Solihull Mental Health
Strategy
2015-2020
– front page
(ask BSMHFT for photos)
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Contents
Foreword
Executive Summary
1. Introduction:
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What are the main types of mental health problem
Scope of the strategy
Improving outcomes
2. Why a new strategy?
3. Our vision for the mental health and wellbeing of people in Solihull
4. How do we know what we need to do?
4.1.
4.2.
4.3.
4.4.
4.5.
4.6.
4.7.
4.8.
4.9.
4.10.
What people using services have told us
National strategies, Policies and Guidance
Local strategies
Integrated care
Social Care
Public Health
Welfare reform act
The Francis Report
Focus on outcomes
The mental health market
5. The Case for Change
5.1. What influences mental health
5.2. The benefits of good mental health
5.3. Parity and human rights
5.4. Financial Case for change
financial environment
Solihull mental health resource
Are we getting best value from these commissioning resources
Economic benefits realised from people having ‘better mental health’
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6. Needs Assessment
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Key National Statistics
The local picture – level of need in Solihull
7. What has been achieved since the last strategy?
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What did we say that we would do?
What did we achieve?
How can the new strategy develop this further?
8. What will we seek to improve?
8.1
Prevention and early help
8.2
Promoting emotional wellbeing and tackling stigma and discrimination
8.3
Personalised recovery based services
8.4
Effective and efficient use of resources to ensure value for money
8.5
Closer collaboration with service users, families and carers in the development of services
8.6
Improving partnerships
8.7
Transitions
Other Priority Areas
8.8
Suicide and self harm
8.9
Personality disorder
8.10
Dual diagnosis
8.11
Support for at risk communities
Looked after children
Mental Health of offenders
people who are homeless
People from BME communities
LGBT communities
8.12
Better integration of mental and physical health
mental health of people with a long term condition
medically unexplained symptoms
physical health of people with a severe mental illness
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EXECUTIVE SUMMARY
What people using the services have told us.
The people best able to tell us what is good about the services that we commission and what needs to
change to make them more effective are the people using them. This strategy is therefore based upon what
people have told us that they want from mental health services and the support that they have said will help
them to live well with their mental illness.
People using services and their carers have told us that service quality and the quality of the relationships with
staff supporting them are key. Continuity of staff is important to people as this helps to build trust and the
confidence to work with the staff to achieve recovery. People using the services and their carers have told us
that they want:
 easy access to good information and advice,
 easier access to meaningful activities
 better communication,
 easier, quicker access to services,
 only having to tell their story once,
 more choice and control over their care and
 more opportunities to actively direct their own support through user led services.
These are not unreasonable expectations and the strategy therefore needs to ensure that these are central
to all discussions and decisions about future service models and pathways.
Our vision
Our vision is to commission integrated mental health services that are effective, evidence based and safe
delivered by staff who inspire confidence and hope and who help the people they are supporting to take
control of their own lives and their recovery.
To deliver this vision will require us to commission services that:
 build resilience in our population through mental health promotion, prevention and early help
 deliver high quality treatment and support when people are unwell
 help people to live well with their mental illness
This vision needs to be underpinned by shared values across Solihull where mental health is seen as
everybody’s business, where there is a focus on the whole person and where all sectors are focusing on
people’s lives and not just the services that are available. Although we have come a long way it does still
feel like people are being fitted into services rather than services being fitted around the people. This
strategy looks at how a lives not services approach can be embedded within any future service
developments and re-design.
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The scope of the strategy
The scope of this strategy is all age and actively considers how we can support people to have good mental
and physical health from cradle to grave enabling them to live well with their illness. There is a large body of
evidence that highlights the impact of childhood experiences with health throughout life.1 Half of people
with lifetime mental illness first experience symptoms by the age of 182 and 75% before the age of 25 with
significant negative impacts on their education, employment, relationships and physical health outcomes.
The recent tender of emotional health and wellbeing services for children and young people in Solihull was
awarded to the Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) in partnership with
Barnardos. The BSMHFT now deliver whole life mental health provision within Solihull which will make it
easier for the Trust to place more of an emphasis on the development of preventative provision in childhood
by supporting parents, schools and looked after children and their foster parents so that children and young
people will be able to easily access high quality mental health treatment and support reducing the burden of
mental illness when they become adults.
The Case for Change
In the document ‘Five Year Forward View’ produced by NHS England in October 2014 it states that although
the NHs has dramatically improved over the last 15 years quality of care can still be variable, preventable
illnesses are widespread and health inequalities deep rooted.
Mental health is a particular challenge especially the need to achieve parity of esteem with physical health
which is a key national priority.
The NHS and Social Care are operating within extremely challenging financial environments. Monitor, NHS
England and Independent Analysts have previously calculated that a combination of growing demand if met
by no further annual efficiencies and flat real terms funding, would produce a mismatch between resources
and service demands of nearly £30billion a year by 2020. So to sustain a comprehensive high quality NHS,
action will be needed on three fronts: demand, efficiency and funding. We therefore need to look at how
we can reduce demand through prevention and early help services, improve the efficiency of services
commissioned/delivered and ensure that we are getting best value from every pound spent on health and
social care within Solihull. This will be achieved through:
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greater focus on prevention – particular action to tackle obesity, smoking, alcohol and other health
risks
developing and supporting new workplace incentives to promote employee health and cut sickness
related employment.
Giving people who need health services greater control of their own care such as through shared
budgets combining health and social care
Improved partnerships with voluntary organisations and local communities – developing less
medicalised approaches in the care and support of people locally.
Overcoming obstacles to health: Report from the Robert wood Johnson Foundation to the Commission to Build a Healthier
America. Braveman, P and Egerter S 2008
2 Kim-Cohen J, Caspi A, Moffit T et al. Prior juvenile diagnosis in adults with mental disorder, development follow-back of a
prospective longitudinal cohort. Archives of General Psychiatry 60 as quoted in No Health without Mental Health (DH 2011)
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Improving integration between GP’s and hospitals, between physical and mental health and
between health and social care.
Improving integration between urgent care services such as A&E, GP Out of Hours, Urgent Care
Centres, NHS 111, ambulance services, police and mental health providers.
What are our main priorities?
 Promotion, prevention and early help are key priorities for Solihull Council and Solihull Clinical
Commissioning Group (CCG). Much has been done locally to improve access to information and advice
services, to support people to find meaningful activities through social prescribing and to break down the
stigma and discrimination of mental health. Building resilience in people is essential as we will no longer
have the resources to be all things for all people. People will need to become experts in the management of
their health conditions and to keep themselves well. The Council and CCG will do all they can to help people
to adopt healthier lifestyles and will do this through Public health commissioned programmes such as the
Health Trainer service, smoking cessation services and social prescribing.
Third sector contracts have been re-tendered against three outcomes based prospectuses and new
contracts, supported by new outcome focused service specifications, have been developed.
We have included performance metrics within the CCG Operating Plan (see appendix 4) that set targets to
improve the satisfaction of service users in being able to access good information and advice, meaningful
activities and peer support services locally. Satisfaction nationally against these has been low and service
users accessing BSMHFT services have said that their experiences are on a par with, or worse than, the
national survey ratings.
We will know that we have got this right when people can say:
“I will have access to appropriate information, advice, advocacy and support to help me to remain independent and
enable me to play a more active role in finding my own solutions and/or support me in my caring roles.”
“I will have more involvement in planning my own support.”
“I will feel less isolated and vulnerable and more connected with my local community.”
“I will be able to talk to someone who understands my condition, is tolerant, flexible, patient and persistent and
who will help me to understand my strengths and my opportunities for a more fulfilled life.”
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High quality treatment and support. Following an extensive inquiry into failings at Mid-Staffordshire
NHS Foundation Trust, Robert Francis QC published his final report on 6 February 2013. It told a story of
appalling suffering of many patients within a culture of secrecy and defensiveness. The inquiry highlighted a
whole system failure. A system which should have had checks and balances in place, and working, to ensure
that patients were treated with dignity, and suffered no harm. The report had 290 recommendations with
major implications for all levels of the health service across England. It called for a whole service, patient
centred focus. The detailed recommendations did not call for a reorganisation of the system, but for a reemphasis on what is important, to ensure that this does not happen again. 3
3
http://www.nhsemployers.org/your-workforce/need-to-know/the-francis-inquiry
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We will therefore continue to work closely with all providers of mental health services to ensure that people
accessing mental health services and support will:
 have access to the right, evidence based treatments
 receive care from the right staff who will be trained to deliver the right care in the right way
 receive their care at the right time and in the right location
 have a care plan based on the outcomes that are important to them
 be confident that the services they access meet the requirements of the 6Cs- Care, Compassion,
Competence, Communication, Courage & Commitment
 know that their complaints are taken seriously and action plans developed to ensure that such issues do
not occur in the future
 know that staff who witness poor care are confident to report it without fear of reprisal
We will know that we have got this right when people can say:
“that I will be supported to achieve the outcomes that are important to me”
“given my risks of ill health I am given priority care to prevent my illness developing”
“I get the best treatment that I need for my condition and my life”
“I can be confident that the services that I access are of high quality, delivering effective
outcomes and that they are safe”
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Living well with a mental health problem.
“Getting a diagnosis was kind of a relief. It helped me start to make sense of the harmful things I was
doing to cope with what I was experiencing. Now I had no choice but to move forward and learn how to
live with it …” Demi Lovato.
Moving forward following a diagnosis of mental illness can be hard. In the past a diagnosis of mental illness
tended to dictate the life that the person would then have. This strategy looks at how Solihull CCG and
Solihull Council will support people living in Solihull to live well with their mental illness. This will be
achieved by supporting people:
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to feel confident about talking about their mental illness.
to help inform the wider population of Solihull about mental illness through programmes such as ‘Time
to Change’ and ‘Time to Talk’
to live independently in stable accommodation
to have a recovery plan that identifies the goals that are important to the individual
to access training, education, and employment
to make choices about, leisure activities, physical wellbeing and home support
for their care to be joined up and planned together with partners
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We will know that we have got this right when people can say:
“I know what I can do to help myself and my life”
“I know what I can do to maintain my recovery and prevent relapse”
“My family and friends are supported to help me”
“I have somewhere that I can call home”
“I continue to be part of my community and contribute to it”
“I will feel empowered to take responsibility for my own recovery.”
“I will feel that I have value.”
“I will have the opportunity to use the expertise that I have gained in managing my own mental
illness to help others and I know that this could lead to formal training and future employment
opportunities if I so chose.”
What will this strategy achieve?
Achieving the priorities identified within this strategy will support an improvement in the lives of people
with mental health conditions in Solihull
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1
INTRODUCTION
This joint mental health and wellbeing strategy for Solihull sets out the key strategic priorities that
we expect to deliver over the life of this strategy.
The focus of the strategy is that of hope and recovery; a strong belief that people with mental health
problems can get better but recognising that this requires people to:
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think about their health: making informed, healthy choices that support mental, physical and
emotional health and wellbeing.
have a stable and safe place to live – a home.
have a purpose: to engage in meaningful daily activities, such as a job or school, volunteering,
caring for their family, or being creative.
work to increase independence, income, and the resources to participate in society.
feel part of a community: to build relationships and social networks that provide support.
The priorities identified within this strategy are those that will strengthen current mental health
systems within Solihull supporting people to achieve the above goals so that they can live healthier,
more fulfilled lives that are not dictated by their mental illness. The strategy identifies what we will
do against the following 3 areas of activity:
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Mental health promotion, prevention and early help – building resilience
High quality treatment and support
Living well with a mental health problem
and identifies how we will achieve the following objectives:
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More people will have good mental health
More people with mental health problems will recover
More people with mental health problems will have good physical health
More people will have a positive experience of care and support
Fewer people will suffer avoidable harm
Fewer people will experience stigma and discrimination
We will measure how successful this strategy is by developing measure and information that will help
us to understand whether we are achieving these outcomes for people in Solihull.
1.1 What are the main types of mental health problem?
Most mental health symptoms have traditionally been divided into groups called either ‘neurotic’ or
‘psychotic’ symptoms. Neurotic covers those symptoms which can be regarded as extreme forms of
‘normal’ emotional experiences such as depression, anxiety or panic.
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Less common are ‘psychotic’ symptoms which interfere with a person’s perception of reality and may
include hallucinations, delusions or paranoia with the person seeing, hearing, smelling, feeling or
believing things that no one else does. Psychotic symptoms or ‘psychoses’ are often associated with
severe mental health problems.
Some illnesses feature both neurotic and psychotic symptoms. It is important to understand the
prevalence of these types of mental health conditions locally to inform the types of services and
interventions that will be required to meet presenting needs. The Mental Health needs assessment
which is attached as Appendix 1
1.2 Scope of the strategy
This strategy takes a life course approach which means that it focusses on the needs of children and
young people, adults of working age and older people although it excludes dementia as this has a
separate strategy4.
Although there is a separate Children and Young Peoples Plan5 it is essential that this strategy
recognises that there is a dependence on children and young people’s mental health services in the
achievement of improved outcomes for adults with mental health problems.
1.3 Improving outcomes
Improving the outcomes and experiences of adults with mental health problems will be harder to
