APPENDIX C

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MENTAL HEALTH NEEDS ASSESSMENT

EVENT 1, 10 October 2014 – WORLD MENTAL HEALTH DAY

EVENT REPORT

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ATTENDANCE

53 registered (14 of these did not attend)

54 attended on the day (15 of whom had not registered)

12 service users attended

5 carers attended

21 evaluation sheets completed

EVALUATION SUMMARY

How many agreed?

My time at this event has

been well spent

21/21

I would recommend a

similar event to my

colleagues

21/21

I felt I was able to

contribute my views and

experience today

20/21*

How would you rate the

various activities you have

participated in?

Good x 16

Excellent x 5

How would you rate the

facilitation of this afternoon’s

event?

Fair x 1

Good x 12

Excellent x 8

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Programme

Timing Description

1.30-1.35 Official welcome: - Cllr Fergus, Mental Health

Champion

1.35-1.40 Official welcome: - Peter Hewitt, Service User and

Involvement Representative, NELFT

1.40-1.50 The aims of the needs assessment and what the data

seem to be telling us

1.50-2.30 Small table discussions and feedback

2.30-3.20 Stories’ session and feedback

3.20-3.45 Afternoon tea and viewing of the stories work

3.45-4.15 Assets and mapping session

4.15-4.25 Our quick reflections on what we’re hearing

4.25-4.45 Plenary feedback from you

4.45-4.55 Next steps

4.55-5.00 Formal thank you and close

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EXERCISE 1

Question 1: To what extent did the presentation match your experience ‘on the ground’? Question 2: To what extent does the service response right across the system meet the needs described? Table 1: (Facilitator: Eugenia Cronin)

For CMI – mild end, education, training, financial support, prevent social isolation

SMI – good models of care - but getting psychology really hard

Connection between physical and mental

CYP – probably higher

Surprised CMI so high - Is it connected with current economic climate - Housing - Lack of work - Pressure of jobs

Things can be done earlier with CYP

Parenting skills needed

Prejudice against people with MI getting jobs

Stiff upper lip

Got better at transition - started running clinics with paediatrician - at 17.5 yrs we start taking over

Strategy needs to include PREVENTION - Include “children with statement” - Learning disability /autism (e.g.)

1. Wholistic approach around CMI patient needed 2. We need peer support workers 3. Prevention

CCG spend 10.8% of budget on MH – National Average is 13% SMICMI patients can access Recovery College

Table 2: (Facilitator: Gemma Hughes)

Alcohol and Drugs: - underlying problem – Mental Health - very difficult to assess - different providers and commissioners for MH and substance misuse → Need more dual diagnosis!!!

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Employment: - lack of trained professionals who can sup[port clients with mental health into work → R

Richmond Fellowship - used to get more support through JobCentre. Now DWP don’t manage it → very unclear/disjointed

*** Lack of clarity/information regarding services and where to go (eg, The Hub – Lambeth …!)

Making sure those affected by the commissioning decisions are involved in the process. Table 3: (Facilitator: Lisa Marin) Question 1:

*** No mention of substance misuse

No mention of sexual health, FGM, rape, prostitution, DV

Depression mentioned

Bullying – awareness, practical help, mental health awareness

More training for professionals, ie, teachers

Changes in life

B&D has special problems (2nd poorest) – specific to areas

*** BPD – challenging Question 2:

Cutbacks – MH Day Centres

Benefits cuts – promoting MH problems no helping

Partnership working

Hard to access services

On line (excluding some people) Table 4: (Facilitator: ?)

Thought there were more people with SMI/CMI

Lower class hit on only

Focus more on people with lower education than those with Degrees, etc

The statistics show a wrong opinion (where do they come from)

What do they mean by the lower classes?

We feel that other classes are not being looked at

If you suffer from a mental illness why is there always a connection that your mental illness has caused your physical illness?

We feel that these statistics should be made more simple as they seem to be very overblown

The statistics do not show how many formal carers there are, how much help goes into helping other people

The statistics do not show what impact mental illness has on an individual person

The mental health system does not work for service users as there is a one size fits all approach

Difficulty of access to services

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Table 5: (Facilitator: Vince Thomas)

Supply not sufficient → Demand

Groups need support/training/finance from the professionals

More funding and support in the community – consequence is less drain on NHS

Mental is physical illness and needs to be treated equally

Long-term health conditions – direct links with mental health

NO LINK was highlighted with substance misuse ……

Individuals with CMI are disadvantaged in society (reduced/limited choices)

Uprise of local community groups – also volunteers. Pros and Cons: Concern – over reliance in long term.

Still a stigma surrounded around CMI – social exclusion

High expectations from volunteers. Without long term required skills/training or support and supervision.

