Bath and North East Somerset Community Health and Care Services:

Community Based

Mental Health Pathway

SD14

1.Introduction

Mental health issues affect a large proportion of society: approximately 1 in 4 people seek help for poor mental health at some point in their lives and may experience this as a long term condition. Yet most resources are allocated to the small percentage of the population requiring intervention from specialist psychiatric services, with around 90% of funds being dedicated to the treatment of a comparatively small group. Moreover, a narrow focus on the medical outcomes of diagnosis and treatment fails to harness the knowledge and expertise of other service users or make best use of solutions with community based support networks and services, which are key factors to sustaining recovery and preventing crisis.

It is proposed to build on new and existing provision to develop a community based mental health pathway offering one-to-one, peer and group support to include a wide range of creative, social, cultural, educational and productive activities as well as high levels of practical, social, therapeutic and emotional input aimed at maximising independent living skills.

This pathway will focus on the needs of the individual and will be fully integrated, with a shared philosophy and way of working, taking a holistic approach to a persons needs, and working closely with the Wellness Service, CAMHS (child and adolescent mental health services) and other Mental Health statutory provision and 3rd sector providers. Throughout the pathway, clients will be supported to develop and improve social skills, a healthy lifestyle, independent living and preparation for work or work related skills.

The development and design of the proposed model has been informed by the Your Care Your Way consultation with service users and stakeholders, and the key principles will be central throughout any further development and implementation of the model:

Choice / Personalisation, with the person at the centre of the support, rather than a service based system

Needs led, taking a holistic view of a persons needs and interests

A joined up approach, on the principle of only telling your story once, with shared Information and appropriate governance protocols, throughout the pathway

Shared Goals for multiple Providers working in partnership

Outcome focused

Cost Effective and demonstrating a sharing of resources

High Quality

Diversity

Transparent

There will also be fluidity of movement between Services / Interventions and with other pathways, such as the Wellness Service

Social action underpins this approach to managing Long Term Conditions, its social value including growing a new peer workforce, patients moving from passivity to becoming contributing citizens, and reduced demand on high cost care services generating investment in growing community capacity and circles of support.

2.Purpose

2.1 Aims and Objectives

Aim:

I can plan my care with people who work together to understand me and my carer(s), allowing me control, and bringing together services to achieve the outcomes important to me.

People will have the capacity to live healthy lives and regain or maintain their independence by addressing the lifestyle, social and risk factors that influence their mental and physical health and wellbeing, and have access to both mainstream services and community resources to support and improve their mental health and quality of life.

Objectives

The encompassing integrated Community Based Mental Health pathway objectives, are-

To use personalised approaches to reduce demand for more formal health and social care services

To enable people who are experiencing the effects of serious mental illness and who may have complex needs, who live in non-residential care accommodation, access to the necessary recovery focused support to enable them to live independently within the community and increase their independence

To reduce the number of people with mental health needs and / or long term conditions requiring emergency hospital admission, attendance at A&E departments, psychiatric, in-patient or residential care

To support the continuous improvement in the safety and effectiveness of community based support resulting in a positive experience for service users

To help people live healthily and independently and improve their quality of life in the community

To ensure, whenever possible and desirable, that people who access secondary care are enabled to recover both a quality of life and achieve independence of health and social care services

These objectives will be achieved through the following-

To make good and effective use of a supportive holistic signposting and assessment service (social prescribing), drawing on peer and community networks where appropriate to reduce demand on clinical services

To enable people to self-access directories of opportunities that meet their needs and interests

To take a preventative approach and deliver effective community based pre-crisis support to help prevent peoples needs escalating and requiring higher level care

To enable service users to develop skills to sustain or regain their own accommodation

To take a holistic and flexible approach with a strong focus on clients abilities and strengths that promote recovery and rehabilitation.

To tailor the support to individuals to facilitate improvements in self-esteem and confidence, focussing on practical, social, therapeutic and emotional issues, working alongside assets within the local community.

To have for all GPs and health professionals a clear pathway for patients to access appropriate social support, including pre-crisis services

To support professionals and community opportunities to work together as an integrated social care team with a focus on the individual rather than the condition

To explore and develop an Alliance Contracting approach within the mental health pathway, to ensure services collaborate and support each other in delivering bespoke services

To develop and make use of clear and close links with Talking Therapies, the Wellness Service (for example Social Prescribing, Volunteer Hub, Employment Development and Wellbeing College), and other clinical and social care pathways as relevant

To deliver a community development function to help build community capacity, resilience and strength, supporting the Give element of 5 Ways to Wellbeing, and enabling people to support each other

To ensure that through integrated working and governance protocols, people only have to tell their story once throughout the pathway. Develop integrated working with other pathways to extend this principle.

To continue to harness the potential of new technology to help make health and social care and support more personalised and integrated.

To ensure that carers are recognised as part of the peer network, and offered appropriate support & training where required

To uphold and promote the rights and expectations detailed in the Mental Health and Wellbeing Charter (appendix 3a) and the Carers Charter (appendix 3b), throughout the Pathway

3.National / local context and Evidence base

Our health, our care, our say (DH White Paper 2006), states that service users and carers want services / care closer to home. It also stated that health and social care services: need to support people to stay healthy and well; empower them to live independently; should tackle inequalities; offer safe and effective services and support people to exercise maximum control over their own life. This direction of travel for the delivery of services is further set out in Putting People First (DH 2007) and Transformation of Adult Care Services (DH LAC 2008) and New Horizons (2009)

A report on mental health and social exclusion (ODPM 2004) identified that one of the causes of social exclusion experienced by many adults with mental health problems is the actual fear of, or rejection from, the community leading to people wanting to stay in the safety of mental health services rather than engaging in the mainstream. The Social Prescribing element and principles of this Mental Health Pathway will support people to take up and be part of mainstream opportunities.

Rapp & Gosha (2006), propose six recovery principles, these being:-

People with psychiatric disabilities can recover, reclaim, and transform their lives

The focus is on individual strengths rather than deficits

The community is viewed as an oasis of resources

The client is the director of the helping process

The case manager-client relationship is primary and essential

The primary setting for the work is the community

The goal for modernised day services is to provide support and help with functioning and to facilitate access to employment and other meaningful daytime activity, with social functioning and social inclusion the key aim. Dr Andrew McCulloch (The Mental Health Foundation)

The action plan of the Social Exclusion Unit report Mental Health and Social Exclusion report (2004), advocated the need to: Transform day services into community resources that promote social inclusion through improved access to mainstream opportunities.

The Strategic Framework for Improving Health in the South West[footnoteRef:1] [1: The Strategic Framework for Improving Health in the South West http://www.southwest.nhs.uk/pdf/Strategic%20Framework%20FINAL%20FOR%20PRINTING.pdf p52]

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