achieve if they have not had the right treatment and support when they were children or adolescents.
National studies identify that more than half of all adults with mental health problems were diagnosed
in childhood yet less than half were treated appropriately at the time.
If we want to make a real difference to the future mental health of Solihull we need to ensure that
children and young people are able to access the right treatment and/or support at the right time.
Children and young people need to be helped to build resilience, emotional awareness and selfregulation at an early age. Getting this right will result in improved outcomes being achieved such as
improved educational achievement, stronger relationships and improved employment opportunities.
This establishes strong foundations for adulthood and will help people to maintain their mental health.
With the Birmingham and Solihull Mental Health Foundation Trust having won the Emotional Health
and Wellbeing for Children and Young People contract they will have the flexibility to determine where
best the resource and capacity needs to be invested to improve the mental health outcomes for the
people of Solihull.
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“Give me something to believe in” Birmingham and Solihull Dementia Strategy 2014-17
Solihull Children and Young People’s Plan 2013-16
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WHY A NEW STRATEGY ?
The mental health strategy upon which the previous re-design of services was based was produced
in 2010 and expires this year (2015). It is a good time to take stock of what has already been
achieved and to look at where mental health services are still not delivering the best outcomes and
experiences for the people using them.
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The fundamental question that we need to answer is: “are we still fitting people into services or
are we now fitting services around the needs of the people?” Solihull Council and the Clinical
Commissioning Group are signed up to a “Lives not Services” approach so how has the previous
strategy helped to achieve this? What do we still need to do and how best do we reflect this in
the new strategy?
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A number of the services that we commission were identified as best practice 15 years ago and
although they may still be needed it is a good time to review them in line with the growing
evidence base of new approaches that are improving service user and wider system outcomes
and experiences. The previous strategy was very health and secondary care focussed.
Discussions with service users and carers identify that it is often low level advice and support
services that have helped them to stay well and manage their mental health more effectively
but that these services are not well linked to current mental health pathways. This strategy will
identify how we will get a much more integrated approach to the delivery of mental health
services and support within Solihull.
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It still feels like there are still too many people becoming mentally unwell and experiencing
crisis so we need to review whether we have commissioned sufficient prevention, early
intervention and community services support capacity within Solihull? We also need to
understand how people are being supported to maintain their recovery so that they stay well
following an acute episode? What services and support have people using mental health
services found most beneficial in maintaining their recovery and what do they feel is still a gap
within currently commissioned services?
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In response to reducing crisis and in particular the number of people requiring admission, there
has been the development of services across Birmingham and Solihull to help address this.
These new services include Street Triage, a Psychiatric Decision Unit, and the recently piloted
mental health crisis line linked to 111. We need to be sure that these new services are the best
way of meeting presenting needs locally and we therefore need to evaluate them as part of the
development of the mental health system within Solihull with the learning from this used to
further develop the mental health service models and pathways locally.
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There are still too many people with a mental illness not able to find suitable employment;
employment is seen to have significant benefits to people with a mental illness so a particular
focus of this new strategy is on improving employment services and support locally. The
strategy will identify how we intend to achieve this and what outcomes we expect to be
delivered. Our priority is wider than just those with a mental health problem who are long
term unemployed. We know that poor employment practice also has an impact on mental
health and the numbers of people off sick due to mental health related conditions are rising.
This strategy, when focussing on employment, must therefore look at how employers within
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Solihull can be encouraged and supported to take the mental health of their workforce more
seriously. With Solihull Council, Solihull CCG and the West Midlands Police all experiencing
significant days lost due to mental health issues we should encourage these organisations to
lead by example.
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Much of the support for people with a mental illness is delivered by their family members.
How well do we support family members to gain the knowledge and skills to feel confident in
their caring role? How well did the last strategy deliver improvements to carers? What still
needs to be done and how will we work to address this during the life of this strategy?
This strategy will therefore review what has been achieved since the publication of the previous
strategy and identify what the priorities are that need to be addressed over the next three years of
this new strategy. This will help to shape a commissioning action plan with expected timescales for
delivery. The Health and Wellbeing board will oversee the implementation of this strategy and the
commissioning action plan.
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3.
OUR VISION FOR THE MENTAL HEALTH AND WELLBEING OF PEOPLE IN SOLIHULL
To commission integrated mental health services that are effective, evidence based,
equitable, safe and delivered by staff who inspire confidence and hope and who help
the people they are supporting to take control of their own lives and their recovery.
Metal health services delivered within Solihull will have a strong focus on:
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The person
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Prevention and early intervention
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Recovery
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Strong partnerships
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Outcomes
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Service quality
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Evidence based practice
We will commission a mental health system that improves access to:
 Information about services and support
 Support to develop meaningful relationships and participation in community activities
 Support for carers
 Support to address both mental and physical health needs
 Early diagnosis and intervention
 Evidence based assessment, treatment and support
 Support for people during acute phases of illness
 Housing with flexible support
 Support to find meaningful occupation or employment and to maintain income
There will be more:
 Involvement of service users in decisions about services and support
 Control and choice in care planning
 Attention to the mental health and wellbeing of carers
 Co-ordinated care
 Effective use of resources in secondary care
 Parity of esteem for mental health
There will be less:
 Stigma and discrimination associated with mental health problems
 Inequality in the treatment of people with a mental illness in the physical health system.
 Avoidable harm and injury
 Time spent away from home by adults with mental health problems
There will be fewer:
 Incidents of self harm
 Avoidable crises and admissions to hospital
 Adults with mental health problems who feel alone and unsupported
 Adults with mental health problems who are excluded from the communities in which they live.
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4.
HOW DO WE KNOW WHAT WE NEED TO DO?
4.1 What people using services have told us
‘I need to know that when I am ill I will be able to access the services that I need to help me get well again’
‘Assessments should identify where I am improving, not just where I am getting worse’
‘There need to be more services in the community with hospital being the last resort and only if a person is not
safe to remain at home. If they have to be admitted, it should be for the shortest time possible’
‘I want more support to help me find work’
‘I want counselling and therapy services that I can access quickly’
‘I need help that addresses my social needs including finance, housing, advocacy and support to access
meaningful activities’
‘There is not a lot of choice available in the services that I can access’
‘I want to be supported by people who really understand mental illness’
‘I want my GP to have a better understanding of mental illness and be able to recognise when I need help’
‘I still feel that there is too much stigma associated with mental illness and that I am discriminated against
because of my mental illness’
‘I should not be criminalised just because I am experiencing a mental health crisis’
‘Carers should be able to talk to a mental health or social care professional on request’
‘Carers need to be more recognised and listened to as partners in providing care’
‘Carers should be able to get immediate help in a crisis and have their own needs assessed and met’
Have asked Di Markman to send through the views expressed by service user and carers
from the New Dawn workstreams.
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4.2 National Strategies, Policies and Guidance
Five Year Forward View6
The ‘Forward View’ sets out a clear direction for the NHS – showing why change is needed and
what it will look like. Some of what is needed can be brought about by the NHS itself. Other
actions require new partnerships with local communities, local authorities and employers. Some
critical decisions – for example on investment, on various public health measures, and on local
service changes – will need explicit support from the next government. The Five Year Forward
View puts a high emphasis on prevention, helping people to live healthier lives so that they do not
become ill. Support for carers is also a high priority and this has been re-inforced within the new
Care Act. There is still a requirement for health and social care to live within their means,
although some new money has been promised this still leaves a funding gap of c£22m if we do not
address demand and system efficiencies.
National Mental Health Strategy ‘No Health Without Mental Health’ (2011)7
In 2011 the Department of Health issued its national mental health strategy ‘No Health Without
Mental Health: A Cross Government Mental Health Outcomes Strategy for People of All Ages’
which identified a set of shared objectives across all Government Departments to improve mental
health outcomes for individuals and the population as a whole. These are:
 More people will have good mental health
 More people with mental health problems will recover
 More people with mental health problems will have good physical health
 More people will have a positive experience of care and support
 Fewer people will suffer avoidable harm
 Fewer people will experience stigma and discrimination
Although this strategy did result in improvements in mental health services across England it was
recognised that there was still a long way to go particularly in:
 Improving the experiences of people accessing mental health services
 Achieving parity of esteem in the treatment of physical and mental health conditions
 Improving the physical health of people with a mental illness – particularly those with psychosis
 Reducing self harm with particular reference to the significant rise of self harm in young people
6
https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
7
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_124058.pdf
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 Crisis support services and reducing the numbers of people having to out of area for admission.
 Knowledge of, and access to, prevention and early help services
 Support to carers
 Ensuring that services are joined up, reducing duplication and service gaps so that it is a
seamless mental health pathway.
With change not happening as quickly or as consistently across the Country as the Department of
Health desired further policy documents and guidance were issued in the form of Closing the Gap:
Priorities for essential change in mental health (February 2014) and the Mental Health Crisis Care
Concordat (February 2014).
Closing the Gap: Priorities for essential change in mental health (February 2014):8
Closing the Gap identifies 25 aspects of mental health care and support where the government –
along with health and social care leaders, academics and a range of representative organisations –
expect to see tangible changes in the next couple of years: changes that will directly affect millions
of lives for the better.
Achieving progress against the 25 priorities is not something that can be done unilaterally. It
requires not only the commitment of those working within the system, but also support and
engagement across all of society. This includes the way that mental health is covered in the media,
how it is addressed in schools, in the workplace and the response of families and friends, in other
words, all of us can do more to improve the lives of people with mental health problems and to
promote wider mental wellbeing.
Solihull has benchmarked itself against the 25 priorities within Closing the Gap and this can be
found by going to XXXXXXXXXXX
Mental Health Crisis Care Concordat (February 2014)9
‘No one experiencing a mental health crisis should ever be turned away from services’. This is
priority 15 within Closing the Gap which states that:
“There are far too many examples of public services failing to respond effectively to people
experiencing a mental health crisis. Children and adults alike have been turned away because
health services were full, or they were made to wait until Monday morning because services are
not available at the weekend. In some cases, they do not receive adequate treatment and support
early enough, because information about their problem is not effectively shared between services.
This is simply unacceptable and must change.”
8
https://www.gov.uk/government/publications/mental-health-priorities-for-change
9https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/281242/36353_Mental_Health_Crisis_access
ible.pdf
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To address this the Department of Health issued the National Mental Health Crisis Care
Concordat. The Concordat is a shared agreed statement, signed by senior representatives from all
organisations involved, which include Health, Social Care, Police, 3rd Sector and other
organisations who come into contact with people in crisis. It covers what needs to happen when
people in mental health crisis need help - from ensuring that it informs strategic priorities and
spending decisions, anticipating and preventing mental health crises wherever possible, and in
making sure effective emergency response systems operate in localities when a crisis does occur.
The Concordat is arranged around:
 Access to support before crisis point
 Urgent and emergency access to crisis care
 The right quality of treatment and care when in crisis
 Recovery and staying well, and preventing future crises
All partners within Solihull have signed up to the following declaration:
Mental Health Crisis Care Concordat: The Joint Statement
“We as partner organisations across Birmingham and Solihull will work together to put in place the
principles of the Mental Health Crisis Care Concordat to improve the system of care and support so
that people, of any age, in crisis because of a mental health condition are kept safe.
We, as partner organisations we will:
 Do all that we can to help people experiencing mental health crisis to find the help they need −
whatever the circumstances − from whichever of our services they turn to first ensuring that no
one who needs help is turned away.
 Work together to prevent crises happening whenever possible, through intervening at an early
stage.
 Make sure we meet the needs of vulnerable people in urgent situations, getting the right care at
the right time from the right people to make sure of the best outcomes.
 Do our very best to make sure that all relevant public services, contractors and independent
sector partners support people with a mental health problem to help them recover.
Everybody who signs this declaration will work towards developing ways of sharing information to
help front line staff provide better responses to people in crisis.
We are responsible for delivering this commitment in Birmingham and Solihull by putting in place,
reviewing and regularly updating the action plan. In devising the action plan we will consult widely
including service users, carers, families and partner organisations.
As partners we recognise that we are operating within a difficult economic climate and that we will
Closing
Gap
and the
Mental Health
Crisis
Care
Concordat
build upon
‘No Health
Without
need tothe
look
at how
the resources
currently
being
expended
in meeting
the needs
of people
with a Mental
mental illness are best invested to deliver improved outcomes within a reducing resource base.
19
Health’ and require local areas to develop action plans to show how they will deliver the identified
priorities and recommendations.
The Mental Health Crisis Care Concordat Action Plan for Solihull can be found at:
http://www.crisiscareconcordat.org.uk/explore-the-map/
Implementation of the action plan will be overseen by the Solihull Health and Wellbeing Board.
4.3 Local strategies:
The delivery of this strategy is dependent upon the delivery of other local strategies for Solihull.