Question 2:

NO Table 6: (Facilitator: Jan Davis) Question 1: Presentation:

Demographics in B&D

Significant increase in referrals of people with mental health needs

Increase due to external factors, ie, employment, family pressures

Higher unemployment in B&D

Constant support and empowerment through their experience Question 2:

NO increase in services (drop in services)

To identify triggers to minimise risks

Identifying priorities, investment

Important family wellbeing, community

Education: - feeling “us and them”

Encourage: - lack of information re what is available - what resources are available

Reactionary: - to establish that the needs are met accordingly

Housing needs not dealing with presenting mental health needs of their tenants

Poor uptake of training from the police

Recovery College at NELFT

Raise awareness of community group-s

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Mental health champions Three Main points:

MH is everyone’s business, better education and training

Rising prevalence and decreasing resources for MH services

Better integration and partnership with housing, police, schools, community groups’ engagement and other external agencies

Table 7: (Facilitator: Sophia Quzi) Question 1:

Match very well, however it only covers those users who have come forward. Also it was not specific enough, ie, those who can’t find work due to illness psychosis or those who lost job due to psychosis.

Extend the voice to include/capture views of young people, age 14 – 25, including their carers.

The time of the survey – was it done before or after the recession? Question 2:

Feel that the services across the Board DO NOT meet the needs of everyone such as Service men and women.

Professionals need more specialist training. Vocational training must mean Vocational training – should be free and not affect benefits

Tables 8 and 9: (Facilitator: Lorna McCarthy and Cynthia Folarin) Question 1:

A) Surprised about the figure, believes it is due to the fact the amount of people moving into the borough and social issues that exist.

B) Not surprised the figure is not higher, due to 2001 report about mental illnesses in the country. Saying 1 in 6 suffer with MH.

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Additional comments:

Starlight: - felt safe - bingo - quiz’s - trips

They need to bring back Starlight

On Wednesday Gary and Jenny do Centre at St Margaret’s Church

Need professional support

Professionals need to appreciate community setting

About Police – living rough

Mental Health is an investment

Funds invested in prevention and promoting positive MH understanding could avoid the impact when a problem develops later; financially and on the person

Need a social firm to fund MH services

Road Map for (Gemma contact) patients/providers for all needs (like Tube Map)

Care Pathways

Need Clubhouse model for day services for Mental Health

Clubhouse is where Service Users volunteer in Day Centre run by professionals

Dementia: - needs to be included - not covered today

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EXERCISE 2 – STORIES SESSION

John: Table 7 (Facilitator: Vince Thomas) Three key points:

1. Early intervention - primary care - ISPT – therapy / self-help - support for employer

2. Knowing where to access help or support 3. Social inclusion opportunities – third sector

Denial

Neighbour support

Duty of employer to refer

Neighbour support to GP

Self-awareness

Mental health education and training for professionals at every level

GP involvement: - Ax / Medication / IAPT referral

Monitoring: - mental state / medication effects / physical health / Consideration of referral to secondary care if appropriate by GP or IAPT

Put on GP “Register”

Screening through physical health appointments

IAPT – therapy – CBT / self help - BWW, books on Px

Referral to support services / social inclusion Reality:

- Long time for recognition / stigma - Lack of awareness of where to access help / support - Does GP recognise symptoms - GP gave leaflet and expected self-referral - Language / jargon used is off-putting - Could of ended up in A&E – “chest pain” - John may have resisted intervention - John deteriorates further - No motivation

Continue with primary care ↓ - GP prescription - IAPT – counselling/therapy - self help - GP/IAPT monitoring - Voluntary sector engagement - Improvement – Discharge - Deteriorate – Refer to:

Referred to secondary care services ↓ - Formal Mental Health Act assessment - Screening Ax by access and assessment - Seen by Psychiatrist - Prescriptions - Referral to Psychology - Admission to inpatients - Home Treatment Team - Community Recovery Team - Outpatients / Community Clinic - Voluntary Sector

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Yasmin: Table 2 (Facilitator: Gemma Hughes)

Understanding boss: - reasonable adjustments - legal rights - no legal aids - employment advice to protect: access rights / levels of expertise varies / referral to 2nd tier

Advice: - housing and employment

Support: - link with family

Mental Health First Aid in the workplace

Support of relative: - data sharing

Early access to MH support: - GP - voluntary - sectioned - home treatment

Access to advice: - Quick access to services that can respond quickly and effectively

Appropriate meds: - wrong medication ** the right medication quickly

Trust / Connecting with others: - important to have positive relationships with those involved in their care ** a relationship with professional (CPN) based on trust

Flexibility

Inner resources

External resources Yasmin: Table 4 (Facilitator: Cynthia Folarin)

Occupational health Line management

GP – poor sleep – not necessarily MH – Experience clarity

Referral to psychiatrist due to hallucinations, etc

No medical organic causes / therapy

Medication

CPN

Self-help, yoga

Paranoia and isolation – doesn’t access service

Medication before you need it

Primary source → gaps in knowledge of GP – training ** Slip through net

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Secondary care → hospital – section

O.T.

