Agenda item

The Medway Adult Mental Health Strategy 2018 to 2023 has been developed by NHS Medway Clinical Commissioning Group and Medway Council. It sets out our vision for improving outcomes for people with mental health problems in Medway over the next five years.

Discussion

The draft Adult Mental Health Strategy had been jointly developed by Medway NHS Clinical Commissioning Group and Medway Council. The development of the Strategy was important in view of the prevalence of mental health issues amongst the population, the increasing population and an increasing severity of need. The Strategy set out the case for change based on a needs analysis undertaken by the Council and feedback from stakeholders. The key focus of the Strategy was on the strengthening of preventative services. This included providing high quality responsive services to support people in crisis and supporting people to live well and manage conditions. The Strategy highlighted the importance of developing mental health services as part of the development of the Medway Model and ensuring that mental health is given the same priority as physical health services as part of development of local care services.

Members of the Committee asked a number of questions which were responded to as follows:

Factors affecting mental health – A Member highlighted a number of contributory factors that could lead to poor mental health, such as homelessness, unemployment, housing difficulties, relationship problems and debt and emphasised that mental health was a wider social issue than just being health specific. The Member was concerned whether there were sufficient resources available locally to tackle the challenge. The Head of Mental Health Commissioning at the CCG agreed that mental health was a wider concern than just being a health problem. The aim was to ensure the provision of adequate community services as well as acute services. One aim of the Strategy would be to increase the number of people seen by Medway Talking Therapies. Currently, 19.8% of people diagnosed with depression accessed the service. The 2021 target was for this to increase to 25%. Funding for services was challenging with the aim being to find new ways of providing services.

Grant funding had been used to support homeless people with mental health problems. This saw a social worker spending half their time working with homeless people to help them access mental health services. The charity Porchlight now employed two employment advisors specifically for Medway using grant funding, while the Meghan Community Interest Company offered peer support.

Local Plan – In view of the forecast population increase in Medway and a decreasing number of GPs, a Member asked whether information from the Strategy would be included in the Medway Local Plan. It was confirmed that the CCG was working closely with the Council in the development of the Local Plan and to ensure that the correct health services were available once the Local Plan was agreed. The Chief Operating officer of the CCG did not recognise the figure quoted by the Member that the number of GPs in Medway would reduce by 25%. The Council’s Local Plan lead officer had attended several CCG events in advance of production of draft Local Plan and had been fully involved in providing information to support Plan development.

Increasing demand for services – It was confirmed that the increased demand for mental health services was due to a combination of better diagnosis and an increasing local population. People were becoming more aware of mental health issues and the link between good mental and physical health and were becoming more prepared to talk about mental health issues.

Referral and Communications Challenges – A Member highlighted the difficulty that people could face in getting a referral for mental health treatment due to high thresholds, that GPs did not always have adequate information to facilitate an effective referral and the risk of relapse once support ended. The Member noted that a number of Committee Members had visited the Kent and Medway Partnership Trust (KMPT) Benchley Unit, which treated people with a personality disorder. It was clear that progress was being made in terms of provision for the most seriously affected people.

The Head of Mental Health Commissioning said that funding for mental health provision was being increased year on year with there being £1million extra available in the current year. Funding was determined as part of a ten year long term plan. Funding was provided for investment in specific areas to ensure it was spent on the intended activity. There was a lack of knowledge of the mental health services available and how to access them. Care Navigators would be working with GPs to help address this and ensure that the GPs were aware of the services available.

Mental impact of physical injury – A Member asked what work was being undertaken to help patients who had suffered physical injury with any resulting mental trauma. The Committee was advised that the CCG worked with Medway Foundation Trust and the hospital’s liaison service. However, it was unlikely that a patient would be referred to the liaison service unless a mental health need had been identified at the time of treatment. This would be discussed further with the liaison service. Work was also being undertaken to better understand the needs of people who frequently attend Accident and Emergency, particularly from a mental health perspective.

Mental Health Model and Three Conversations – A Member asked for an explanation of what a diagram of the proposed Mental Health Model contained in the report and also how staff were being prepared for the implementation of the Three Conversations approach within Adult Social Care. It was confirmed that the diagram in the report indicated how people would be supported. The circles at the centre of the diagram showed the support that people would access most frequently while the outer circles indicated services that would be accessed less frequently as the aim would be for successful intervention to have occurred before the person’s health reached crisis point.

The Three Conversations Model had been implemented in Adult Social Care over the previous eighteen months and had gradually been extended to cover the whole service. The Committee had previously been provided updates on progress. It was acknowledged that traditional approaches towards social care, such as assessing the needs of a person and then identifying an appropriate package of care to support this need did not always work effectively for someone with mental health needs. Three Conversations considered how people could be better supported on an ongoing basis. Discussions were taking place with the CCG and other partners to consider how to embed Three Conversations across the healthcare system. It was noted that the Community Support Outreach Team supported people following a crisis or episode of mental health difficulties. This included working with people to provide support and help them to gain access to appropriate services and help avoid the need for long term support.

Continuity of care – A Member emphasised that this was crucial in the diagnosis and treatment of a mental health problem. It was acknowledged that ensuring continuity of care from GPs was a challenge. The Committee was informed that efforts were made to ensure that a patient had the same care co-ordinator throughout their mental health treatment and that work was taking place within the crisis and home treatment teams to look at how continuity of care could be ensured. This was challenging in a 24/7 service. The age at which those who had received services as a child could continue to be treated before transitioning to adult services was now 25 which helped to facilitate a smoother transition.

Safeguarding – A Committee Member highlighted that safeguarding concerns raised about people with primary mental health needs that had progressed to a full enquiry had increased from 14 in a year to 16, which was a significant percentage increase. The Assistant Director of Adult Social Care said that the increase highlighted the increasing awareness of the importance of safeguarding and that the increase could therefore considered to be positive. A Safeguarding Awareness week had recently be held, jointly with Kent County Council, with the theme having been exploitation and social isolation. The Director of People – Children and Adults Services added that one area of growing awareness in relation to safeguarding was self-neglect and it was anticipated that referrals for adults with long term mental health needs would increase further.

Decision

The Committee commented on the draft strategy prior to its consideration by the Health and Wellbeing Board and presentation to Cabinet for approval.