Solihull Health and Wellbeing strategy 2013-2016
Children and Young People’s Plan 2013 – 2016
Solihull Carers strategy ‘Caring for our carers’ 2014 2017
Birmingham and Solihull Dementia Strategy ‘Give me something to believe in’ 2014-17
4.4 Integrated Care
Integrated working can offer the opportunity for health, social care and the community and
voluntary sector to operate equally, breaking down traditional barriers and creating seamless
services. National Voices defines the service user vision for integrated care as.
“My care is planned with people who work together to understand me and my carer(s), puts me
in control, co-ordinate and deliver services to achieve my best outcomes”
There is an enduring legacy of integration of health and social care from the time when Solihull
had a Care Trust. The desire for integrated working continues with the establishment of SolihullTogether for Better Lives a partnership of local health and social care organisations. The
partners are:








NHS Solihull Clinical Commissioning Group
Solihull Metropolitan Borough Council
Heart of England NHS Foundation Trust
Birmingham and Solihull Mental Health NHS Foundation Trust
Solihull primary care providers
Solihull voluntary and community sector
Lay members representing people using services, their carers and the wider Solihull
community
and YOU
Solihull – Together for Better lives have adopted the National Voices vision and over the next
five years it aims to:



support you and your family so that you are better able to look after yourselves
work with you to make sure you’re getting the right care and support
provide you with care where it’s best for you
20

reduce the number of people who end up in hospital unnecessarily, or find themselves in a
home for long-term care.
It’s really important to everyone involved in Solihull – Together for Better Lives that people in
Solihull are able to live a healthier life in a thriving borough that supports them. To help do this,
the Solihull – Together for Better Lives Partnership is focusing on three things:



Helping the local economy to grow in a way that provides long-term stability and quality jobs
Making communities stronger
Improving people’s health and wellbeing.
These all work together – when people are better off, they’re healthier and have a greater sense
of wellbeing, as they do if they feel part of a strong and connected local community. So, as well
as bringing together health and care services, we’ll make sure people can get the information
and advice they need, and we’ll support a healthy and connected community that helps reduce
the loneliness people sometimes feel.
Such aspirations cannot be achieved by one organisation alone, partnership is essential if we are
to achieve the health and social care outcomes desired by the people of Solihull.
4.5 Social Care
This strategy is guided by the legislative framework for Councils.
Since April 2011 Putting People First our transformation programme for adult social care, has
been one of the Council’s six key priorities. We are improving the way we help local people to
find good advice and accessible information so they can make the best possible choices to enjoy
living as independently as possible and receive high quality care and support.
The Adult Social Care Directorate have fully embraced Think Local Act Personal 10 (TLAP), the
sector wide commitment to transform adult social care through personalisation and communitybased support. The Making It Real (MIR) framework, shaped by Think Local Act Personal,
enables us to deliver our transformation programme with local people involved at every step of
the process. The MIR approach has built on existing good practice in how we engage people in
Solihull but has also incorporated co-production as a part of our normal working practice - The
Solihull Way.
Making it Real sets out what people who use services and carers expect to see and experience if
support services are truly personalised. They are set of "progress markers" - written by real
people and families - that can help an organisation to check how they are going towards
transforming adult social care. The aim of Making it Real is for people to have more choice and
control so they can live full and independent lives.
Under the new Care Act (2014)11 councils’ now have a duty to consider the physical, mental and
10
http://www.thinklocalactpersonal.org.uk/
21
emotional wellbeing of the individuals needing care. They also have a new duty to provide
preventative services to maintain people’s health.
The Act has created a single, modern law that makes it clear what kind of care people should
expect introducing a minimum eligibility threshold across the country – a set of criteria that
makes it clear when local authorities will have to provide support to people. Councils will not be
allowed to tighten their thresholds beyond this minimum threshold, giving those who are eligible
peace of mind that they won’t have their care taken away from them while they still have these
eligible needs.
4.6
Public Health
Since the last strategy was published Local Authorities now have the lead responsibility for
public health, including public mental health. This helps to ensure a more integrated approach
to improving public health outcomes and tackling the wider determinants of mental ill health.
4.7 Welfare Reform Act (2012)
This Act legislates for a range of changes to the welfare system, some of which have a direct
impact on people with mental health problems. Since the Act coming into effect there have
been significant concerns raised nationally by a range of mental health organisations about the
impact of the Welfare Reform Act on people with mental health problems.
We need to ensure that people with mental health problems can get easy access to information
and advice services to get a better understanding about the impact of the Welfare Reform Act on
their circumstances, helping to maximise the benefits that they are entitled to and supporting
them to move into employment.
4.8
The Francis Report (2013)
The Francis Report looked into the high mortality rate and poor patient and carer experience at
the Mid Staffordshire NHS Foundation Trust. Commissioners and providers have looked at the
recommendations from this report to ensure that the quality and safety of care provided is as
good as it can be and that there will not be a repeat of the failings identified within the report.
Following the Francis Report the BSMHFT in looking at the recommendations made, identified
that patient safety and service quality were being compromised due to low staff to bed ratios in
their inpatient units. They successfully argued for a reduced cash releasing efficiency saving and
this money was used to increase the staffing ratios within mental health inpatient services.
Get some more info from the BSMHFT re the actions that they have taken in light of the Francis
11
http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted
22
Report.
4.9 Focus on outcomes
National Outcomes Frameworks for the NHS12, the Commissioning Outcomes Frameworks for
CCG’s, the Adult Social Care Outcomes Framework and the Public Health Outcomes Framework
for Councils all include outcomes that both directly and indirectly relate to mental health.
The outcomes that we seek to achieve are those which were identified within the ‘No Health
Without Mental Health’ National Strategy.






More People will have good mental health
More people with mental health problems will recover
More people with mental health problems will have good physical health
More people will have a positive experience of care and support
Fewer people will suffer avoidable harm
Fewer people will experience stigma and discrimination
4.10 The Mental Health Market
The NHS has traditionally been the major provider of local mental health services with a number
of independent and third sector organisations delivering specific services that are
complementary to those provided by the statutory sector. NHS Procurement, Patient Choice
and Competition Regulations place requirements on commissioners to improve the quality and
efficiency of services by procuring from the providers most capable of meeting that objective
and delivering best value for money. The market environment in the NHS and social care should
therefore expand to admit a wider range of providers which may mean that the NHS may no
longer be the default option for commissioners thereby enabling independent and third sector
providers to deliver a greater range of services.
12
https://www.gov.uk/government/publications/nhs-outcomes-framework-2015-to-2016
23
5.
THE CASE FOR CHANGE
5.1 What influences mental health?
Levels of mental ‘health’ are influenced by the conditions people are:
• born into,
• grow up in,
 live and work in
And
include








Good relationships
Access to social support
A sense of belonging
Satisfying work
Financial security
The right living environment
Developing resilience
Levels of crime
The National Mental Health Strategy ‘No Health Without Mental Health’ states that mental
health is:
“A positive state of mind and body, feeling safe and able to cope, with a sense of connection
with people, communities and the wider environment.”
Improving mental health and wellbeing therefore requires us to take a holistic view of mental
illness that focusses on the person not just their symptoms. Current mental health systems do
not do this as well as they should and this results in poorer outcomes and experiences for the
people accessing them. No one organisation can do it all; improving the mental health of
people within Solihull is everybody’s business. This strategy looks at how we can assure
ourselves that Solihull, as a whole system, works together to support people with mental
health difficulties to recover and for them to have a life that is not dictated by their mental
illness.
5.2 The benefits of Good Mental Health
There is good quality evidence from reputable organisations such as the Kings Fund and the
London School of Economics that improving wellbeing, including mental wellbeing, has a
wide range of health, social and economic benefits. These include:





