NHS 111 mental health triage service

Key benefits and outcomes

• 88 per cent of all calls were supported with home management/self-care, compared to 11 per cent before the service.
• 1.9 per cent of calls needed an emergency ambulance response.
• 0.3 per cent of calls were recommended to attend A&E.
• Reduction in patient referrals to primary care from 69 per cent to 10 per cent.
• 999 mental health contacts reduced by 26 per cent.

What the organisation faced

NHS Hampshire, Southampton and Isle of Wight Clinical Commissioning Group (CCG) recognised that it can be difficult for people experiencing a mental crisis to navigate the system to get the help they need. Particularly at a time when they are extremely distressed and very vulnerable. Getting help involves accessing both the mental health and the integrated and urgent and emergency care systems. Both are complex systems, which don’t always work in an integrated way.  To address this, the CCG agreed that something needed to be done to make it easier for people to access support.

What the organisation did

The CCG worked with partners, including people with lived experience, to develop a seamless, single of point of access to mental health crisis support using mental health nurses working in NHS 111. The nurses helped to ensure that people with mental health issues using the service could be appropriately triaged or given appropriate support. This could mean that the mental health nurses support them directly, or refer them on to other services or voluntary sector organisations.

This work was genuinely co-produced and included patients, ambulance services and 111 providers, police, GPs, A&E, voluntary sector organisations, mental health services, other community services such as pharmacies. Policy drivers such as the NHS Long Term Plan and funding helped them move forward with developing this service.

The CCG had a convening role, and a commitment to improve mental health services, but also the drive to make this service model a reality to improve patient care.

Developing the relationships and trusts with NHS mental health trusts, ambulance trusts and other local partners was key to bringing these partners on board. The mental health crisis commissioner in the CCG, had a background in urgent and emergency services, which made it easier as the relationships were already in place.

It was essential to get the message out to people in the local area about the new service in a user-friendly way and how they can access it. They produced a You Tube video to explain the service, which is narrated by a service user. They also produced some user-friendly posters.

Results and benefits

The service is a co-produced, integrated mental health and physical health offer for all ages, which has reduced pressures on other services.

It has reduced the number of people needing to be transferred to A&E and reduces pressures on ambulance services. In 2020/21 there were 21,697 contacts, 87 per cent of which were supported with home management/self-care; 1.9 per cent needed an emergency ambulance response, 10 per cent were asked to see their GP; 0.3 per cent were recommended to attend A&E.

When the service first started, 69 per cent of patients were referred to primary care, compared to 10 per cent now

They have reduced the 999 mental health contacts by 26 per cent.

There is also a good case for the triage service being managed by a mental health nurse, as now 88 per cent of calls are supported with self-care and home management, compared to 11 per cent when the service was provided by a clinician from NHS 111 with little or no-mental health experience and minimal access to patients’ care management plans or crisis plans, which were held in the mental health trust.

The service is driven by people’s needs and service users are at its heart, ensuring they have easy access to support at the right time and in the right place for them, including enabling people to get help mental health support before a problem becomes a crisis.

It highlights what systems can do when you work together, with funding, on a common purpose for the benefit of patients.

Takeaway tips

• Mental health nurses working in NHS 111 were essential to providing the right level of support.
• Genuine co-production was essential for developing and running the service.
• Building a relationship with other partners was key.
• Having a common purpose backed up by the national policy drivers and funding was also important.

Further information

For more information about the work in this case study, please contact Sonya Mclean, senior programme  manager – mental health crisis care, at  NHS Hampshire, Southampton, and Isle of Wight CCG  sonyamclean@nhs.net