**Waiting times, delays in accessing appropriate staff due to shortage of staff

Relationship of client/professional needs to be therapeutic

Balance between talking treatment/medication

Person-centred, individual

***One size fits all

** Care coordinators (not everyone has one) Colin: Table 5 (Facilitator: Sue Seeley)

Referral to substance misuse services (YP services) o To address cannabis and alcohol use o Mother referred to carers groups o Police are aware of Colin’s situation and therefore doesn’t arrest him when he is in trouble,

but takes him home o GP o ADHD specialists/clinics to support him into CTE o Integrated service to link education/MH/employment o Be realistic about employment ambitions

Family support with uncle finding him employment

Colin was listened to regarding his career choice

Education in the hone – parental and carers involvement down to the food that is offered, etc

Therapist involved Colin’s mother as part of therapy

Early intervention may have prevented the substance misuse

Support groups in substance misuse for family members

Transition age within MH services – go from lots of support to very little

ADHD – is there a clear pathway for transition age?

There are transition clinics from 17.5 years

Youth group – activities to make friends / peer mentor / Buddy

** Excellent communication links between MH and drug treatment services is essential

Colin was thoroughly assessed for his needs and ** got support from a peer mentor *** little or none in mental health in ADHD

Colin trusted the person he worked with because he didn’t see lots of different professionals GAP: Joint working / communication in all sectors

Do teachers know where to refer to? How is ADHD flagged up?

Sharing information amongst professionals

** Need a transitional pathway for all mental health issues

Dyslexia/Dyspraxia diagnosis and support

** Pathways from schools – teachers need advice and consultation

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ASSETS SESSION

Groups asked to identify assets that are important for people’s mental health, that exist in the borough. These might be community or geographical – participants identified a list of assets and identified those which had a ‘geographical presence’ and assigned a flag which was placed on a map. Table 4: Yellow (Facilitator: Gemma Hughes)

Weather

Pets

Radio

Sister

Free newspapers

Baking

Exercise

Gardening

Walking

Fellowship meetings

Daughter

Fishing

Neighbours

Freedom Pass

Knitting

Gym

Music

Friends

Crosswords

Mum

Therapists

NELFT Sports Day Geographical:

Becontree Leisure Centre

Learning Centre

Raphael Park

Barking College

Public Benches, Barking Station

Town Square

Eastbury Manor

Eco-Therapy Walks – The Chase

Library

Recovery Café

St Margaret’s Church Café

Support Group (Tues, Weds, Thurs 11-2pm) – St Margaret’s

Barking Bathhouse

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Dagenham and Redbridge Football Club

Barking Park Table 5: Blue (Facilitator: Sue Seeley/Vince Thomas/Sue Butcher)

Internet cafes / Library – to keep in touch with family/relatives

Children’s Centres

Choirs (there is one in Dagenham – can’t remember the name)

Amateur dramatics/orchestras – in surrounding areas

Coping through football

Valence House

Eastbury Manor House

Dagenham Open Mike – Talent (last Thursday of the month) - yoga - tai chi

Cuckoos Nest Support group MH

Bath House (part of BLC)

Volunteer Service (CVS)

NELFT Services

Benefits

Job Centre

Gardens (own and others) – make a window box/indoor plants

Drug and Alcohol Services + AA/NA etc

Abbey Sports Centre

Leisure Centres

Fit for Life

Barking Library / Learning Centre

Dagenham Library

Heath Library

Thames View Library

Valence Library

Broadway Theatre

Relish Café

Valence Park

Ranger Walks – Mayesbrook Park

Barking Park

Barking Adult College

Barking and Dagenham College

Recovery College (NELFT)

Richmond Fellowship

CAB

DABD

Festival Leisure Centre

Pubs (health warning)

Transport to and from Barking and surrounding areas (Freedom Pass)

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Table 6: Green (Facilitator: Jan Davis) Geographical

Green open spaces - all parks - activities in them

Becontree Leisure Centre – exercise on prescription

Abbey Leisure Centre

Barking Abbey ruins – off North St

Eastbury Manor

Valence House

Barking Learning Centre

Dagenham Library

Dagenham and Redbridge Football Club

Allotments – Becontree Heath

Broadway Theatre Table 7: Red (Facilitator: Sophia/Olu)

Library – Dagenham Heathway

Parks – East Brook

Cafes – Shepards

Pubs – Royal Oak, Becontree

Leisure Centres – Dagenham

Churches – religious centres (St Margaret)

Barking Market and Dagenham Heathway

Shopping Mall - Vicarage Field

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FINAL SESSION

What we missed today?