Reduced risk of mental illness and suicide
Improved physical health and life expectancy
Better educational attainment
Reduced health risk behaviours such as smoking, alcohol and drug use.
Improved employment rates and productivity
24



Reduced anti-social behaviour and criminality
Higher levels of social interaction and participation
Supporting recovery and reducing stigma and discrimination faced by people with
mental health problems
Mental health treatment reduces medical costs. Many research studies have shown that
when people receive appropriate mental health care their use of medical services reduces.
Psychological problems also increase the likelihood that people will make poor behavioural
choices which can contribute to medical problems such as smoking, excessive alcohol and
drug use, poor eating habits and reckless behaviour can all result in severe physical
problems and the need for medical services.
5.3 Stigma and discrimination
Nine out of every ten people with a mental illness report that they experience stigma and
discrimination and that this has impacted negatively on their lives. They felt that stigma and
discrimination were widespread and included employers, communities and also themselves
through self-stigma which impacts on their self esteem and confidence. Stigma and
discrimination are significant because they:
prevent people seeking help
delay treatment
impair recovery
isolate people
exclude people from day to day activities and stop people getting jobs.
Unless we tackle stigma and discrimination we will not be able to improve the mental health
of our local population so this is a key priority to address within Solihull.
5.4 Parity and Human Rights
The NHS faces a series of unprecedented challenges and one of these is to address the fact
that it does not provide high quality care for everyone – especially those with mental health
problems. The disparity between people with physical and mental health problems is
significant for example over 75% of those with heart disease and more than 90% of people
with diabetes or hypertension are in treatment, yet only 15% of people with depression or
anxiety receive treatment. Having a mental illness can reduce life expectancy by 10 years due
to poor physical health; 14-20 years for those with schizophrenia. Individuals with mental
health issues have the same life expectancy as the general population did 50 years ago. The
system is failing these individuals, additionally it is often overlooked that poor physical health
is accompanied by poor mental health and research shows that this adversely affects
25
outcomes and increases the cost to the health and social care system.
Mental illness costs the UK economy £70-£100 billion per year (4.5% of GDP – OECD estimate).
Since 2009 the number of working days lost to stress, depression and anxiety has increased by
23% nationally. For people with a severe mental illness the number of working days lost
nationally has doubled since 2009. Between 10% and 16% of working age people with a
mental health condition, excluding depression, are in employment however, the vast majority
of people with mental health problems want to work. Only 7% of people with a severe mental
illness nationally get evidence based care to get paid employment.
Mental and behavioural disorders are by far the most common reason for individuals claiming
Incapacity Benefit or Employment Support Allowance. In 2013 almost 41% of Employment and
Support Allowance recipients nationally had a ‘mental or behavioural disorder’ as their
primary condition. For Solihull recipients of ESA and Incapacity benefits with mental or
behavioural disorders accounted for 47% of the claims representing 2,970 individuals.
5.5 Financial Case for change
Financial Environment
No other health condition matches mental ill health in the combined extent of prevalence,
persistence and breadth of impact.13 The annual cost of mental ill health in England is
estimated to be £105bn. 14 By comparison, the total costs of obesity to the UK economy is
£16bn15 a year and cardio-vascular disease £31bn.16 In 2010/11 £12bn was spent on NHS
services to treat mental disorder, equivalent to 11% of the NHS budget.17
Most people will feel that they have become worse off over the last few years, whether they
are people accessing welfare support, retired people managing on a pension or employed
people who have seen a real terms reduction in their wages. The situation is the same for
Solihull Clinical Commissioning Group and Solihull Council. Most Councils’ have seen their
revenue support grants reduced by almost a quarter. Although Health spending was
protected by the Government the resources available to health fall well short of what is
required to meet the ever increasing demands for health services and to keep pace with
medical advances. The funding gap between the resources available and the expected costs
of meeting service demand across health is expected to be £30bn nationally by 2020.18 The
‘Five Year Forward View’ highlights the need to take action on three fronts – demand,
Promoting mental health and preventing mental illness, Freidli, L & Parsonage, M 2009
The Economic and Social Costs of Mental Health Problems in 2009/10 Centre for Mental Health 2010.
15 Tackling obesities: future choices. Project Report Government office for Science Foresight 2007
16 Prevention of cardio-vascular disease at population level NICE 2010
17 Programme budgeting tools and data. National expenditure data Department of Health 2012
18 http://www.hsj.co.uk/news/kelsey-nhs-faces-30bn-funding-gap-by-2020/5060745.article
13
14
26
efficiency and funding in order to reduce the funding gap by 2020.
Doing more of the same is therefore not an option. People need to think more about keeping
themselves both mentally and physically well and doing more to access any help and support
required early so that they can try to prevent themselves becoming more unwell. The Council
and the CCG have looked at what they can do to make it easier for people to access such
support and this is detailed in section 8 of this strategy.
Under the New Care Act 19councils will now have a duty to consider the physical, mental and
emotional wellbeing of the individuals needing care. They will also have a new duty to provide
preventative services to maintain people’s health.
By forcing Councils’ to take this approach it is expected that this will result in more people
being supported to stay well thereby reducing the number of people requiring more
expensive and intensive support.
Solihull Mental Health Resource
The current commissioning resource for mental health services and support for both Solihull
Council and the Solihull Clinical Commissioning Group is £27,610,653.
Included within this figure is:
 spend on dementia as it is not easy to separate out the spend on dementia from older
adult functional mental health.
 It also includes continuing healthcare spend on clients with a mental health need of just
over £5 million. This needs to be analysed into the different elements of spend and look at
whether we could deliver such healthcare support more cost effectively.
 The Mental Health Social Work and Promoting Social Inclusion and Independence Teams.
What is not included is:
 the spend on mental health clients in acute hospitals
 the spend on Solihull Integrated Addiction Services
The mental health budget for Solihull CCG is £24,495,653 which accounts for 8.9% of the total
programme budget spend. Solihull Council has a budgeted spend for mental health of
£3,115,000 which is c6.1% of the total Adult Social Care budget.
Mental health services in Solihull need to be delivered within this resource envelope. Analysis
of the value achieved out of all the spend on people with mental health conditions is essential
if we are to improve outcomes.
19
The Care Act 2014 http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted
27
Mental ill health represents up to 23% of ill health in the UK and is the largest single cause of
disability.
Are we getting best value from these commissioning resources?
There are many indicators that show that in Solihull we are achieving higher than average
outcomes in relation to our spend on mental health services.20
That said we know that there are still areas of spend where we are not getting as good
outcomes as we should. For example, last year we spent over £400,000 on 25 people having
to go out of area for acute mental health inpatient services. We think that this money can be
better invested in developing local service capacity such as respite and extended day hospital
services which will provide more intensive support earlier to people at risk of being admitted.
Such services would also support discharge thereby freeing up the flow through local
inpatient units.
Our aspiration is to have no one out of area by the end of March 2016 and for it to remain that
way unless it is clinically advocated and in the best interest of the patient.
Another example is the spend on specialist personality disorder (PD) placements. Last year
we spent in excess of £900,000 on such placements and in addition to this at any one time
between between 1 and 2 mental health acute assessment beds are occupied by a person
with a PD at a cost of c£132,00021 per annum. The length of stay following admission for a
person with a PD tends to be far longer than for a person without PD as their presentation is
often made worse by the admission, increasing the risks and making it harder to discharge
them. People with a PD often make high use of A&E and acute hospital services as a result of
self harm behaviours. Therefore the cost to the system of treating people with a personality
disorder is significant yet the outcomes currently being achieved are poor.
Our aspiration is to change the way that we think about and understand the needs of people
with borderline and emotionally unstable personality traits and to improve service user
outcomes and experiences when accessing services. By establishing more intensive
community based provision that enables people to access the specialist help that they need
earlier we aim to reduce the impact on, and demand for, services. We aim to do this by
increasing the range of evidence based psychological interventions available to support people
with a personality disorder within Birmingham and Solihull.
The price cluster matrix also identifies spend on secondary care services for people who
should be being managed in primary care. We need to be working with the BSMHFT, primary
care and the voluntary sector to identify how best these resources can be invested to meet
the gaps within the primary and community sectors to provide a more appropriate response
to patients within these lower cluster groupings. One of the gaps identified that would help
support this shift out of secondary care would be psychological services that sit between what
Solihull Healthy Minds are able to provide and specialist psychological interventions delivered
20
21
http://www.yhpho.org.uk/quad/pdfs/05P%20Solihull%20SPOT%202014%20Full%20Briefing.pdf
BSMHFT Price Cluster Matrix Month 7 snapshot
28
in secondary care. (Mel Snape to inform) Also improved early signposting to psychological
services, information and advice services, meaningful activities and peer support will help
some people .
Our aspiration is to have the primary, community and secondary care sectors working well
together in the delivery of care and support for people with a mental illness in Solihull.
Economic benefits realised from people having ‘better mental health’
There are significant economic benefits to be realised from better mental health with many
reports highlighting the cost benefits of evidence based mental health interventions. A paper
entitled ‘Mental Health promotion and Prevention: The Economic Case’ produced by the
Personal Social Services Research Unit of the London School of Economics22 identified and
analysed the costs and economic pay-offs of a range of interventions in the area of mental
health promotion, prevention and early intervention.
The report concluded that investing in prevention and early intervention makes economic
sense. For every £1 spent the following whole system savings can be achieved:








