Joint Mental Health Commissioning Strategy ‘Mainstreaming Mental Health’

1. Joint Mental Health Commissioning Strategy ‘Mainstreaming Mental Health’

2. Mental Health Partnership BoardVision & Values Values In working towards our vision we will: Act with integrity in the spirit of openness and true partnership Encourage and empower individuals to exercise their rights to choice , respect, dignity and independence through equality, opportunity, and inclusion Embrace the diversity of our local population to facilitate their mental wellbeing Involve and inform local people in planning and reviewing services to meet their needs Implement rapidly and systematically improvements in service delivery, basedon evidenced practice through effective and accountable leadership and management Ensure appropriate and timely access to services Value and accept feedback from Individuals and providers across Kirklees Do what we say we will Vision • The vision for Kirklees is designed to enable our local population, to maintain and improve their mental health and wellbeing. • For those who experience mental health distress, our aspiration is for them to obtain the highest level of self sufficiency within their communities, through the use of valued, quality support, networks and services

3. What Works and Ways Forward Promote Well being Target High Risk Groups: People with MH problems People with disabilities Vulnerable Young people Offenders Homeless people Disadvantaged families Isolated older people Travellers & asylum seekers BME Groups Address underlying Risk Factors & Promote Protective Factors Reduce Risk Factors Resilience – Life Skills to deal with Everyday traumas Violence & Abuse • Promote • Protective Factors • Access to Creativity • Emotional Literacy • Relationship Skills • Talking Therapies Mental Well Being Individual Physical Risk Factors • ReduceRisk Factors • Smoking • Drugs • Alcohol • Promote Protective Factors • Healthy Eating • Physical Activity Physical Well Being Social Determinants • Reduce Risk Factors • Unemployment • Poverty & Homelessness • Discrimination • Family Breakdown Social Well Being • Promote Protective Factors • Housing,Benefits Advice & Advocacy • Community Activity & Social Networks • Health settings-work, Hospitals, Prisons Access and Discrimination Engagement with Third Sector and Citizens

4. Psychological Services Biological Services Environmental Experience Economic Trends Social Services Social Integration Recovery

5. Stepped/Tiered Approach - Prevalence & Incidence Between 1000 – 1200 people Acute Illness Significant Risk Tier 1 Treatment resistant - Severe & enduring illness Between 1,200 – 3,000 people Tier 2 Tier 3 This is the neglected majority. Between 5,000 – 7,000 people Common & Enduring Illness Milder Disorder Tier 4 In Primary care 40,000 Some concern ‘watchful regard’ Tier 5 In Primary care 10,000 The whole working age population some 237,250 people. It has been acknowledged that the science behind the numbers is not as precise as everyone would want. This is particularly significant at Tiers 3, 4 and 5. In Kirklees the overall adult population is predicted to rise by 3%. It has to be the case that numbers alone will not best inform what needs are.

6. Community resilience is problematic together with some key areas of provision. In using a range of approaches to assess need, we can capture themes expressed by people who experience services. In the national MIND survey of 2004 the issues below were seen as a major or contributory cause of isolation and mental distress. Issue Mentioned by Discrimination 58% of people Isolation 79% Lack of confidence 78% A lack of close relationships 74% A lack of work 54% Lack of money 59% Lack of transport 42% Lack of supportive housing 42% Lack of information 43% Lack of support 57% Not feeling safe 60%

7. There is little education and training for work • Literacy and innumeracy are issues. • Learning “for itself” is not available • Creative arts and cultural activity is important • They want physical activity alongside recreational and sporting activity • Volunteering needs to be an option. • They want more coping resources including self help. • Can I connect with faith-based groups? • Is there money, debt, and legal advice? • Are there opportunities for social participation? • They want an increased sense of responsibility. • Friendships and social support outside of “professional” networks. • Access to the telephone or the internet. • Mentoring and buddying around skill development. • Access to ways to campaign. • Affordable, accessible social activity

9. Target Service – What does this mean for Mental Health • Future • Focus on integrated partnership working • ~ Across NHS services • ~ With social care and local government • ~ With the third sector • ~ With people who experience services • and their carers. • Emphasis on health promotion and well-being, community capacity and diversity. Responding to the key themes of need. • Greater investment in improved practice-based primary care services for diagnosis, assessment, more treatment and care options • Investment in more community-based care • management • Changing focus on investment from • services to neighbourhoods. • Investment in employment opportunity • More supported housing • Access to talking therapies and self help, and • to engage with women only provision. • Addressing the needs of hard to reach groups • of people e.g. people with a dual diagnosis. • A modern workforce strategy. Now • Focus on secondary care services ~ Small numbers ~ High cost/High risk ~ Single local provider ~ Discharge difficulties • Limited partnership working • Patchy investment in community based services ~ Blocked care pathways ~ Serious gaps in prevention ~ Lack of capacity in primary care • Too little emphasis on public service roles in health promotion, diagnosis and assessment, and well-being • Major unmet need e.g. Employment Supported Housing Talking therapies Advice Responding to diversity Carer support BME community development Creativity, physical activity.

10. Desired Service Model 2010: • The focus of public services will be on well-being, rather than on mental ill-health. • Citizens-commissioners will be accessing personalised services via individualised budgets. • More choices – the third sector will be available and include access to learning, leisure, creativity, volunteering and employment. • There will be increased investment in community based solutions at the expense of more traditional provision. • M.H. services need to be integrated into ‘ordinary’ services such as libraries, G.P. surgeries, places of work and community groups. • Care management will be based on the principles of hope and recovery and will have a brokerage function. • Supported living will have been enhanced. • The anti-stigma movement will be stronger • Current Service Model 2007: • Recovery model established to support people leaving hospital. • Integrated assessment and care management service across health and social care. • Service users and carers involved in service planning and monitoring. • Single point of entry via CMHT’s. • Supporting People schemes supporting people to live independently. • A limited range of living options available • Too much reliance on out of area placements. • PICU managed by SWYMHT + 5 additional local acute beds. • Assertive Outreach Service in place • Range of specialist mental health Carers’ Support Services available. • Independent Mental Capacity Advocacy Service in place. • Partial early Intervention in Psychosis (EIP) Service in place. Planning for Services for Adults with Mental Health Needs Commissioning / Service Activity Workforce planning will focus on well-being and recovery Specialist employment support provision will be enhanced by social Enterprise Planning for Services for Adults with Mental Health Needs The breadth of supported accommodation will increase Break provision will be supported Carer assessments will feature as core services S117 situations will be reviewed annually The number of Approved Social Workers will increase to 1 per 10,000 of the population Capacity in primary care around ccbt, cbt and talking therapies will beenhanced Day activity will have more of a focus on community linkages April 2009 April 2010 April 2011 • 200 people using Direct Payments. • Out of area places down to 5. • 3 Social Enterprises established. • 60 people in paid work or work preparation • Day Care reframed as community link • Some open access provision • 100% of workforce equipped with skills to deliver well-being and recovery • 100 people using Direct Payments. • 30 people – in paid work or work preparation. • 730 bed nights of break provision available a year. • CCBT network established in primary care. • Creative options in place • 250 people using Direct Payments. • Citizen Commissioning network established • Supported accommodation increased by 100 units of floating support. • Dual diagnosis service in place • Brief intervention team in Primary care established.