GAPS: → Slide

A&D → Sub-mis and individuals that are attending frequently but do not have a disease specific issue – classed as MH but are not → LABEL

Need to focus on the cultural needs of individuals 3% of individuals on CPA are in employment, however compared to general population in B&D this is good

Remploy has been lost from B&D

GAP: Lack of Peer support → also identified in CQC survey

How are we doing? Who is missing?

Police → Community Support Police

Decision makers

GPs (without a special interest in MH)

MP

A&D staff

Faith Leaders

Community Pharmacist

Schools

CPN

Housing

Employers

Job Centre →

Transport → Bus Drivers

Ambulance Event 2: 12.11.14

Look at good practice from elsewhere:- - Lambeth - Sandiwell

Priorities in a co-produced way: Priorities → short/long term goals → realistic!

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When will decision-makers be brought in? (EC replied: will be reporting to MH Sub Group on 3.12.14 with recommendations)

PTSD

More from Service users → sharing their experience (have service users speaking from the front rather than around the table).

‘Stigma’ – inflammatory use of language by professionals – can be found offensive! Unravel stigma.

EC advised that the information would be tabulated into the report and will be sent to everyone. Thanks to Facilitators

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Detailed evaluation

To what extent do you agree with the following statements (please tick one):

My time at this event has been well spent: Agree x 21 (100%)

I would recommend a similar event to my colleagues: Agree x 21 (100%)

I have felt able to contribute my views and experience today: Agree x 20 Neither Agree nor Disagree x 1

How would you rate the various activities you have participated in this afternoon?

Good x 16

Excellent x 5 How would you rate the facilitation for this afternoon’s event?

Fair x 1

Good x 12

Excellent x 8 Please give any further comments:

Good group exercises but some exercises were based on subjective opinion, rather than objective experience

Needed more time for the amount of activities scheduled

Well organised and thoughtfully planned

One of the facilitators wasn’t that good – the others were excellent, so the average is fair What are the two most useful things you have learned or will take away with you?

Networking and trouble shooting

Transition

Views of the users

Assets in B&D

Facilitation is out there (just needs better networking)

Assets was very useful exercise

Issues which affect service users / being listened to

Service users are more active than thought they would be

I learnt about the resources on offer in B&D

LBBD is serious in raising awareness of mental health and preventative care – and focussing on our young people

Being able to network with such a diverse group of people

Early intervention

Full service for service users

The amount of support available in the area

The input of services users was great – learnt their perspective

Engagement is difficult for some MH services

Time constraint affects the quality

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The knowledge connected to all aspects of the MH group

Enjoyed doing this work with people from a range of perspectives

Met some people who work in borough services

Seemed well organised

Need for appropriate early intervention

Need for appropriate education and awareness for GPs and general community

To take part in group conversation

Diversity of group CSUs and professionals

The range of activities available

How many allotments there are in B&D

More about how CPA works

Insight from different areas

What two changes, if any, would you make to future events?

For service users to be more involved, ie, to run half of the session

Apart from fruit, there was no vegetarian options

Engagement of more front line staff, as they seemed to be lacking – CPNs, social work, GPs etc, albeit great representation of service users

Provide with vegetarian food for the participants

Put more events on using the same approach as today

Focus on the mental health needs of our young people

Ensure there are young people represented at day (14 – 25 years) or on a different specific young people day. There is a young people’s group call ‘Listen!’ (part of TLZ, young people’s counselling service) – they could be consulted.

None

Not on a Friday afternoon

Make sure there is feedback on what is going to change as a result of this event

Smaller groups of people, who need more time

Mini events

Find some different and more inclusive ways to engage with people with mild/moderate mental health problems

Sound check as we needed a microphone

Ask people to turn off mobiles

Would like for dementia to be mentioned

To have more tea breaks as it is a long day

To have some air in the meeting room

Look at how a service user is supported after discharge from CRT

Explore the need for and shape of a day service

Service users taking a bigger role

Plenary speakers

Less moving around What is the single most important thing that you think the mental health needs assessment should cover?

Transition

Service specification to meet local needs

Interaction

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An increase in population in Barking & Dagenham and increase in referrals to secondary care MH services, who are constantly expected to deliver care with a reduction in budget. This needs to be acknowledged and addressed by commissioners, who just keep increasing targets. There is a disconnect.

Train up some of our young people to work with their peers – to raise awareness via the education system

I am very excited that we are actually having open and frank discussions including service users. Cllr Fergus

Wellbeing

Drugs and Alcohol Pathway and Dual Diagnosis provision

Moving people forward for better health and wellbeing

Easy access to what is on offer and individual case treatments

Service user (a range of services) perspective

Meaningful activities / work in the borough

Growing issue of dementia in members of the community - growing population of older people

To recognise the person first before the illness

Communication and services available

Appropriate housing

Practical education and training