£84 from school-based social and emotional learning programmes
£14 from school-based interventions to reduce bullying
£10 from work-based mental health promotion (after 1 year)
£ 5 from early diagnosis and treatment of depression at work
£18 from early intervention in psychosis
£10 from early intervention in pre-psychosis
£12 from screening and brief interventions in primary care for alcohol misuse
£ 4 from debt advice services
The Economic impact of Mental Health Promotion Prevention and Early Intervention report
provides greater detail about how the above savings can be achieved and in which sectors the
benefits are realised.
Analysis such as this helps us to identify where we can get the greatest returns thus releasing
resources to invest in other areas of mental health.
In developing the strategy we have looked at what we need to do locally to maximise the
potential whole system benefits identified above as this will help us to support more people,
more effectively, within the current mental health resource. These are detailed in section 8 of
this strategy.
22
Mental Health Promotion and Prevention: The Economic Case Martin Knapp, David McDaid and Michael Parsonage 2011
29
6
NEEDS ASSESSMENT
Needs Assessment – key national statistics
The National strategy for mental health ‘No Health Without Mental Health: A cross-government
mental health outcomes strategy for people of all ages23 shows why tackling mental illness and
promoting wellbeing is essential not only for individuals and their families but to society as a
whole:
Mental health problems are common
 At least one in four people will
experience a mental health problem at
some point in their life and one in six
adults have a mental health problem at
any one time.
 Almost half of all adults will experience
at least one episode of depression during
their lifetime.
 About half of the people with common
mental health problems are no longer
affected after 18 months but poorer
people, the long term sick and
unemployed people are far more likely
to still be affected than the general
population.
 Depression affects one in 5 older people
living in the community and two in five
living in care homes.
 One in ten new mothers experiences
postnatal depression.
Burden of mental ill health
 Nationally the NHS spends around 11%
of its budget on mental health.
 Mental ill health represents up to 23% of
ill health in the UK and is the largest
single cause of disability.
Mental Health problems in children and young people
 One in ten children and young people ages 5-16 suffer
from a diagnosable mental health disorder.
 Over 8,000 children in the UK aged under 10 suffer
from severe depression.
 Between one in every twelve children and one in every
15 young people deliberately self harm.
 There has been a 68% increase in the number of young
people being admitted to hospital because of self
harm.
 More than half of all adults with mental health
problems were diagnosed in childhood. Less than half
were treated appropriately at the time.
 72% of children in care have behavioural or emotional
problems – these are some of the most vulnerable
people in our society.
Mental ill-health can have a devastating impact
 People with severe mental illness die on average 15-20
years earlier than the general population.
 Schizophrenia accounts for approximately 30% of the
expenditure on adult mental health and social care
services.
 Only one in ten prisoners has no mental disorder.
 Suicide remains the most common cause of death in
men aged under 35.
 The UK has one of the highest rates of self harm in
Europe at 400 per 100,000 population.
The overall number of people with mental health problems has not changed significantly in
recent years, but worries about things like money, jobs and benefits can make it harder for
people to cope.
23
No Health Without Mental Health: A cross-government outcomes strategy for people of all ages (DoH 2011)
30
The Local Picture – level of need in Solihull
The Solihull Joint Strategic Needs Assessment (JSNA) and the Mental Health Needs Assessment
provide information on the current and future health and wellbeing needs of the population of
Solihull. The current JSNA (2012) can be found at:
http://www.solihull.gov.uk/About-the-Council/Statistics-data/JSNA
Table 1 below identifies the expected prevalence of specific mental health conditions for
Solihull.
Table 1: Expected Prevalence for the different types of mental health conditions in Solihull
Type of Mental Illness
Common Mental Health Problems :
depression, anxiety, OCD, Phobias
Eating Disorders:
Anorexia Nervosa
Bulimia Nervosa
Eating Disorders not otherwise specified
Self Harm (c 400 per 100,000 population)
Personality Disorder (between 4% and 5% of
population – calc. based on people aged 20-64)
Bipolar Disorder (between 0.9% and 2.1% of
adult population 20-64 years of age)
Schizophrenia and schizoaffective (between)
Conduct disorder
Solihull
Prevalence
ages 15-64
21,645
980
5,500 - 6,500
1178 – 2,749
800 and 1,033
XXXX
Areas for specific consideration:
 The quality Outcome Framework 2012/13 and 2013/14 mental health register which
includes people with schizophrenia, bi-polar affective disorder and other psychoses
identified 1,633 and 1,699 people with such conditions on Solihull GP registers. This
accounts for 0.69% (2012/13) and 0.71% (2013/14) of the registered population. This is a
gap of between 279 and 2,083 when compared to the estimated prevalence rates for
Solihull.
 The number of suicides in Solihull is small and much lower than the national average and
that of comparable CCGs. The overall rate of male suicides has decreased markedly in
Solihull since 1995, although the female suicide rate has stayed the same. The number of
suicides is higher in the regeneration area (Chelmsley Wood, Kingshurst and Fordbridge and
Smiths Wood).
 Admissions for self harm have …..
 There were 52 adults with a mental illness living in permanent residential care at the end of
2014 this is a rise of 33 over the life of the previous strategy. Some of this is due to a drive
to ensure that people who no longer need inpatient services, particularly inpatient
31
rehabilitation services, are discharged to more appropriate care settings. More work is
being done to understand why there has been such a big increase and to reverse this
through the commissioning of more supported living services within Solihull. One such
scheme is coming on stream in May 2015 (Aviary House) and there are discussions with
other organisations to look at the opportunities to develop similar schemes in other parts of
the Borough.
 Personality disorder is an area that we need to focus on with this strategy. The expected
prevalence for Solihull is between 5,500 and 6,500 for the adults of working age population
although there is a significant range of complexity and impact within this cohort. The impact
of personality disorder is felt across all sectors mainly health, social services and criminal
justice as well as to the economy more widely as a result of the inability to work or
premature deaths. The cost of personality disorder is significant yet the outcomes being
achieved are poor.
 In 2014 Solihull had the 7th (out of 332 LA’s) rate of homelessness acceptances. Violence
and harassment) is the most notable reason for homelessness in Solihull with this being
recorded in 33% of cases compared to 20% for comparator LA’s. Mental illness in terms of
priority of need accounts for 20% of Solihull homelessness acceptances compared to 29%
within comparator local Authorities. A key priority to be addressed during the life of this
strategy is to support homeless people with a diagnosed mental illness to find stable
accommodation.
 Mental health problems in children are common, affecting up to 1 in 10 of the younger
population, depending on age. 7.3% of children aged 5–10 and 10.1% of those aged 11–15
have a mental health problem. Emotional disorder and conduct disorder are the most
frequently occurring conditions. It is estimated that in Solihull in any one year we will have
in excess of 390 and 560 children and young people with conduct and emotional disorders
respectively.
 In 2014 there were 101 looked after children in Solihull, this was a higher rate per 10,000
children than the national average and our comparator group. The number of children by
age is as follows:
- 5 were under 1
- 17 were between the ages 1 and 4 years
- 21 were between the ages 5-9 years
- 36 were between the ages 10-15 years
- 22 were aged over 16 years
Young people who are looked after experience high levels of social disadvantage, ill health
and risk taking behaviours after leaving care. 20 % will experience some kind of
homelessness within the first two years. 23% of adult prisoners and 38% of young prisoners
had been in care. Permanent exclusion rates among children in care is 10 times higher than
the average and as many as 30% of children in care are out of mainstream education
through exclusion or truancy.
Further information about mental health diagnoses, at risk groups and Solihull statistics can
be found in the Solihull JSNA.
32
7
What has been achieved since the last strategy?
What did we say
we would do?
What did we achieve?
How can the new strategy develop this
further?
That we would look to
develop, with the
BSMHFT, a single point
of access (SPoA) into
secondary care mental
health services with a
single assessment
process.
 The Single Point of Access (SPoA) was
launched in April 2014.
 A new referral form co-produced
between GP’s and Consultants was
produced to support the SPoA to aid
onward referral.
 Single assessment process introduced
so that people only have to tell their
story once.
 More needs to be done to improve the links
between the SPoA and the GPs referring.
 We will scope the potential benefits of there
being a SPoA for Solihull and whether this
should be for mental health services only or
part of a wider Solihull SPoA for access to all
health provision locally.
That we would Improve
access to psychological
therapies (IAPT)
 More people are accessing
psychological therapies delivered by
Solihull Healthy Minds. Increased
numbers of people moving to recovery
and back to work (supported by Solihull
Mind Employment Support Service). All
national targets are being delivered.
 IAPT services were expanded to support
young people aged 16 and above and
has also been working with Age UK to
promote psychological services to older
people living within Solihull.
 Books on prescription were made
available at all libraries within Solihull,
the IAPT website contains self help
materials and audio files. These can be
found at:
 IAPT initiatives were originally designed to
get people off sickness/unemployment
benefits and back into employment.
However the development of IAPT services
has identified a need for improved access to
psychological therapies for young people,
older people, people with long term
conditions and those with medically
unexplained symptoms (MUS). There are
significant wider system benefits achievable
though IAPT interventions for these cohorts
of the poulation and this needs to be further
explored during the life of this strategy.
 We will also be evaluating the current
psychological and counselling services
pathways within Solihull during 2015 to
assess how well the current pathways work,
how they can be improved and to scope the
benefits of a single pathway. There are
currently long waiting times for the Solihull
Mind Counselling Service which the review
will need to address.
 We are still not using all resources as
effectively as we could. Are patients with
low PHQ9 and GAD7 scores being
encouraged to try self help first? Are we
taking up assessment time with people who
do not meet ‘caseness’? Do GPs require
further training in supporting their patients
to access the most appropriate service? Are
we making best use of universal services
through social prescribing, peer support etc?
Are we supporting people to address other
aspects of their life which are impacting on
their mental health such as debt, benefits
etc.? All of these issues need to be explored
as part of the re-design of the counselling
and psychological services pathway during
2015.
http://www.covwarkpt.nhs.uk/iapt/Pages/default.
aspx
 During the life of the strategy an IAPT
pilot looking at the benefits of
supporting people on the virtual ward
service who had both physical and
wellbeing difficulties was implemented.
Although the results were good for the
people who accessed this service it was
not well used and it was therefore an
expensive service for a few people so
was not continued post the pilot.
33
What did we say
we would do?
Did we achieve this?
How can the new strategy develop this
further?
That we would ensure
that people with longer
term mental health
problems have better
access to mainstream
services such as
housing, education and
employment.
 We have worked with Stonham
Homegroup to develop a new scheme
comprising 28 individual flats, replacing
what was currently a 15 bedded mental
health care home. This will provide
people with their own flat with access
to 24/7 support.
 Much has been done to link up the
various employment support schemes
across Solihull for example Solihull Mind
Employment Support service with
Solihull Economic Development
Schemes such as ‘Hot Jobs’
 We have worked with Solihull Mind to
develop the Horticultural site to be able
to deliver recognised qualifications to
support people back into employment.
 We have worked with the BSMHFT and
BITA Pathways to try and develop the
previous Express Signs service into a
sustainable business.
 Bev PETCH – schools initiatives
 Solihull College – for adult education
 There is a shortage of accommodation for
people with a mental illness especially
accommodation that has access to support.
We are working with a range of
organisations locally to develop more
accommodation within Solihull that is at
affordable rent levels.
 We are working with local providers and the
Economic Development team at the Council
to bid for European Social Funds to expand
employment support activities locally.
Services developed using these funds will be
expected to support people to get relevant
training and qualifications and to help them
move into permanent employment.
 We will be looking to local providers
including the BSMHFT, HEFT, Solihull CCG
and the Council to provide work experience
opportunities to people wanting to get into,
or back into, employment.
That we would ensure
more individual choice
and control within care
planning including the
use of personal
budgets.
 Much work has been done within
Solihull to encourage people to take a
personal budget and for this to be in the
form of a direct payment as this offers
people more choice, flexibility and
control about how their needs are met.
 This helps to ensure that people are not
expected to fit into existing services but
have the opportunity to use their
budget to develop support plans which
are tailored to their individual needs
and preferences within their assessed
budget.
 The percentage of people living in
Solihull who are directly commissioning
their support through a direct payment
now stands at 51.3% this is a significant
increase from the levels recorded at the
start of the strategy which was xx%
 Further development of the care and
support market is required within Solihull.
 Many people would like to use their budget
to employ a personal assistant but these are
a scarce resource locally. One of the
schemes to be developed by a local provider
‘Independent Advocacy’ is to train up people
with ‘lived experience’ to become either
advocates or personal assistants. This gives
a further route into employment for people
having recovered from a mental illness and
to use their experiences to help support
other people to achieve recovery.
In patient assessment
provision will be in fit
for purpose
accommodation with
the right level and skill
mix of staffing to
enable active
treatment and
discharge
 We failed to achieve this during the life
of the previous strategy and it therefore
needs to be carried over into this new
strategy. The decision about the future
of this unit has been further delayed
because of the potential impact of the
0-25 tender in Birmingham. The Trust
may have too much inpatient provision
if they do not win the tender and may
 We will continue to work with the BSMHFT
on potential options to replace the Bruce
Burns Unit.
 We will continue to enhance the capacity
within existing services, or develop new
specialist community provision that will
provide earlier help and support to reduce
the numbers of people moving to crisis and
requiring admission.
34
not be in a position financially to invest
in a new inpatient facility in Solihull.
 In line with the Francis Report the
BSMHFT has increased the ratio of the
number of staff to beds to ensure
higher quality, safer inpatient services.
 We will work with providers to scope the
What did we say
we would do?
What did we achieve?
How can the new strategy develop this
further?
That recovery services
and the support
workers within them
will be able to flexibly
support people to
achieve independence
including opportunities
to seek education and
employment
 The role of the Community Recovery
Team was reviewed in 2013. The
review identified a requirement for a
more goal focused recovery approach
and once the person had been
supported to achieve their goals they
were discharged. People requiring a
longer term support service were
signposted to other provision outside of
secondary care unless they had
complex, unstable needs, were at
higher risk of relapse or were involved
in safeguarding. The service was
renamed the Promoting Social Inclusion
and Independence Team (PSII).
 The Express Signs service which was
being delivered by the BSMHFT is now
being managed by BITA Pathways who
we hope will be able to breathe new life
into this service and ensure that it is a
sustainable business going forward.
 Public Health commissioned smoking
cessation and weight management
services that are delivered by health
trainers.
 Social prescribing another newly
commissioned public health service
offers opportunities for people to
access local clubs and activity groups to
support them to become more active
and less socially isolated.
 The Rapid Assessment Interface and
Discharge Service (RAID) operates out of
all acute hospitals, supporting the
management of both the physical and
mental health needs of patients
attending A&E or those admitted.
 Street Triage – people identified as
potentially requiring access to a place of
safety will be assessed by the street
triage team which comprises
paramedic, CPN and Police officer. This
results in the person getting a robust
assessment of both their physical and
mental health needs to determine most
appropriate service response.
 IAPT – supports people with depression
and/or anxiety. People with poor
mental health will most likely have poor
physical health and vice versa.
 This strategy will facilitate closer working
with professional staff to enable PSII
workers to deliver recovery support services
earlier in the service users’ pathway. This
will include increased use of alternatives to
formal support using community services
such as social prescribing, the third sector
and the information and advice hubs.
 Improving the employment opportunities for
people with a mental illness is a key priority
within this strategy. We will work with third
sector organisations to develop bids for ESF
monies to enhance employment support
services locally enabling more people with
MH problems to move into employment.
That we would
proactively consider
both mental and
physical health needs
through active liaison
and joint working.
benefits of developing step down provision,
such as residential respite and extended day
hospital. This will support people to be
discharged as soon as they no longer require
inpatient treatment.
 We will work with Public Health to open up
referral to the social prescribing service to
CPN’s and MH Social Workers.
 We will seek to strengthen the partnership
working between the BSMHFT and the
Public Health Commissioned Health Trainers.
 We will continue to promote the Making
Every Contact Count programme,
encouraging providers to look at the whole
person and not just the presenting
condition. To spot early signs of mental
illness or distress and to be proactive in
signposting/supporting the person to get the
help that they require.
 We will support the development of more
robust shared care arrangements between
primary and secondary care for those in
contact with mental health services.
 We will monitor the delivery of the National
CQUIN – improving physical healthcare to
reduce premature mortality in people with
severe mental illness.
35
Supporting the person to improve their
mental health will therefore improve
their physical health.
 Physical Health monitoring – this is
particularly important for people with
psychosis and such monitoring has been
significantly improved over the life of
the last strategy.
What did we say
we would do?
Did we achieve this?
How can the new strategy develop this
further?
That we would
promote recovery and
independence by
supporting people
where they live in their
local communities
through flexible 24/7
services across health
and social care
 A dedicated Home Treatment Team
Consultant was appointed to lead the
team. This has supported more people
to be able to remain at home and not
be admitted.
 MH Crisis Line Pilot started in March
2015 and provides BSMHFT specialist
staff working in the 111 call centre at
times of peak call volumes. The Crisis
Line is also supported by Solihull Mind
who provide information advice and
listening services for people with lower
level mental health needs who have
called 111.
 Solihull Mind provide drop in services 7
days a week – this is an existing service
not newly commissioned during the life
of the strategy but a lot of work has
been done to raise the awareness of
this service so that it can support more
people to get the help that they need.
 Supported living scheme developed in
Smithswood which provides 28 flats for
people with mental health needs.
Fifteen of the flats will support people
who are currently living in a residential
care home and will provide a more
enabling environment to promote
greater independence for the people
living there.
That we would work
with wider partners to
ensure that people
who need help in a
crisis or who urgently
need assessment and
support from specialist
mental health services
will be able to access
this on a 24/7 basis.
 A MH Crisis Care Concordat Action plan
has been produced for Solihull
identifying what we are already doing
well and what we still need to improve
and by when. The Health and Wellbeing
Board will oversee the implementation
of this action plan.
 The MH Crisis Line Pilot linked to 111 (as
described above)
 Street Triage (as described above.)
 RAID (as described above)
 Psychiatric Decision Unit – new service
established late 2014 and which is the
mental health equivalent of emergency
departments within Acute Hospitals.
Ensures robust MH assessment to
determine most appropriate treatment
 We will work with Housing Providers to
develop more supported living schemes
locally.
 We will develop respite provision within
Solihull
 We will work with the Birmingham Joint
Commissioning Team to scope the likely
benefits of a ‘Peer House’ and to jointly
commission this provision if such a model is
seen to deliver better outcomes for patients
and better value to the health and social
care system.
 We will scope the separation of crisis
resolution from home treatment – looking at
how home treatment can be more proactive, intervening earlier and preventing
crises occurring.
 We will evaluate the Mental Health Crisis
Line linked to 111 and develop a business
case to secure recurrent funding if proving
to deliver expected outcomes and better
value.
 We will continue to promote the benefits of
social prescribing, third sector provision and
the information and advice hubs to people
with a mental illness and the staff
supporting them.
 We will ensure that organisations providing
support for people with a mental illness are
formally linked to the mental health
pathway.
 We will implement the Crisis Care Concordat
Action Plan.
 We will continue to evaluate the wider
system impact of the 111 crisis line and
identify recurrent funding if it continues to
deliver expected outcomes.
 We will work with the Birmingham Joint
commissioning team to ensure that the
street Triage be formally commissioned from
April 2016.
 As with Street triage above the funding for
RAID still sits outside of the main contract
and this now needs to be formalised as a key
service to be commissioned recurrently.
 We want to scope the opportunities for a
second MH psychiatric decision unit for
North East Birmingham and Solihull based at
36
and support. This has had significant
impact on numbers of A&E breaches
and also on the numbers of people
being admitted into a mental health
acute assessment service.
 Home treatment service – providing
more intensive support to people at risk
of requiring admission.
Heartlands Hospital.
 We want to scope the potential benefits of
splitting the crisis resolution element from
the home treatment element.
What did we say
we would do?
Did we achieve this?
How can the new strategy develop this
further?
People in crisis will be
supported at home
and/or in local short
term facilities including
crisis or respite beds
which enable them to
return home after a
short period
 support at home to people in crisis is
delivered by services such as
- the Home Treatment Team
- Street triage
- MH Crisis Line
 We were not able to develop short term
facilities such as access to respite/crisis
house services locally during the life of
the previous strategy although the
development of Aviary House gives us
the opportunity to commission 4 respite
units within this scheme.
 Social prescribing service established in
2014.
 Mind horticultural service supported to
develop and deliver recognised
qualifications to support people into
permanent employment.
 The re-tendering of third sector
provision within Solihull has resulted in
some new innovative services to be
delivered within Solihull such as the
training of people with lived experience
to train to become personal assistants
or advocates.
 We will establish a pilot for MH respite
provision in Solihull and evaluate outcomes
 As part of the urgent and acute work stream
we will identify a better model of crisis
resolution and home treatment services
locally. This approach will be piloted in a
number of teams across Birmingham and
Solihull and the system impact evaluated.
Social inclusion services
(employment, work,
meaningful activity
/day opportunities) will
be provided from
mainstream universal
environments such as
third sector
organisations which
can offer choice and
personalisation
Rehabilitation and
recovery services will
be commissioned from
providers who can
offer flexible packages
which are not buildings
based but provided in
normal environments
with opportunities to
test out skills in step
down houses and
supported living
options
 During the life of the previous strategy
we worked with the Trust to support
people no longer requiring inpatient
treatment to be discharged to more
appropriate community provision. Most
people moved into residential care,
hence the increase in the numbers of
people in permanent care from the
2010 position.
 We wanted to scope the development
of a community rehabilitation team to
reduce the numbers of people moving
into inpatient rehabilitation services.
This was not delivered and therefore
needs to be addressed within the life of
this strategy.
 The respite beds that we are looking to
commission from Aviary House will
 We will open up referral to the social
prescribing service to CPNs and social
workers.
 We will continue to look with our partners,
including the DWP and Job Centre Plus at
how we can best support people with a
mental illness to secure employment.
 We will use this knowledge to develop bids
for ESF funding to expand employment
support services within Solihull.
 We will promote partnership working across
the sector.
 We will scope opportunities for time
banking, peer support and other such
initiatives that would help people to engage
in meaningful activities and develop a sense
of belonging within their local community.
 We will scope the potential to reduce the
numbers of inpatient rehabilitation beds
commissioned and to use the resource freed
up to develop a community rehabilitation
team.
 We will pilot 4 units within Aviary House as
respite units which can support step down
and admission avoidance.
37
Services for adult
Attention Deficit
Hyperactivity Disorder
(ADHD) will be
developed
alongside CAMHS and
GPs
support this new approach.
 We extended the age for ADHD
assessments with the CAMHS service up
to 18th Birthday. This had previously
been a gap.
 Adult ADHD services commissioned for
people aged 18 and above.
 We will review the outcomes being achieved
and the experiences of people accessing
these services and use this to re-shape
ADHD service models and pathways locally.
 We will review the level of demand and
service capacity requirements so that
waiting times from referral to intervention
remain appropriate.
What did we say
we would do?
Did we achieve this?
How can the new strategy develop this
further?
Services for people
with mental ill health
and substance misuse
issues will be more
coordinated alongside
the new services being
put in place by the
Alcohol Strategy
 Substance misuse services delivered via
Solihull Integrated Addiction Service
(SIAS) are now really well embedded
within Solihull and delivering improved
outcomes for people.
 SIAS works well with mental health
services working in partnership with
them to meet the dual needs of people
within Solihull.
 The RAID service supports people with
mental health and or substance misuse
disorders who attend A&E or who have
been admitted.
 The majority of people with an alcohol
problem are now detoxed in the
community and there is also a local
rehabilitation service so fewer people
need to go out of Solihull unless this is
in their best interests or clinically
advocated.
 CHRIS CLARKE/SARA ROONEY
Services for people
with a personality
disorder will be further
developed in the
community
 We commissioned a community
personality disorder (PD) service for
people within Solihull..
 The service delivers Dialectical
Behavioural Therapy a form of therapy
designed to help people change
patterns of behaviour that are not
helpful, such as self harm, suicidal
thinking and substance abuse.
 We commissioned the service to
support people aged 14 and above with
young people under 18 years of age
continuing to be case managed by the
child and adolescent mental health
services.
We will work with the BSMHFT and the third
sector to:
 Develop a 2 - 3 year re-design plan
 Change our thinking and understanding of
the needs of people with borderline and
emotionally unstable personality traits
 Improve outcomes and service user
experience
 Reduce impact on and demand for services
 Increase range of, and access to, evidence
based psychological and psychologically
informed interventions and environments
38
What did we say
we would do?
Did we achieve this?
How can the new strategy develop this
further?
That we would improve
the transitions
experiences of children
and young people
moving out of Child
and Adolescent MH
services
 We reviewed and revised the transitions
protocol
 We commissioned a place of safety for
children and young people
 We reduced the eligibility age to 14 for
access to community dialectical
behavioural therapy services.
 We extended the age eligibility for
access to CAMHS ADHD services to 18.
 We developed a new service model for
emotional health and wellbeing services
for children and young people and
tendered out this service.
 We awarded the new contract for
emotional health and wellbeing services
to the BSMHFT in partnership with
Barnados.
 We agreed to develop a separate
mental health crisis care concordat for
children and young people








