The report that captures the outcomes and spirit of the #ProjectA Accelerated Design Event (February 14th 2019). Improving the ambulance service response to mental ill health and emotional distress.

1. 14th February 2018
Twitter hashtag #ProjectA
Report of the #ProjectA Mental Health Collaborative
Accelerated Design Event
Responding to people in mental health crisis and
emotional distress

2. The purpose of this report
What this report seeks to do:
• Provide a record of the inputs and outputs from the day
• Show what happened on the day and the energy in the room
• Document the wealth of information and experience that the attendees
brought to the day
What this report does NOT seek
to do:
• Make verbatim notes
• Analyse, synthesise or prioritise ideas
• Develop a decision document or action plan
Report compiled by Lynsey Oates and Ian Baines NHS Horizons

3. Showcase table and wall area
Share and show materials from mental
health initiatives around the country – learn
and share from one another!

4. Welcome by Will Hancock CEO of South Central
Ambulance Service.
Why today is important…
There was a request for a Mental
Health collaborative right from the
initial #ProjectA launch.
There is a lack of confidence at present
in how to treat people with mental ill
health and frustration in front line staff
so this work is critical.
Thank you for your continued
leadership in this area. We want to
support and nurture you, so you have
a voice to bring this agenda to the
fore.
This is a chance to share the great
work we are doing today, and a safe
environment to do so.

5. In the room are people who
aren't ambulance staff - these
are critical friends, and who
are here to help us – embrace
them!
Helen Bevan Chief Transformation Officer
NHS Horizons set the context for the day
This is not your usual conference or
workshop, it is a specially designed
process which enables a depth and
quality of output that would usually
be unachievable in such a short
timeframe...we’ll do three months’
worth of work today.

6. Valentine’s Day
Some people had sacrificed their
Valentines Day to be here; it was a
worthy sacrifice as everyone is here
to design a response to people in
mental health crisis or emotional
distress.
Avedis Donabedian was one of the
founding fathers of healthcare
quality improvement; his ethos was
about love.
Let’s channel the spirit of
Donabedian and St Valentine today
- to focus on love.

7. The activity:
On your own, look through the
magazines and find two pictures that
symbolise for you:
•How the midwifery profession
is now (sometimesalways)
•How things could be different
in the future
People travelled to London from as
far afield as Northern Ireland and
Scotland to attend the event. Every
ambulance service in the UK was
represented.

8. The aims for the day
To:
• Build connections and collaboration between people
across the country who are passionate about
improving the ambulance service response to people
experiencing mental health crisis
• Share existing knowledge and good practice
• Contribute to the emerging national mental health
workplan being developed by the Association of
Ambulance Chief Executives and NHS Clinical
Commissioners stakeholder group
• Build a commitment to translating the knowledge
gained into practical action in local settings whilst
providing high level actions for the national workplan
• Test out ideas and identify our next steps

9. Talking about our lived
experience of mental ill health
#ProjectA
Leigh Kendall – NHS Horizons
@leighakendall
David Morgan –
North East
Ambulance
Service
@djmtees
Elle Todd –
Service user by
experience
@elletodd8

10. Where is your biggest interest ?
Lived Experience
I have walked in
patients’ shoes.
I was too mad for
some services and
not mad enough
for other services.
Let’s work together
today to share good
practice and work
together to provide a
better service for
people living with
mental ill health, crisis
and emotional distress.
Kindness,
compassion,
empathy and
dignity is needed
when treating
those in crisis.

11. What unites us?
3. They were then requested to
introduce themselves to other people
at the table and use the card to tell a
story in relation to the card they
chose, disclosing as much or little as
they were comfortable doing
4. Each table was asked to create a
sentence about what unites all the
personal stories
1. Attendees were asked to reflect on their own lived
experience of mental health
2. To then choose a card that represents that
reflection
#ProjectA

12. What unites us? Collaboration and shared experiences in action
Reflect on your own lived experience of mental health, then choose a card that represents that reflection.

13. Sharing stories with others on their table.

14. There is a
person
behind the
story
Mental
health can
unite or
divide us
Frustration
Creating a sentence about what unites our personal stories
Everyone is
on a
journey

15. The
feedback

16. What unites us: table feedback from the transformation cards
1 - Everyone is on a journey and our personal journeys have helped us to grow and
to develop and have influenced our practice to become more responsive than
reactive
2 - Frustration
3 - We are all aware of personal, system and societal challenges which need to be
balanced and expectations changed, to enable us all to survive and thrive
4 - There is a person behind the mental health story and experience
5 - Metamorphosis through difficult experiences helps us to become better people
6 - There are blurred lines, between life experiences coping strategies and our
mental health. Mental health can unite or divide us
7 - Your response can influence my response by seeing the person behind the call
8 -We have all seen dark places and can tell the tale of experience with the desire
to open doors

18. TRIZ Step 1: Devise a list in response to the question. Be creative!

19. Where is your biggest interest ?
Step 1

20. Where is your biggest interest ?
Step 2 - Is there anything that we are
currently doing that in any way, shape or
form resembles any of the items on list one

21. Step 3 what are the first steps that will help us stop getting
undesirable results?” Identify one big idea for action

22. Step 3 what are the first steps that will help us stop getting
undesirable results?” Identify one big idea for action

23. Each table identified one “big idea” as a result of the TRIZ
exercise
1 – Training - high quality across the board improve understanding and allow continual
improvement
2 - Education and training, national plan that is coordinated
3 - Digital road maps, interoperability between ambulances, trusts and mental health
services
4 - Right response to the right person, frequent caller management and transportation,
look at a whole system approach that provides the right response - Blue light hubs
5 - Access to crisis care plans
6- National mental health response training that is agreed for all staff and also
potential resilience training
7 - Sign Post patients at 999 at the first point of contact as it is likely to impact on their
journey
8 - Challenge culture through standardised training and awareness campaigns

24. Learn and share
• What do we do well?
• Our biggest challenges
• Our current improvement
ideas/initiatives
• What needs to happen?

