BME Mental Health 14 November 2018 NHS Croydon CCG Paulette Lewis - - PowerPoint PPT Presentation

BME Mental Health

14 November 2018

NHS Croydon CCG

Paulette Lewis

Lay Member for Public and Patient Involvement

• Introduction
• Croydon: Population Challenges

& Our Vision for Mental Health

94,434 0-17 year olds 237,663 18-64 year olds 50,206 Aged 65+

Croydon has one of the largest populations of all the London Boroughs

Who is Croydon?

Croydon’s Diversity – a reminder

• A large, diverse and growing population
• It will grow 12% in next 15 years
• The largest London borough
• Around 380,000 residents – half of which are BAME
• More than 100 languages spoken
• From Albanian to Yoruba
• Croydon has 6,000-7,000 new immigrants from outside the UK per

year

• But 3,000 people emigrated from Croydon
• High rates of isolation
• Croydon is 19th most deprived borough in London – on current trends

deprivation will increase

• Risk factors for ill-health (mental & physical) is linked to deprivation

Mental ill-health increases risk of other illness/risky behaviour

Mental Health Priorities & Croydon’s Diverse Communities

In July we spoke about our plans to develop mental health services that helped people to:

• live longer, healthier lives
• to make their own choices
• enjoy high quality outcomes
• access services before crises happened

In addition we wanted services that addressed specific gaps, were responsive to community needs & were culturally appropriate. The next presentation will tell you what we have been doing …

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NHS Croydon CCG

Marlon Brown

Head of Mental Health Commissioning

A new way to deliver Mental Health services

Current System: The ‘As Is’ Pathway Map

• In May-18, we developed ‘As Is’ pathway to take stock of the

current Mental Health offer, identifying issues, gaps and potential solutions

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Problems with current model

• Barriers for patients travelling between the green, yellow & red silos
• Lack of joined-up approaches within the silos
• High A&E attendance
• Physical health problems for those with undiagnosed severe

mental illness

• GPs unable/unwilling to accept stable people with severe mental

illness

• This results in people spending too long in secondary care
• It places more pressure on the Trust and creates longer

waiting times

• The voluntary sector lacks capacity to help
• People suitable for primary care not discharged because lack of

community resources

• Impact on wider determinants on mental health

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New System: ‘As Will Be’ Pathway Map

Aims of the new system

• To create a single point of entry to the mental health ‘system’, via a cross-

agency ‘front door’ approach

• To give equal weight to the social, physical and mental health needs as

defined by the service user, carer and their GP

• To create a diverse range of timely, accessible services that support

recovery, resilience and instil hope

• To reduce mental health crisis escalations and reliance on urgent care, in

so doing.

• To provide a proactive, valued resource for its members that encourages

them to use the service proactively, supporting their self-efficacy to manage their continued recovery and avoid crises

• To integrate service delivery across existing providers and General

Practice, including a single assessment, care plan and care record with EMIS at its heart

• To co-locate and deliver services across a number of community-based

‘Hubs’ and spokes, to ensure maximum accessibility and joint working with existing community groups.

High Level Description of Integrated Mental Health & Well-Being ‘Building Blocks’ Provider Assessment, Clinical Case Management, GP Liaison/Advice Line. Psychiatrists and CPNs/SWs/OTs. The single MDT ‘way in’ to access all primary and secondary MH services. Rapid triage, assessment, formulation and care planning/treatment entry (directly to secondary care if indicated). Key offer: case management & brief intervention (up to 6 sessions) & advice line/liaison for GPs. TBC Navigators Team of expert health and social care navigators to work alongside the clinical team within the MDT approach. Coordinates and supports delivery of social elements of care and support (housing, debt, welfare, employment, training, CAB etc). Typically 2-3 contacts max. TBC Employment Support Expert service to support people to keep jobs, re-join the workforce, train or volunteer. Provides 121 mentoring and workplace support, help with applications, CVs, interview support, group training. Coordinates link to wider employment initiatives across the Borough in pursuit of ‘no wrong front door’ approach. TBC Psychological Therapies Direct access to Step 2, 3 and 4 psychology from Primary Care and the Hub. Using a reciprocal ‘hub and spoke’ approach, existing services delivered in Hubs and other community settings, including larger GP Practices. Promotes access to ‘IAPT’ services via better community integration and targeting of 65+ and key LTC groups. TBC Peer Support Centrally located development workers who will provide a range of peer support activities including time- banking, mentoring programmes, skills-swaps, befriending, a volunteer pool, and coordination of activities. TBC Self Help/Self Care Literature, group-based (guided) and on-line self-help to support and maintain recovery and well-being. A range