We will improve emotional wellbeing and
mental health for children, young people
and their carers so that they are more
resilient, able to manage their mental
health needs and have a life which is not
defined by their mental illness.
Children and young people with emotional
wellbeing and mental health needs will be
identified early and supported in
community settings including schools,
reducing the need for access to more
specialist mental health services.
Children and young people will receive
mental health services locally, within their
own community and close to home,
reducing the need to be admitted to
inpatient services.
Young people will experience a seamless
transition to adult services.
Parents and carers will promote the
emotional wellbeing of their children.
Children, young people and their carers
feel well informed and supported.
Parents and professionals in universal
services such as schools and primary care
will feel more confident about responding
to emotional wellbeing needs and are
clear about when and how to refer on for
additional help.
We will deliver improved outcomes for
children and young people who are
Looked After and adopted through
reduced placement disruption and
breakdown.
Children, young people and families will
design and influence the arrangements for
emotional wellbeing and mental health
services.
The above identifies that although much was delivered during the life of the
previous strategy there is still a lot more to do if we are going to really improve
the experiences and out comes of people, and their carers, accessing mental
health services.
39
8
WHAT WILL WE SEEK TO IMPROVE?
To achieve the outcomes described in section 4.9 above will require a holistic approach which
touches on all aspects of a person’s life not just their medical needs. It will require a
recognition of the benefits of good quality housing, employment and supportive relationships.
It is important to identify and fill any gaps between public health and prevention and primary
and secondary care services so that people with mental health needs who do not meet the
eligibility criteria for secondary care provision still have access to any help and support that
they require to maintain their mental health.
In order for us to deliver our aim for continual improvement in the outcomes and experiences
of people with mental illness in Solihull we will focus on some key areas for development.
These priorities have been informed by stakeholder and service user and carer forums, local
and national policy and the evidence of need within the JSNA. Much of what still needs to be
done is detailed in section 7 of this strategy and the Mental Health Crisis Care Concordat
Action Plan and delivering these will help us to deliver the key objectives as described below:
8.1
Prevention and early help
Keeping people well by preventing ill health and intervening early when people are becoming
unwell is one of the key priorities for the CCG and Council. To achieve our aims for improved
prevention and early help locally we will:

