Agenda item

This report presents the Health and Wellbeing Board with the Medway Adult Mental Health Strategy 2018 to 2023, which has been developed by NHS Medway Clinical Commissioning Group and Medway Council. It sets out the 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 local 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. A 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 their 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. The draft Strategy had previously been presented to the Medway NHS Clinical Commissioning Group’s (CCG) Commissioning Committee and to the Health and Adult Social Care Overview and Scrutiny Committee.

A number of questions were raised by the Board as follows:

Service roadmap – It was requested that a roadmap of services be created to enable Councillors to effectively signpost residents to mental health services. It was also requested that a briefing be arranged for Members once a roadmap had been created. The CCG Head of Mental Health Commissioning agreed that a roadmap of services would be helpful. Some work had already been undertaken to map services but it was difficult to keep such lists up to date. Imago had won the contract for the provision of Care Navigators in Medway. These Navigators would play a key part in helping people to navigate services. 

Medway Community Mental Health Team (CMHT) – The Strategy recognised that this Team was under pressure, was experiencing high caseloads and that GP and patient experience of the service needed to improve. The Member considered that investment in this area could effectively be a saving as it would help to prevent mental health issues from escalating. The Head of Mental Health Commissioning advised that the Kent and Medway NHS and Social Care Partnership Trust (KMPT) was working to improve the CMHT. KMPT was implementing a new Choice and Partnership Approach (CAPA) model and a new service manager was in place. The CCG would be working closely with KMPT to address the challenges. It was noted that CMHT provided secondary mental health services rather than provision for people in acute need. 

Section 136 facilities – Medway did not have its own specialist facilities to accommodate people detained under section 136 of the Mental Health Act. This was particularly concerning as this situation has persisted for several years, resulting in a strain on Police services and people with mental health difficulties being inappropriately detained in Police cells. A Board Member said that there was a clear need for the provision of a section 136 suite locally, preferably in Medway. It was requested that timescales for addressing this issue be provided to the Board. The Head of Mental Health Commissioning said that it was not currently possible to provide timescales due to the complexity of the work required across Kent and Medway. She agreed that Section 136 provision locally was a concern, particularly as Medway had the highest number of Section 136 detentions in Kent and Medway. KMPT had already submitted a bid for funding for the establishment of a central suite in Maidstone. The Managing Director at Dartford, Gravesham and Swanley; Swale; Medway and West Kent CCGs was the Chair of the Kent & Medway Mental Health Crisis Care Concordat Steering Group. The Group was considering how it could work with the Police to address the challenges relating to Section 136 with an Action Plan having been developed. One current issue was that Police Officers often did not phone the specialist advice line that offered advice prior to a person being sectioned and therefore the Officer would not be able to follow this advice.

It was agreed that the Managing Director would be invited to present a report to the next meeting of the Board on the work to address the Section 136 concerns. It was requested that this should set out what an effective system would look like, what type of provision would be most effective and if this could not be achieved, what would be the alternative. The report would also include details of timescales and actions required to facilitate delivery. It was suggested that this could be included as part of the Mental Health Crisis Care Concordat report that was also due to be presented to the Board at its next meeting.    

Mental Health Funding – The Managing Director of KMPT said that, in view of the Government announcement of increased funding for mental health provision, there was an opportunity for Medway to consider the services required locally and how to ensure that it could access the maximum level of funding possible. The development of the NHS 111 service and access to advice and guidance for people experiencing mental health difficulties were suggested as particular areas of opportunity for development as well as work with schools on prevention to help avoid mental health difficulties becoming more problematic as children and young people get older.

Out of area placements – Very few patients needed to be placed outside Kent and Medway, the one exception being female psychiatric intensive care patients as there was no facility for this group in Kent and Medway. Some Board Members emphasised that they considered an out of area placement to be any patient who was placed outside Medway, rather than outside Kent and Medway. As the majority of provision for Medway residents was currently in Maidstone or Dartford, the Members considered that all these placements were out of area.

Transition from child to adult mental health services – A Board Member asked whether it was known which areas were good at managing the transition from child to adult mental health services and whether Medway could learn from them. It was requested that reference be included in the Strategy to say that learning from best practice would be undertaken over the next five years and embedded in the Medway model.

Consideration of the Hoo Peninsula – A Member felt that there was not enough recognition in the draft Strategy of the specific issues affecting the Hoo Peninsula in view of the fact that it had 25,000 residents and was growing. Recognition was needed of the difficulty Peninsula residents faced in accessing services in Chatham, Gillingham, Rochester or Rainham.

Other issues - In relation to the piloting of services in Medway, a Board Member considered that more needed to be done to make clear that a pilot project was trial of a service rather than necessarily being permanent provision.

In relation to problem gambling, while upper tier local authorities provided services to support people who misused alcohol or drugs, the Member was not aware of any authorities that provided similar support for people with gambling addiction. It was requested that reference be made in the Strategy that the need for this provision had been nationally recognised.

It was also noted that the Medway Ethnic Minority Forum was now the Medway Diversity Forum and that the reference to this in the draft strategy would need to be amended.

Decision

The Board commented on the draft Mental Health Strategy prior to its presentation to Cabinet for approval.