert staff may at times run out of things to do, and have to sit around just waiting for the call. Middle managment (and some posters on here, given some of the comments I read on fire/ambulance service threads) cannot cope with this sacrifice of overall productivity versus the ability to respond properly, expertly and immediately when needed ...but the more you spread your staff between different roles at the same time (general ward staff, unit co-ordinator, emergency response person, Place Of Safety/Sec 136 Person) the greater the chance of something terrible happening because everyone was too tied up in their other role to be able to deal with the emergency. In our local POS suite the permanent member of staff (not a qualified mental health nurse BTW) is usually called to help out on the wards if there is no one in on a 136 because the wards are so horrendously busy. That being so, what happens when it all kicks off in the POS suite: what chance have the wards of helping out there and what compromises do they make to the care and safety of the inpatients on the ward in order to attend an emergency elsewhere in the unit?