• f coordinated self-care activities such as gym/swimming club membership/passes and also massage,

acupuncture, mindfulness meditation to be made available at Hubs and existing community settings. TBC Connected: Social Activities Coordination and promotion of a range of supportive activities that reduce social isolation and support mental health and well-being through participation, creativity, achievement and ‘belonging’ (e.g. yoga, gardening, walks, social and community events such as theatre, arts trails, etc). Web-based platform for booking. TBC GP Enhanced Care A new GP specification will be the bedrock of a proactive/preventive population-based approach. An annual ‘Well-Being & Recovery’ Review and Plan (Bio-Psycho-Social) for all those with long-term complex mental health needs (SMI + Complex Non-psychotic needs). Extended appointment times up to 3 x 30 minutes. TBC

Social Prescribing

Brian Dickens

Croydon Social Prescribing Community Engagement Team

Where are we: The Journey

July 2017 – 1 Practice July 2018 – 42 Practices Why? How? Impact?

Community Engagement

Why

• Practices have increasing and unmanageable patient lists
• Increasing complexity of medical care provided by GP’s
• 20% of GP consultations do not require clinical intervention
• Currently practices have a few patients taking up 90% of practice time
• Those who need to engage do not attend or manage their own health
• Shortage of GPs fuelled in part by pressures of workload
• Reducing available NHS Budget
• Need to change patient and community behaviour around health self

management for more effective use of resources

Community Engagement

Why

• We are in the thick of it
• Majority of our area and some patients are in either from 5%-10% most

deprived in the country of 10%-20%

• We deal with a cohort that includes health issues such as 2 in 3 adults,

roughly 181,000 Croydon are obese / overweight

• Half the number of women giving birth are overweight / obese / morbidly
• bese and 5% of these are diabetic
• 23% of children live in poverty
• 58% of females and 43% males are not physically active
• Life expectancy is 9.1 years lower for men and 7.7 for women than the

national average

Social Prescribing

Community Engagement

LOCAL SOCIAL ISSUES

• Social Isolation
• Financial / Debt advice
• Health and Exercise / Health management
• Diet
• Mental Health issues
• Community Safety / Mentoring
• Unemployment Rate – Highest in London
• Community Cohesion / integration

Social Prescribing

Community Engagement

• Need to look at long-term behavioural change
• Change Patient Dependency
• Capacity Build the local provider
• Develop patient self referral to more community structures
• Develop more holistic community interventions
• Multi Agency- Multi disciplinary Approach
• Community Hubs / led by the community / for the community / owned

by the community / SUSTAINABLE

• One stop shops for community development / health interventions

Social Prescribing

Community Engagement

How

• All of this has been achieved
• Small Dedicated community based team
• A Partnership approach
• Development of relationships with GP practice’s
• Small Localized Funding – and Community Support
• No NHS Support or Funding
• Because
• No Barriers
• No Delays
• No Red Tape
• This was always about Doing! Not Waiting!

Partnerships - Opportunities

• Croydon Council
• Local MP
• Local Councillors
• Croydon Commissioning Group
• GP Practices
• Christians Against Poverty
• Nike / Brand Jordan: Practical

partners in positive change

• Apple
• NHS – National Team
• Best Start
• Crystal Palace Foundation
• Croydon Voluntary Action
• Croydon BME Forum
• Various Local Churches and

Community organisations

• We have delivered partnerships

that includes support from

• Statutory Sector / Public Sector /

Third Sector and the Commercial Sector

• This is the route to sustainability

and long term impact

Social Prescribing

Community Engagement

Key partners

• Palace for Life Foundation
• Nike Community Ambassadors
• NHS England
• Croydon Best Start
• Apple
• St Paul’s Church
• NHS Croydon CCG

Community Engagement

Impact

Strategic Developments

• Partnership and strategic support from NHS England at a National level
• Winner of the NHS Parliamentary Award for excellence in Primary Care

Programme Development

• Access to and partnerships with 60 interventions: from health classes- choirs---to

counselling Partnership Development

• Over 60 partnerships- covering, corporate-public- third sector- local community

Community Hubs

• 21 community hubs signed up to be part of the programme

Participation

• Over 28,000 attendances in six months

Independent Research

• Resourced and underway

Community Engagement

Next Steps / Opportunities

• Food Stop Project – Partnership with Fairshare / All major food retailers around
• verall support for Thornton Heath Community
• New Addington & Selsdon network
• Group Consultations – Tremendous feedback already
• Development of Local Voluntary Partnerships : - Alliance
• GPs in the community
• Barbershop project
• Physical Activity Young people
• Community Gyms / Well Being Centres
• Health help Now App
• Meeting with Simon Stevens: CEO NHS
• Formalisation of the social prescribing community engagement team