Thursday, 6 July 2017

Crisis Service in Crisis?

In April 2016 Derry and Strabane District Council announced their intention to put together a business case for a Crisis Intervention Centre in Derry. This followed an initial scoping exercise which determined the need for this type of service in the city. The need was further consolidated via the Community Planning Health and Well-being Thematic Group as part of the City’s One Plan which identified a Community Crisis Intervention Service’ (CCIS) within the Council area as a priority need.’

If implemented and run properly this service would be a vital resource for the City as Derry is known to have one of, if not the highest suicide rates in the North. What further compounds this, is the impact of many of the social and economic determinants which influence poor mental health, such as high unemployment, poverty, poor housing and high deprivation. So ideally as well as having a service here to support those in crisis the underlying factors that influence mental health & wellbeing need to be included somewhere in the equation.

The proposed Crisis Intervention Service has recently been the subject of some public discussion. However, this pales in comparison to the attention the issue received in advance of the last Assembly Election. Here Sinn Fein’s MLA candidate Elisha McCallion (MP) announced that the service was weeks away from being opened outside of ‘dotting ‘I’s’ and crossing a few ‘t’s.’ As you would expect, this announcement was widely welcomed despite being quickly disputed by Independent Councillor Warren Robinson who through a response from council officials discovered that the proposed service was still at the discussion stage.

To seek further clarity on the matter, a few months ago  local campaigner for addiction / crisis intervention services Monica McClements and I met with two members of the North-West Addiction Task Force, a group which has worked closely with Council on this project. These members stated that a Community Crisis Intervention Service would be operational by this summer and that the initial pilot service would run for a period of 12-18 months.

So where am I going with this?

Today members of Derry City and Strabane District Council’s Health and Community Committee were asked to approve the initiation of an ‘open procurement process for a low threshold responsive Community Crisis Intervention Service (CCIS) over a six-month period.’ This with a budget of £50,000. £40,000 from Council and £10,000 from the Western Health and Social Care Trust. At this meeting Councillor Brian Tierney proposed that the subject be brought out of ‘confidential council business' and into the public arena, this proposal was supported by his SDLP colleague Councillor Shauna Cusack. Here many councilors raised genuine concerns. Despite this, few substantive answers were provided. 

In absence of answers from Council here’s what we do know. The Community Crisis Intervention Service is set to provide:

‘A timely non-clinical community response to individuals experiencing social, emotional or situational crisis over the weekend period. It is envisaged that this service will be provided within a neutral venue with fair and equitable access.
It will have a prominent community aspect and individuals of all ages can be brought to this central facility where they can be supported, receive comfort and individual staff will focus on de-escalation, risk assessment, stabilisation, reconnection e.g. with family/support or onward referral to statutory services as appropriate. Whilst this service is not perceived to be a service exclusively for those experiencing harmful alcohol and drug misuse it is anticipated that the protocols will reflect the safe and appropriate management of individuals who are under the influence and do not require immediate medical intervention.’

In theory, this looks promising, but a few things jump out at me, the first being the six-month pilot service period which falls short of the expected 12-18 months. Another issue for me is the £50,000 budget. Even a quick calculation of this figure against potential running costs doesn’t seem right. Now for the sake of expediency and counting each month as 4 weeks, if this service is to run over a 48-hour period each week over six months this service will be expected to run on a budget of £43.40 per hour. And we need to bear in mind this figure needs to cover staff costs, running costs, staff training costs (to meet NISCC standards) admin, IT and public liability insurance, and these are just a few of the things which come to mind.

According to the proposal The proposed service would be subject to on-going evaluation, which the Ulster University, Magee has agreed to undertake. The pilot will facilitate further development and evaluation of any CCIS delivery model should more long-term procurement of a service be required subject to the evaluation outcome being positive.’  They haven’t said how this evaluation would be paid for, and even today at the Council meeting council officers refused to answer this.

In the event of a positive evaluation outcome the various agencies set to benefit from the service (according to the Council document) such as the PSNI and Emergency Services will ‘be required to commit funding on the basis of a co- design Community Plan approach should the initial evaluation determine an extension of or development of a long-term service is required’. My question here is has anyone within Council confirmed that these agencies will be happy to, or have the budget to commit funding, or has whoever drafted this document on behalf of Council just decided that this will be a requirement? To take this a step further, if the agencies who are set to benefit from this service see the merit from the outset, then why have they not contributed in advance to the running costs?

I just want to make it clear that I am fully supportive of a Crisis Intervention Service but like many others across this city & beyond I want to make sure it’s done right, this is too serious and too sensitive an issue to play games with.

In the absence of clarity I would take this opportunity to ask the following questions:

Has work on this Co-design Community Plan started?

How can you evaluate something properly over a period of 6 months when it takes time for any new service to bed in?

What is the actual nature of the service and what is considered low threshold in this case?

Will this service prove sufficient in terms of the need identified? This with the initial scoping exercise by council following on from a high-profile campaign for a Detox Facility.

Has this service been modeled on evidence based practice?

How will the success of this project be measured, what are the Key Performance Indicators?

How will this service be any different to what is currently on offer?

Foyle Search and Rescue offer a Community Crisis Intervention Suicide Prevention Programme. As such, how will this service differ?

Has the University (Ulster University) undertaken to carry out this evaluation free of charge? If not, what money has been allocated for this? Or will this expenditure come from the current £50,000 funding budget?

Has consideration been given to how operating on a relatively small budget could have an adverse effect on the quality of service and the final evaluation?

Essentially, will £50,000 cover sufficient levels of staffing and additional running costs? If so please provide a breakdown in line with Council’s business plan.

As part of the overall initiative will Council place an added focus on courses such as Safe Talk, Mental Health First Aid and Applied Suicide Intervention Skills Training (ASSIST) for the wider North-West community? This to build on the excellent work carried out by the Derry Healthy Cities CLEAR Project

From a personal point of view, with a small budget and a lot hinging on a positive final evaluation after six months my concern is that any chance of a sufficient long-term sustainable service will be reduced.

In the past, I have asked related questions of council only to be told that my questions would need to be answered by the preferred service provider, which is a nonsense, with council having a lead role in this project.

I would now call on Derry and Strabane District Council, the North-West Addiction Task Force and the local MP Elisha McCallion who has worked on this ‘tooth and nail’ to provide answers.

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