What is 111 Press 2?
111 Press 2 is a mental health service available 24 hours a day, 7 days a week, for all ages. People can use the number if they have an urgent mental health concern for themselves or someone they know. It provides access to a mental health professional without the need for a GP referral. It can help people to support mental health crisis and in many cases be an alternative to attending emergency departments or calling the police.
The service can be accessed by calling NHS 111 and selecting option 2. Callers are then transferred to a dedicated member of the mental health team in their locality. The call includes an assessment of needs and a telephone based intervention to reduce stress. Where appropriate individuals can be referred to mental health services, given self-care advice or signposted to other support.
Why do we have 111 Press 2?
It came about following the publication of a report called Beyond the Call. This took a snapshot in Wales of where people presented in mental health crisis. People presented to 17 different places in total, including the police, Welsh Ambulance service, C.A.L.L. Helpline, Psychiatric Liaison Teams and others, which shows that it was not clear how to access mental health services appropriately.
The idea was to provide one number across Wales that’s easily accessible and people know they can rely on to access mental health support. This would then also reduce pressure on police, ambulance and other emergency services.
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| Beyond the call report, 2020 |
Anyone, any age, registered with a Powys GP or visitors to Powys, can call 111 Press 2. If you are calling about someone else the staff can only give advice, they need to speak to the person directly concerned to make referrals to other services.
We take calls from any person registered with a GP in Powys, or visitors to Powys, whether they are known or not to mental health services. 111 Press 2 can refer on to any of the services within mental health. They are encouraging people to call 111 Press 2 as an alternative to attending their GP. People are triaged by a mental health practitioner and onward referral is made if required. Some GPs are actually redirecting people who call in to surgeries to access support. It’s important that the general public know that if they call 111 Press 2 they can be referred anywhere and receive any support. An exception would be if it is a medication query, for example, the person may have commenced medication and want to discuss this further with the GP.
We are working with the Powys Child & Adolescent Mental Health Support (CAMHS) Schools In-Reach team to help spread the word in schools about the service, and CAMHS teams are also promoting it.
There is a separate dedicated Professionals’ Line which is prioritised in the call queue. So far in Powys it is available to GPs, the police and the ambulance service. Currently an average of 2 calls a day are received by this line, so further promotional work is required to spread the word.
The call handlers are using an interpreting service called LanguageLine to provide support to people who speak a language other than English or Welsh. The issue is whether there is a translator available at the time of the call.
There are two Welsh speakers in the team. People can request a Welsh language speaker when they call which would take them directly to a Welsh-speaking call handler.
What can 111 Press 2 do?
What 111 Press 2 cannot do
There is no face-to-face or video calling service available. Staff cannot prescribe medication - a referral would be made to mental health services or advice to attend the GP surgery or call ShropDoc out of hours.
111 Press 2 does not call people back at others’ request - the person must call themselves.
Is 111 Press 2 a listening service?
The service is different to CALL Helpline or other listening services. It is a mental health triage service so you would expect a person to ring with a mental health need.
The practitioners will always listen to the person calling and seek to support them with their mental health need whether that be through de-escalation or onward referral to an appropriate service. Callers who are not presenting with a mental health need will be advised to call another helpline or listening service if they wish to.
111 Press 2 seeks to reduce the distress felt by the caller - practitioners use a measure called the Subjective Unit of Distress Scale. It is used as a reflective tool at the end of a call to find out if there has been a change in how people feel from the beginning to the end of the call. If nothing has changed it could be that this highlights areas that have been missed. It gives control over to the person. Nobody’s distress has gone up since the Powys service began. It is about a 50/50 split on - stay the same or decreased. However, not all callers want to engage with this scale, and it is not appropriate for third party callers.
- Conduct a mental health triage to assess a person’s needs.
- Provide a therapeutic conversation.
- De-escalate crisis situations (and reduce pressures of A&E and emergency services).
- Give advice on how to improve and maintain your mental wellbeing.
- Signpost to Third Sector services.
- Refer directly into mental health services for a mental health assessment, eg: Local Primary Mental Health team, Community Mental Health team, Crisis Resolution Home Treatment team, Perinatal team, Early Intervention Psychosis, Eating Disorder Services, Child & Adolescent Mental Health Services single point of access.
There is no face-to-face or video calling service available. Staff cannot prescribe medication - a referral would be made to mental health services or advice to attend the GP surgery or call ShropDoc out of hours.
111 Press 2 does not call people back at others’ request - the person must call themselves.
Is 111 Press 2 a listening service?
The service is different to CALL Helpline or other listening services. It is a mental health triage service so you would expect a person to ring with a mental health need.
The practitioners will always listen to the person calling and seek to support them with their mental health need whether that be through de-escalation or onward referral to an appropriate service. Callers who are not presenting with a mental health need will be advised to call another helpline or listening service if they wish to.
111 Press 2 seeks to reduce the distress felt by the caller - practitioners use a measure called the Subjective Unit of Distress Scale. It is used as a reflective tool at the end of a call to find out if there has been a change in how people feel from the beginning to the end of the call. If nothing has changed it could be that this highlights areas that have been missed. It gives control over to the person. Nobody’s distress has gone up since the Powys service began. It is about a 50/50 split on - stay the same or decreased. However, not all callers want to engage with this scale, and it is not appropriate for third party callers.
Who’s in the 111 Press 2 team?
7 x Band 5 Wellbeing Practitioners (Support Workers, Psychology graduates, therapists & social care staff).
1 x Band 5 Service Coordinator (administrative).
6 x Band 6 Senior Mental Health Practitioners (with a professional registration in Mental Health Nursing, Social Work or Occupational Therapy).
1 x Band 7 Team Lead (Mental Health nurse).
1 x Band 8 Service Manager (Mental Health nurse).
In a normal shift one of the senior practitioners will be supporting two of the wellbeing practitioners.
Triage scale
Practitioners use a triage scale as a guide to decide how quickly a person needs support.
The majority of the calls (over 60% May 2023 - January 2024) are for advice and information, or advice to contact alternative providers. Emergency responses made up 11% of the calls.
Live Data (May 2023 - January 2024)
We have gathered information about the number and type of calls the team have been receiving since the service started in Powys:
- 3421 calls received in total.
- Calls equally distributed across Powys
- Averaging 19 calls a day.
- On average calls are answered in less than 2 minutes.
- Calls are evenly spread throughout the week, with peak times - 6 - 8pm.
- Age range of callers - 11 years to 95 years.
- Average caller is male, 44 - 65.
- 53% callers active to mental health services, 24% closed to mental health services, and 23% no mental health history.
The new service has already highlighted the need to the health board of certain gaps in current mental health services, for example out-of-hours crisis care. The Crisis Care team is not available after 9.30pm so by default 111 Press 2 are taking many crisis calls during the night time, as the only out of hours contact for Powys Teaching Health Board.
The team is working closely with other services to identify where the service gaps are so that they can really focus on developing those areas. It’s finding what is working for individuals and what isn’t. 111 Press 2 is in the early stages at the moment but has amazing potential to do great things. In fact, 111 Press 2 is at the forefront of transforming how services are operating!
In summary
111 Press 2 is a single point of access into mental health services for the general public.
111 Press 2 is for everybody.
111 Press 2 provides quick access to a mental health professional
for advice, support and / or a referral.
Many thanks to Marielle for telling us more about the NHS 111 Press 2 service.
You can find out more about 111 Press 2 on this Welsh Government website.
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