commission services that will deliver on-going support and education for people so
that they can improve their life skills such as parenting, employment, engagement and
healthy lifestyle choices around eating, exercising and smoking.

seek to gain a better understanding of, and identify how best to address, the known
triggers to poor mental health such as loneliness, unemployment, boredom, substance
misuse and self harm.

create better signposting to resources and education that promote and support
mental health and well-being including volunteering, leisure and physical activity
opportunities. This will include an information and advice portal which is currently
being developed.

further develop the evidence base around mental health in Solihull to improve our
understanding of mental illness and use this learning to inform service development.
40
8.2
Promoting emotional wellbeing and tackling stigma and discrimination
Tackling stigma and discrimination is one of the areas of highest priority that service
users told us should be included in this strategy. Many people with mental health
problems experience stigma and discrimination. Together with our partners we will:
8.3

work with communities to ensure that local communities have a better understanding
of mental health in order to reduce the stigma associated with it.

promote emotional health and wellbeing so that people understand that this is just as
important as keeping themselves physically healthy.
Personalised recovery based services
The single highest priority for service users of working age in the development of this
Strategy is to build a recovery culture across Solihull mental health services. Recovery
means the process through which people find ways of living meaningful lives with or
without on-going symptoms of their condition.
To develop a recovery culture across Solihull we will:
 commission the provision of flexible preventative support, education and treatment
pathways, providing service users with the tools and confidence to manage and
maintain their recovery and wellbeing.
 ensure that compassion, respect and dignity are core values within all of the services
that we commission and we will monitor this through regular feedback from people
accessing services.
 enhance peer support services locally in light of the emerging evidence base that peer
support is an effective and cost effective means of delivering support for mental health
service users.24
 work with partners to consider opportunities for developing and commissioning a
shared decision making approach to ensure that services users have choice and control
over their care and support options.
 look to pilot personal health budgets in mental health in light of emerging national
evidence of he benefits of such an approach.
 We will work with the third sector, Job Centre Plus and other partners such as Solihull
Mind Employment Support Service and BITA Pathways to review the services we
24
Wellbeing enterprises CIC/NTA/NHS Nottinghamshire
41
jointly provide and commission to support people into employment. We will
strengthen the way that primary care psychology services meet the national criteria
for employment support in IAPT services
 continue to review the housing needs of people with a mental illness both general
purpose and supported housing. We will specifically address the current issues re
people with a diagnosed mental illness who are homeless.
8.4 Support for carers
Carers play an important and often central role in the lives of people with mental health
problems. In our joint CCG and Council Carers strategy, we have already committed to and
are delivering:
-
provision of information and training for carers of people with severe and enduring
mental health problems
access to assessments for carers of their own health, wellbeing and support needs.
facilitated carers forums proving essential peer support opportunities for carers of
people with mental health problems.
We will therefore ensure the delivery of the Carers Strategy, and associated milestones, as
they relate to carers of people with mental health problems
8.5 Effective and efficient use of resources to ensure value for money
To deliver improved value for money through a better use of the Solihull pound we will:
- ensure that good outcomes are being achieved from all services commissioned
- benchmark the outcomes and spend being achieved within Solihull against other
comparator CCGs and Local Authorities.
- look at opportunities for inter-disciplinary working, training and care between mental
health services and other key services delivered such as emergency, prison and
probation services.
8.6 Closer collaboration with service users, families and carers in the development
of services
Service user involvement has moved from being an exception to an expected part of
service planning and delivery25 Service users are “experts by experience‟ who must be
involved in the development, planning, delivery and review of local services to ensure that
they are relevant and effective.
25
Making Service Involvement Effective – Mental Health Foundation
42
Our joint commissioning approach is underpinned by our absolute commitment to
ensuring that service users are centrally involved in planning mental health services for the
future. Whilst we currently have a range of mechanisms through which we aim to ensure
that service users are involved in mental health service planning, we believe that there are
opportunities to strengthen the current arrangements. NICE has issued a quality standard
on the service user experience that we will continue to refer to as we develop the means of
engagement locally.26 We will achieve this by:

Working with service users and carers to undertake gap analyses in services for specific
areas of need and explore options for further development where gaps exist. Areas
might include: ADHD, autism, personality disorder, eating disorder, dual diagnosis and
perinatal/parent-child health and prison probation mental health.

To evaluate the ease of access and spread across the Borough of our services both acute
and preventative, especially as many vulnerable individuals do not have independent
transport.

A commitment to assess and respond as appropriate to unexpected but significant new
need and demand.
8.6 Improving partnerships
We believe that by working together, across health, social care, education, the voluntary sector and
with service user and carers we can more effectively develop and deliver the range of services and
interventions that can help to alleviate the impact of mental health problems on individuals,
families and communities within the borough. There are a range of other service providers who also
have a significant impact on mental health, for example the Metropolitan Police, the Fire Brigade,
the Department of Work and Pensions, registered social landlords. We will do this by:
 working with other commissioners and agencies to ensure that opportunities for identifying and
supporting people with mental health problems are proactively considered in each of our major
work streams, including: Maternity, Children and young people, Urgent care, Planned care,
Integrated care, Long term conditions, Last years of life, Information and technology,
Prescribing, Primary care development
 examining, across the Council and the CCG, as the two main public sector
commissioning bodies in the borough, opportunities to use the ‘Time to Change’ pledge
to include in our contracts an obligation on suppliers to provide a mental health friendly
workplace for their employees.
 looking at how we can use information technology more effectively, including data
collection and sharing of information.
 ensuring clear and robust interfaces with learning disability services.
 ensuring clear pathways through primary and secondary mental health services.
26
Service User Experience in Adult Mental Health (QS14) NICE 2011
43
 eradicating multiple assessments where much of the information is already known.
 Sharing and keeping up to date with best practice, skills, knowledge and relationships
across teams, disciplines and employers across the Borough, including modern
technology, and assistant technology with professionals skilled in how to promote and
use them.
 Continue to build robust safeguarding mechanisms, but also to promote safeguarding
for internet and social media use, especially with more vulnerable groups.
 Ensure that services and resources are provided in such a way that they are accessible
to people regardless of where in the Borough they live.
8.7 Transitions
Poor transition between stages of the life course, or services, can contribute to poor outcomes in
the short, medium and long term. It can impact upon a person’s chance of achieving employment,
accessing education, maintaining independence, moving on from services or accessing services in
the future. Conversely, effective transition can have a positive effect on peoples‟ life chances and
their future mental health and wellbeing.
Transition for young adults is particularly important. Its aim should be to help to improve the
chances of recovery and independence through the provision of high-quality, effective health and
social care services that continue seamlessly as the individual moves from adolescence to
adulthood.27 We want to ensure that the transition for children and young people to adult mental
health services and the transition for adults to older people’s mental health services is improved as
part of our life course approach to mental health and wellbeing.
We will do this by:

designing new pathways of support for children and young people, ensuring that these take
account of the life events that impact on young people with mental health problems,
including leaving education, leaving home, leaving family, emerging autonomy28
The transition for existing adult service users to older adult community provision is an area that
requires further focus, especially thinking about those people who may develop organic disorders
such as dementia.

