Issue - meetings

The Service Director (Adult Social Care) and the Commissioning Manager, Mental Health (Stockport Council) will attend the meeting to provide an overview of mental health provision available in the community, including innovative approaches to people powered health and peer support.

(i) Terry Dafter (Service Director (Adult Social Care)) and Nic Dixon (Commissioning Manager for Mental Health, Drug & Alcohol Services), Stockport Council, attended the meeting to make a presentation on community-centred approached to mental wellbeing and recovery.

An information note setting out background information in relation to co-production in mental health pathways was also submitted (copies of which had been circulated).

The presentation covered the following issues:-

Background

·         Resources were skewed toward acute care and clinical approaches to mental illness. Users were in danger of being ‘warehoused’ in acute settings.

·         Emphasis needed to shift toward recovery that was focussed on sufferers ‘getting their life back’ rather than entirely overcoming illness or symptoms.

Outcome Focus – ‘getting life back’

·         Personalisation, handled properly, was more effective at ensuring a focus on outcomes for sufferer.

·         Getting a life back recognised the importance of a sufferer’s community setting, as well as empowering them in their treatment.

·         Shift from the ‘Professional Gift’ model to ‘Citizenship’ model.

·         Shift of resource from the intensive and costly treatments by discouraging people from entering acute services unless absolutely necessary.

·         Strong evidence that co-production delivered improved outcomes for less cost.

NESTA Project

·         Stockport had a track record of success in innovative mental health treatments through support for co-production and community-based approaches. Through attracting NESTA funding it was possible to widen the scope of smaller projects to support a programme of transformation of treatment for long-term conditions, based in Brinnington.

·         The aim of the project was to prevent the escalation of conditions while reducing the severity of conditions in other users.

·         Evidence from Brinnington GPs was that the number of referrals and repeat appointments had reduced.

Barriers to community based approaches

·         Paternalistic approach of acute care – once in the system it was difficult for sufferers to get out.

·         ‘Payment by Results’ disincentivised discharge and alternative treatments.

·         GPs were not necessarily empowered and skilled to make referrals to community-based or co-produced treatment alternatives.

·         Patients and carers – may have had to battle to get into the service so resistant to change.

Benefits of Co-Production

·         In financially restricted environment, Peer Support provided an effective and low-cost opportunity for expanding provision.

·         An opportunity to explore ‘Time Banking’ to tap into community/ volunteering/ peer support assets.

·         Savings could be reinvested while simultaneously improving outcomes.

·         Impact on other services, i.e., fewer hospital admissions, reduced benefit claims

·         Building community capacity through volunteering for peer support.

·         Peer Support provided hope for sufferers.

(ii) Shirley Dean (Chair, Stockport User Friendly Forum (STUFF)) and Jackie, a peer supporter, attended the meeting to provide an overview of their work in co-production and peer-support.

The following issues were highlighted:-

Background

·         The National Framework sought to put users and volunteers at the centre of decision-making about commissioning.

·         STUFF worked collaboratively with commissioners (Council), providers (Pennine Care NHS Foundation Trust) and other voluntary sector organisations (Stockport MIND) in providing support and training.

Challenges

·         Small voluntary organisations struggled with tendering processes.

·         Overcoming user’s reliance and feelings of security in service ‘warehouses’ which often did not address underlying causes of mental illness.

·         Empowering users to have confidence in making decisions about their own treatment and support.

Benefits

·         Co-production put the user/ sufferer at the centre, and recognised the value of their wider support network, be that family or people in the community.

·         Peer support had benefits for both those coming into the service but also for those volunteering as it allowed them to use negative experiences for a positive purpose. Volunteering often provided a stepping stone for work.

·         Users often stressed the value and importance peer support had in their recovery.

Members of the Committee then discussed the presentations and the following issues were raised/ comments made:-

·         Collaborative working between commissioners, acute providers and the voluntary sector was providing opportunities for innovation.

·         The work of the ‘NESTA project’ was extremely positive and provided a route toward more radical approaches to treatment and care.

·         It should  ...  view the full minutes text for item 3

Members of the Scrutiny Committee are invited to consider the parameters for a piece of work around mental health, as per the decision of the Council Meeting on 16 August 2012.

Representatives from partner agencies have been invited to the meeting to assist members in their discussions.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

The Chair invited the Scrutiny Committee to consider areas for further investigation and discussion as part of the planned Scrutiny Review of Mental Health.

Gina Evans (Mental Health Commissioning Lead, NHS Stockport), Dr Nij Hussain (Mental Health lead, Stockport Clinical Commissioning Group) and Sarah Newsam (Head of Health & Wellbeing, Stockport Council) and Dr Stephen Watkins (Director of Public Health) attended the meeting and provided background information about mental health services in Stockport and challenges and opportunities for service delivery and mental health more generally.

The following areas were highlighted:

·         Since the ‘Improving Access to Psychological Therapies’ Scrutiny Review in 2008, there had been significant improvement in service delivery following increased investment. This had resulted in improvements in recovery rates, reduced waiting lists and improvements against performance indicators, though there remained significant scope for further improvement.

·         Service provision in Stockport was heavily skewed toward patients with complex needs, rather than the more prevalent mild and moderate conditions, many of whom were being managed through their GP rather than a specialist service.

·         Work was on-going to widen access to services, particularly young people through Improving Access to Psychological Therapies, and to address the links with complex medical conditions. Pilots were being undertaken to improve mental health assessments as part of the discharge from acute care including A&E .There was a national driver for improvements in the life expectancy of those with severe mental health issues as part of the Nation Outcomes Framework.

·         The challenge for commissioners was to increase capacity in the system, particularly for the moderate to mild need, through more cost effective treatments, which often could be delivered in the community.

The Scrutiny Committee discussed the issues raised. The main threads from the discussion were:-

·         The link between mental health, physical health and general wellbeing/ integration, particularly through the impact on employment, and the impact of complex mental health conditions on life expectancy and physical health.

·         Opportunities to increase capacity for simple, community based, people powered care for low to moderate conditions as a means of prevention. Opportunities to create links with Neighbourhood Management.

·         Effectiveness of GP activity, both in referring to mental health services and managing low to moderate conditions.

·         Overcoming stigma of mental health and improving awareness of services and where to seek help for oneself and others.

RESOLVED – That the Mental Health Scrutiny Review investigate in further detail the following areas:-

·         Mental Health support provided to young people through CAMHS, Central Youth and by colleges in Stockport, particularly against the background of high levels of youth unemployment and inactivity. Further consideration of the pilot of expanding  Improved Access to Psychological Services for young people.

·         Support offered by employers to employees struggle with mental ill-health to help them back to work, particularly for the largest public sector employers (Stockport Council and Stockport NHS Foundation Trust) within the context of public sector financial reductions.

·         The impact of mental ill-health on the work of the Police and Probation Services, with particular reference to comments made by the Chief Superintendent of J-Division about prevalence of mental health issues for individuals involved with Police incidents. The development of a Police strategy on mental health should also be explored.

·         Pennine Care NHS Trust’s role in providing mental health services, in particular the RAID (Rapid Access Interface Discharge) initiative and the impact this would have on patients ion acute care and upon discharge.

·         The role of the Third Sector in providing services and support outside of the ‘institutional’ setting; the role of peer support and community/ people powered health (Brinnington NESTA project) in providing alternatives to medicalised care and in responding to low to moderate depression, anxiety and other mental health conditions. Opportunities for the use of ICT and mobile technology in providing simple interventions.