Case Study: Evaluation of the Mental Health Urgent Assessment Centre at LPFT

Edge health led a health economic evaluation of the Mental Health Urgent Assessment Centre (MHUAC) within Lincolnshire Partnership NHS Foundation Trust (LPFT), working closely with both the project team at LPFT and the East Midlands Academic Health Science Network (EMAHSN).

Working in partnership with Edge Health has really added value to the evaluation process, they have been fantastic with regards to communication. It’s obvious from interaction with them that they have a keen interest in the project and really have been supportive with regards to their view on difference our new service is making.

Simon Ringland, Business Manager – Adult Inpatients & Urgent Care, Lincolnshire Partnership Foundation Trust

Innovative support for patients in a mental health crisis – the Mental Health Urgent Assessment Centre

People in a mental health crisis are at their most vulnerable. It is essential that they receive the care and support they need as quickly as possible, in a place where they can feel safe, and are cared for by people who understand their needs.

Patients requiring emergency mental health services often present to the Emergency Department (ED). With EDs under extreme pressures, waiting times for mental health patients attending ED have increased substantially. The busy, often noisy and sometimes crowded ED is also not considered the best environment for patients in mental health crisis to wait to be seen.

To address the needs of patients in mental health crisis who attend ED, Camden and Islington NHS trust implemented a Mental Health Assessment Centre to offer support in a different way. This involved the mobilisation of a Mental Health Urgent Assessment Centre (MHUAC), to offer those that were medically fit a service that did not require attendance at ED for support. The service offered rapid assessment of mental health need and an additional place of safety in an environment that was appropriate and calming. The benefits of the service were identified as lessened 12-hour breaches in ED, decreased footfall through ED, improved patient and system partner satisfaction.

Similarities between the challenges faced by Camden and Islington NHS trust and Lincolnshire Partnership Foundation Trust with mental health crisis care led to the decision that Lincolnshire would benefit for a service similar to Camden and Islington’s Model.

A rigorous evaluation methodology

We conducted an independent evaluation of the measurable impact of the MHUAC at LPFT on patients, staff, and the health system using data from the trust, a patient and staff survey designed and deployed by our team, and several patient and staff interviews. This data collection allowed us to determine the costs and benefits of the pilot and the potential annual savings if the pilot were to expand across the Midlands.

We took the following approach to achieve this:

• mapped out a patient journey, identifying the changes in behaviour brought about by the new service delivery model;
• using this journey, summarised an “impact pathway” to set out a long-list of potential benefits across a number of different stakeholder groups;
• quantified and valued these benefits, based on available data, literature and stakeholder engagement; and
• scaled these results to give an indication at a Midlands-wide scaling of the potential costs and savings from wider roll-out of the pilot.

The work involved a visit to the site at Lincoln County Hospital where we spoke with both patients and staff about their experiences and views on the new service. This work helped guide the analysis, informed our findings and enabled our team to have a deep understanding of the service.

Project outputs included clarity on the big-ticket drivers of benefit and value delivered by the MHUAC and a clear, impactful and robust estimate of the savings delivered to health systems, delivered within the client’s timeframes.

Impactful outputs

Our analysis demonstrated that the innovative service delivery transformation has been incredibly well-received by patients and all staff involved in the mental health crisis pathway, with approximately 85% of both staff and patients suggesting this is a better alternative to ED for patients in mental health crisis.

Alongside the extremely positive feedback from staff and patients, there is also evidence to suggest that this pilot has been cost effective. So far, this pilot has seen measurable benefits, such as, a reduction in inpatient attendances (£789,239 saved) and relapses (£61,473 saved). When scaled across the Midlands region, these benefits could reach over £14.4 million annually.

Therefore, we reported the MHUAC has a benefit cost ratio of 3.5. This ratio may also still improve with time, with a number of significant benefits, including societal benefits, not possible to quantify at this early stage of the pilot.

Given the significant potential of this initiative, it is important the right processes are in place to maximise the benefits it delivers. To aid with this, the evaluation also generated several considerations to improve the service both at the Lincolnshire site and to aid other Trusts if the MHUAC were to expand to other sites.

The evaluation report is now helping to drive conversations locally to recommend the MHUAC initiative to other local organisations. The report has also helped the AHSN to robustly articulate the success of the project which they are now planning to submit to the national Health Service Journal awards.