Southe hern H n Health N h NHS Foun undation T on Trust Menta tal H Heal alth Karen G en Guy: Gene eneral M Man anager Ad Adult M Ment ental H Heal ealth Jessica B ca Berry: H Head o of Mental ntal H Heal alth C th Commissioni oning ng acr across the the f five H e Ham ampshire C CCGs
Overview This presentation provides an overview on : Adult Mental Health services Expenditure Adult Mental Health services pathway Recent changes to in-patient acute mental health capacity Section 136 suite provision and future plans Challenges and developments in community mental health Performance 2
Adult Mental Health services There are various levels of support for adults needing mental health care: • Step 1 – Early signs – Watchful waiting by Primary Care professionals • Steps 2 and 3 – Improving access to psychological therapies (IAPT), known as ‘italk’ – Patients assessed and treated with signposting, advice cognitive behaviour therapy and telephone support • Step 4 – Community Mental Health Teams (CMHTs) • Step 5 – In-patient units 3
Adult Mental Health spend During 2014/15 the CCG spent almost £15.5 million on adult mental health services. This included: • Inpatient services - £3,230,242 • Access and Assessment Teams and Community Treatment Teams - £4,004,490 • Eating disorder and Perinatal services - £99,359 • Older People’s Mental Health services - £5,811,053 • Learning Disability Services - £1,210,652 • IAPT services (‘italk’) - £1,125,777 4
‘italk’ ‘italk’ provides the Improving Access to Psychological Service in Fareham and Gosport • Patients can referred themselves to the service or be referred by their GP or another healthcare professional • All patients are assessed and treated through a range of ways including signposting, advice, cognitive behaviour therapy (CBT) and telephone support • Patients needing high intensity support are provided with up to 20 face-to-face sessions of CBT 5
Acute pathway There are two types of inpatient facilities that can provide treatment: • Psychiatric Intensive Care Unit (PICU) • Length of stay shorter than acute • Patients are sectioned under the Mental Health Act (MHA) • Locked ward environment due to high risk of absconsion • Acute Unit • Average length of stay of 30 days • Patients may not be locked in and units cannot care for patients who have been sectioned under the MHA • Separate male and female wards with communal areas 6
Bed capacity There has been an increase in demand for inpatient services so we opened an additional 18 beds: • Opened all contingency beds from 107 – 115 (eight beds) • PICU Parklands, Basingstoke (two beds) • The Orchards, St James Hospital, Portsmouth (two beds) • Huntercombe, Roehampton (six beds) In addition we are planning to open a further eight beds in Eastrop House in Basingstoke 7
Number of admissions From April to November 2014 there were: • 27 admissions to a PICU with 63% treated in their local unit • 127 admissions to an Acute Unit with 42% treated in their local unit To prevent patients who need acute care having to travel out of area we have changed some of the PICU beds to acute beds as this has higher demand. From December 2014 to February 2015 there were: • 10 admissions to a PICU with the majority being cared for in a Hampshire unit • 54 admissions to an Acute Unit with 65% (compared to 42%) treated in their local unit 8
What is Section 136? Section 136 of the Mental Health Act 1983 allows a police officer to remove a person they think is mentally disordered and ‘in immediate need of care or control’ from a public place to a place of safety, in the interest of that person or for the protection of others. The person may be detained for up to 72hrs so that they can be examined by a registered medial practitioner and interviewed by an approved mental health professional (AMHP), and to make any necessary arrangements for their treatment or care. 9
Section 136 local challenges • No dedicated staffing for places of safety • In some cases the suite(s) are not aligned to the acute/PICU wards • Pressure on ward staffing has led to some occasions when the Police have been told no-one can be admitted to the suite • Mental Health Crisis Care Concordat expects that health- based places of safety “should be provided at a level that allows for around the clock availability, and that meets the needs of the local population” 10
Local S136 plans for adults and children • Medisec currently convey all section 136 patients on behalf of the Police and the approved mental health professional (AMHP) service • Subcontracting to Medisec staffing of section 136 on a spot purchase basis, which would mean that once the two-man Medisec crew convey the patient to the place of safety, they would remain with the patient until the end of the assessment, providing the continuity of care to the patient • The nurse in charge of the ward would need to complete the section 136 admission process, but would then be able to return to the ward 11
Local challenges Increase in acuity, complexity and length of treatment time due to: • Physical health and co-morbidity Social factors such as debt, unemployment and housing • • Drug and alcohol use, gambling and petty crime related issues • Safeguarding and vulnerability in the community Recruitment of key professional roles: • Psychiatrists, Mental Health Nurses, Psychologists • National shortage • Training placements • Retention 12
Local performance • Care Programme Approach clients 12 month review – national target of 95% achieved locally • Seven day follow up appointment – national target of 95% achieved locally • Seven week (routine referral) follow up appointment – national target of 95% achieved locally • 98.8% of planned contacts with community staff made • Did not attends (DNAs) in Fareham and Gosport (11.6%) lower then the Hampshire average (12.3%) 13
Links to other services Southern Health works closely with other service commissioned by the CCG and Hampshire County Council Wellbeing Centres • • Carers Services • Advocacy • Dementia Advisors • Chronic Fatigue • Autism & ADHD 14
NHS 5 Year Forward View • Pre-existing mandate objectives (IAPT and Dementia) • Mental Health Access – New waiting standards • Psychiatric Liaison • Children and Adolescent Mental Health • Mental Health Crisis Care concordat 15
Any questions? 16
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