27
28
We will review current community pathways for older adults with a functional
mental health problem, in the context of our developing plans for integrated care in
the borough.
Tools for transition. Anderson Y, HASCAS
Transition: Filling the Void? Hewson Dr L, National Advisory Council Feb 2010
44
Other Priority Areas
8.8
Suicide and self harm
Although we have low rates of suicide per head of population relative to other
comparator areas any suicide is one too many and we aim to do all that we can to have
no suicides in Solihull. We also recognise that the numbers of people, particularly
children and young people, who are self harming is increasing and this is something that
we need to address as a priority locally. We will therefore:





8.9
work to enhance protective factors and to reduce risk factors for suicide.
provide people with support and encouragement to look after their mental health
and wellbeing, one of the main risk factors for suicide.
Aim to commission evidence based care for those who are affected by self harm and
suicide.
Ensure that people in contact with mental health services will have a contingency
plan which they have developed and own.
Ensure that there are a range of services available 24/7 that can support people in a
crisis and who are at risk of self harm and suicide.
Personality disorder
Services for people with a personality disorder are not well integrated despite the impact
of personality disorder being felt across both mental and physical health services. We
believe that there is a lot more that can be done to support people earlier and better, this
includes better management of conduct disorder in children and young peoples services
and more intensive community and third sector provision. To improve the current
treatment and support for people with personality disorder we will:




establish a specific task and finish project group, with clear executive sponsorship
and service user and carer membership to deliver on the personality disorder
service re-design.
Scope relevant issues and concerns via serious incidents, complaints, service user
and carer feedback, feedback from wider mental health professionals and through
learning from other best practice services and use this information to inform the redesign.
Work with the Trust to design pathways for emerging personality disorder in those
under 25 years of age for Solihull.
Develop a plan, owned across all partner agencies on how to overcome potential
challenges to a new approach to the management of personality disorder ie risk
management policies and reconfiguration of resources.
45
8.9
Dual diagnosis
Fiona/Ash can you include something given the work you are doing re the dual
diagnosis pathway please?
8.10 Support for at risk communities
- Looked after children
Looked after children are known to be at very high risk of developing mental health
problems. To better support the mental health and wellbeing of looked after children
we will:
- work to design new pathways of support for children and young people,
- consider how to most effectively provide support to children at risk, including
looked after children, and in particular how to most effectively support children’s
social care staff with developing knowledge and skills around mental health
- Mental Health of offenders
The health of offenders is now a recognised major public health issue. The
connections between mental illness and social exclusion are as well known as they
are between deprivation and offending behaviour 29 People with mental health
problems are over represented in prison and across the criminal justice system. The
Bradley review 30 laid out a series of recommendations aimed at improving the health
of offenders, and placed a strong emphasis on mental health. The national Offender
Personality Disorder Strategy31, details in particular proposals to improve the
recognition and support for people with personality disorder in the criminal justice
system.
The landscape of offender management is current changing significantly. Whilst some
forensic services are the responsibility of NHS England specialist commissioners,
including in-patient services and some community outreach services, general mental
health services for people with a mental health problem and a forensic history are
the responsibility of the Clinical Commissioning Group and the Council. At the same
time, there have been changes to the organisation of probation services across the
country32.
29
30
31
32
Social Exclusion and Mental Health, ODPM, 2004
http://www.prisonreformtrust.org.uk/ProjectsResearch/Mentalhealth/TroubledInside/Bradleyreviewcallsfornewapproachtooffenders
http://www.personalitydisorder.org.uk/criminal-justice/about-dspd-programme/
http://www.justice.gov.uk/transforming-rehabilitation
46
To improve the mental health support available to people with offending behaviours
we will:
work with probation and mental health service providers to ensure the successful delivery of
support for offenders with mental health problems including personality disorder
-
People who are homeless
Good quality, affordable, safe housing underpins our mental and physical wellbeing.
All too often, severe mental ill health can lead to homelessness. People with mental
health problems, particularly those with a serious mental illness, can sometimes find
it difficult to secure and maintain good quality accommodation. We will:
- work with the mental health social work and housing teams to identify people with
a diagnosable mental illness and who are identified as homeless.
- include a specific outcome related to securing stable accommodation within their
care and support plan.
-
People from Black and Minority Ethnic (BME) communities
People from different ethnic communities and cultural backgrounds may well have a
different understanding of and responses to mental health difficulties in themselves,
their families and their communities. This is equally true of the knowledge of
professionals about how mental health difficulties may present in different
communities and this may be compounded by services not being configured in a way
that feels accessible to people from these communities. As a result the take up of
mental health services is not always as we might expect from what we know of our
population profile for Solihull.
To improve access to mental health services for people from BME communities will
require us to:
ensure that there are appropriate voluntary sector services close to
communities to provide information, advice and signposting to early help
support.
develop local anti-stigma campaigns using community and voluntary sector
organisations such as the community development workers employed by Accord Group
(Ashram)
-
ensure that services provide culturally and language appropriate support.
develop a dashboard for access to services by race to inform future
commissioning.
47
-
Lesbian Gay Bisexual and Transgender (LGBT) communities
There are no clear figures indicating how many gay, lesbian bisexual or transgender residents
there are in Solihull. National estimates indicate that between 5 – 7% of the population is
gay, lesbian or bisexual. Studies show that LGBT people show higher levels of anxiety,
depression and suicidal feelings than heterosexual men and women. Rates of drug and
alcohol misuse have also been found to be higher. But the real picture is uncertain because
of the reluctance of some patients to disclose their sexuality, and some healthcare staff
feeling uncomfortable asking the question.
Poor levels of mental health among gay and bisexual people have often been linked to
experiences of homophobic discrimination and bullying.
To improve the experiences of LGBT people with mental health difficulties we will:
develop local anti-stigma campaigns using community and voluntary sector
organisations such as the community development workers employed by Accord Group
(Ashram).
work with providers to improve the recording of sexual orientation as part of our
equalities monitoring requirements and will consider, as part of our plans for the
commissioning of preventative services, options for further specific services for LGBT
communities such as peer support, drop in services etc.
8.11
Better integration of mental and physical health
-
mental health of people with a long term condition
We know that around 30% of the population of England has a long term
condition, and that people with long term conditions are two to three times
more likely to have a mental health problem. It is particularly likely that people
with cardiovascular disease, diabetes, chronic obstructive pulmonary disease and
some musculo-skeletal conditions will have a mental health problem. It has been
estimated that between 12 – 18% of all expenditure on long term conditions is
linked to mental health
Much has already been done to improve the mental health of people with long
term conditions. We have Improving Access to Psycholgical Therapies services in
the form of Solihull Mind which deliver cognitive therapy based interventions.
These services are attached to practices locally and also operate out of a range of
community venues to make it as easy as possible for people to access the
service. We have the Rapid Access, Interface and Discharge Team (RAID)
operating out of all acute hospitals across Birmingham and Solihull ensuring that
mental health problems in people admitted for a physical health problems are
identified, offered appropriate treatment, and sign-posted into appropriate
community services on discharge
48
There is a strong ‘making every contact count’ ethos operating within Solihull we
want clinical teams supporting people with long tem conditions have regard to
the mental health and wellbeing of their patients, promoting the importance of
good mental wellbeing in the management of their long term condition. To
support this we will need to make it as easy as possible for wider clinical teams
to have information about where they can signpost people to access support for
mental health and other social issues that may be impacting negatively on the
management of their physical health condition.
Through our work to build a “mental health is everybody’s business” culture
within the Clincial Commissioning Group, we will ensure that relevant chronic
disease work streams consider opportunities for better integrating mental health
support with primary care and chronic disease management programmes, with
closer working between mental health specialists and other professionals.
Through our work to develop an integrated care system to support people who
have the most complex health and social care problems, including those who are
most at risk of admission to hospital, we are currently developing with Primary
Care, the Heart of England NHS Foundation Trust (community services) and the
BSMHFT, new integrated community teams, that are linked into primary care
networks. We want to ensure that mental health is at the heart of our plans for
integrated care, and this is a key focus of this strategy and the commissioning
actions plans being developed across all key work streams within Solihull.
We will achieve this by:
-
-
-
-
commissioning specialist mental health input into the new
community integrated care services to ensure that these services can
address the holistic needs of patients and service users in one place.
We will continue to promote the importance of early identification of
mental health problems and ensure that there is a good awareness
across the health and social care system of what services are available
and how patients can access them.
encouraging all services to promote the importance of good mental
health in the management of physical health conditions. This will
support with reducing the stigma associated with mental health.
Physical health of people with a severe mental illness
People with severe mental illness die on average 20 years younger than the general
population, often from preventable physical illnesses.33 People with mental illness have
a higher prevalence of smoking, drug and alcohol misuse, an increased risk of physical
33
20 Years too Soon Rethink 2012
49
illness and reduced life expectancy. 42% of all tobacco consumed in England is smoked
by people with mental disorders.34 As a further example, depression is associated with a
50% increased mortality from all disease and reduced life expectancy of around 11
years in men and seven years for women. 35Schizophrenia is associated with increased
mortality from all disease and a reduced life expectancy of around 21 years for men and
16 years for women.36 People with mental health problems are almost twice as likely to
die from coronary heart disease as the general population and four times more likely to
die from respiratory disease37 38 39.
We are further developing our approach to improving the physical health of people with
a serious mental illness. Information on physical health is now routinely shared across
primary and secondary care. The BSMHFT is continuing to improve the knowledge and
skills of staff and the assessment processes, to ensure that physical health needs are
identified and appropriately assessed. Public Health have commissioned health trainers,
smoking cessation, obesity services and sexual health services, and continue to work
with the CCG and Council to identify the most appropriate service models and best
practice to support people with mental health problems to lead healthy lifestyles.
We will:
continue to commission the health trainer service and work with health trainers
to ensure that they focus attention on supporting people with severe and
enduring mental health problems.
commission smoking cessation programmes from mental health service
providers to support more people to quit smoking..
ensure that mental health staff are aware of what healthy lifestyle services and
support are available locally and encourage the people they are supporting to
access them.
monitor the success BSMHFT and primary care in delivering the CQUIN which
seeks to ‘Improve Physical Healthcare to Reduce Premature Mortality in People
with Severe Mental Illness (SMI)’
-
Medically unexplained symptoms
Many people present with medically unexplained symptoms. For example, more than a
quarter of primary care patients in England have unexplained chronic pain, irritable
Cigarette smoking and mental health in England Data from the Adult Psychiatric Morbidity Survey. London: National
Centre for Social Research.McManus S, Meltzer H, Campion J 2010
35 Guidance for commissioning public mental health services JCP-MH 2012
36 Causes of the excess mortality of schizophrenia British Journal of Psychiatry,2000; 177: 212 Brown S, Inskip H and
Barraclough B.
37 The physical health of patients with mental illness: a neglected area, Mental Health Promotion Update, 2001; Cohen A
and Phelan M. 5-6
38 Background evidence for the DRC‟s formal investigation into health inequalities experienced by people with learning
difficulties or mental health problems, Disability Rights Commission (www.drc-gb.org) London; 2004. Nocon A.
39 Solihull JSNA
34
50
bowel syndrome, or chronic fatigue, and in secondary and tertiary care, around a third
of new neurological outpatients have symptoms thought by neurologists to be “not at
all” or only “somewhat” explained by disease. If not treated properly medically
unexplained symptoms can result in large amounts of resources being wasted and
patient harm through the patient experiencing problems which have been induced by
the treatment itself.
To improve the management of medically unexplained treatments we will:
-
PAUL TURNER/ANAND CHITNIS TO INFORM
Development of neurological services pathways, clarifying the role of GP’s,
access criteria, not being afraid to say that there is no treatment as no physical
condition, ensure robust signposting of people to IAPT, etc.
51