25. Mental health - learn and share

26. Mental health - learn and share

27. Analysing data from people who have
engaged in the process. Helping to get rid of
the stigma and helping people to open up.
Focus now on distress brief intervention in
children
Hearing from the room - Julie Fletcher
Scottish Ambulance Service
Distress Brief Interventions originated from the
suicide prevention strategy 2016, it was a
challenge for the Scottish Government and
Ambulance Service. Aligned our policy to the
strategy and the actions that were important to
us.
I am passionate about mental health and fought
to get the Scottish Ambulance Service involved
including first responders along with accident
and emergency departments. All have different
challenges.
The level of engagement in terms of response
needed is determined by level of distress. This
gave us an alternative to A&E.
A&E is not the right place for people in distress.
Sterling University researched this. It was found
that 14 people brought to A&E went on to take
their own lives.

28. Next steps include having drop down boxes
on the e-form rather than having to input
manually.
The pilot finishes in March, with the
evaluation to take place in April.
Darren Early, North West Ambulance
I want to share my work to combat the
complexity and lack of education and training in
terms of mental health response.
JRCalc guidelines are very long, hard to
remember and not user friendly. We’ve
developed something that’s usable and simple.
Components of mental health assessment on A5
card - based on risk factors not a risk assessment.
Risk factors do not generate a score but a
conversation as to next steps and treatment.
We also made an A4 version that is on the
ambulances.

29. Will Hancock - Mental health
stakeholder group
As Chair of AACE and Clinical Commissioners Mental
Health Stakeholders group I would like you to help us
develop the workplan.
Co-creation is important in helping the group have a
workplan to address the ambulance services concerns
in relation to mental health.
We are developing five workstreams:
What good looks like
Integrated urgent and emergency care
Face to face work
Expanding capacity, capability and resilience
Education
Take a look at the workplan on your table and take this
big opportunity to contribute to shaping the work from
the start.

30. World Café
A different table then looked
at each element of the five
workstreams of the AACE and
NACN stakeholder group

31. World Café Session

32. The Feedback from World Café

33. World Café – Feedback for National Working Group
1 – What Good Looks Like
Right care – right people - at the right time is foundation and principal for what good looks like.
Quality indicators – 80% resistance to having a timed target, needs to shift to the patient experience of quality.
Systems – to the person in crisis it is confusing and challenging e.g. 8 different triages in one time, putting mental health
professionals into control rooms may be another layer of complexity. It needs simplifying.
Cannot just be ambulance service it needs system partners to be more engaged.
3 - Integrated Urgent and Emergency Care
Third sector clinical assessments model - 111 999 extending primary care and 24 hours services to mental health.
Need an up to date directory of service.
Accelerate consistency of services eg street cars not in all ambulance services.
Fragmentation is huge, particularly issues with technology – eg not being able to see people’s care plans.
Support worker roles can support us as there are not enough across the services.
5 - Face to Face
Accelerate the concise interpretation to support practice, make every intervention count.
We need to stop ‘Pilotitis’, 136 targets for the ambulance service and an approach that thinks one size fits all.
We need to collaborate on multi agency basis around significant incidents.
Better care plan access and national bank of good ideas.
6 - Expanding Capability, Capacity and Resilience
We need dedicated 24/7 resource and speciality roles - take the care to the patients and use technology better to help to stop
duplication.
Stop silos and default conveyance, do not just go with the default. If it was working we would not be sat here looking for
alternatives.
Collaborate and start working with partners and sharing the evidence
7 - Education
Need to consider if education can then lead to specialist roles. National repository for information would be good. Whoever picks
the phone (111-999) needs the skills - usually these people are non clinicians (give these people the skills they need and desire).
We need to rethink, hear and treat, see and treat, differently. Not all have the key skills that we need for patients with mentalill
health. Involve patients and carers as it is important. Simulation for existing staff and understanding for student paramedics what
training they need
NHS Horizons
will compile full
feedback
report for
National
Working Group

34. What’s my offer?
• There is huge value in sharing and connections
• We asked people to think - What can I offer
the room?
– As a result of my knowledge and experience?
– As a result of my experience?
– As a result of my conversations today?
• Also does anyone in the room want some help
from others? NHS Horizons will compile the
offers of services and individual
support with regard to Mental
Health and share these across the
attendees.

35. What's My Offer?

36. Action planning
We asked attendees to move to their ambulance
service teams with critical friends and do some
action planning. Questions that were asked included:
• What are the implications from today for our
service?
• Who do we need to engage?
• What are our next steps?
The teams captured actions in real time – local and
collaborative

37. Service action plans
Individual action plans were drawn up by each
ambulance service. These will be shared to
ensure learnings and connections are
implemented

38. All our power together, now
is the time to make some
amazing things happen.
Our commitments will take
us forward.
Thank you all for your
fantastic contribution.
Lived experience, let’s stick
with the essence of that to
motivate us, to connect
people together and keep
the conversation going.
Helen Bevan
Thinking through next steps

40. Commitment line

41. Today has been amazing - a
really good day sharing and
learning.
Great to see the passion for
mental health support. It’s easy
to become siloed – we need to
stop that.
Lets work on moving forward to
break down the barriers, share
the learning.
Thanks everyone for a great day.
Final thoughts
Carl Betts, Paramedic and Quality
Improvement Fellow Yorkshire
Ambulance

44. Twitter stats