Merton Voice
A
detailed review of the adult mental health services is currently under way, which also includes qualitative
work to explore user, carer and provider perspectives on mental health services in Merton.
In
the recent past the following has been done to explore patient voice and perspectives:
Inform,
encourage, and support –
accessing physical health services
for those with severe mental illness (SMI) in Sutton and Merton, Resonant Media, November 2013 for Sutton
and Merton Public Health Teams
This research mapped the service provision
in Merton, and explored the weaknesses and opportunities. In addition the research explored the barriers,
which prevent people with SMI accessing physical health and health improvement services. These barriers
include both services related issues, and emotional and mental illness issues:
Service-related
issues
- Lack of understanding of mental health issues
- Surroundings
and systems are unwelcoming
- Lack of coordination between physical and mental health
services
- Lack of awareness of services among service users
- Health
promotion is not targeted for service users.
Psychological/mental
illness issues
- Fear and lack of motivation
- Need
for support/lack of confidence
- Maybe not right time/not focused.
Mental
health acute inpatient survey 2009: Key Facts
This was the first
survey of mental health acute inpatient services in NHS trusts in England. People were eligible for
the survey if they were aged 16-65, and had stayed on an acute ward or a psychiatric intensive care
unit for at least 48 hours. The final report shows how each trust scored for each question in the survey
in comparison with national benchmark results.
South
West London and St George's (SWLSTG) Mental Health NHS Trust Survey
The
averages of the scores for the key areas of experience were calculated, showing how the Trust’s score
compares with the threshold of lowest and highest scoring in 20% of NHS Trusts. It shows that for three
experience areas (hospital staff, your care and treatment and the overall rating), the Trust’s average
score was definitely within the lowest, scoring fifth out of the Trusts.
In
light of these results SWLSTG has developed a Patient Experience Improvement programme, incorporating
three key strands of work:
- The patient experience: how service users
and carers feel about the care they have received.
- Resources (including the workforce):
looking at training, new ways of working, skill mix and communications.
- The environment:
how to design new facilities, as well as look at the way existing ones are managed, to ensure that services
are being run in safe, therapeutic and sustainable environments.
The
Trust’s Quality Account for 2009-10 details two priorities to improve patient experience:
- reducing
reliance on bank and agency staff (service user feedback suggests that frequent use of such staff is
detrimental to the patient experience)
- reducing the number of transfers between wards
during an admission (service users report that the process of transferring between wards during an admission
is unsettling, unpleasant and detrimental to their experience).
Community
mental health services survey 2010
The 2010 survey included all service
users in contact with local NHS mental health services, including those who receive care under the Care
Programme Approach (CPA). The final report shows how each trust scored for each question in the survey
in comparison with national benchmark results.
Key
commissioning implications
Implications for services to support improved
mental health and wellbeing
As mentioned earlier, the Merton adult
mental health services review is currently underway and will help to inform future commissioning intentions.
The recommendations will be included in a refresh of the mental health section of the current JSNA when
it is ready and available.
With changes proposed
for commissioning in the NHS, as well as changes to Public Health, and the drive to provide care in
community settings, it is imperative that consideration is given to the overlap between commissioning
inpatient mental healthcare for people with dual diagnosis and support in the community. Further investigation
is recommended to identify the specific needs of this group of individuals to assess whether the balance
of admission and community support is appropriate and to understand which services care is accessed
through.
In terms of treatment services, commissioners should focus on developing
a whole system approach to mental health with more joined-up services to improve experience and outcomes.
They should also focus on developing better data and local information on outcomes, and on addressing
health inequalities in relation to mental health. There should be further investigation into why Merton
has higher rates of depression than London, in light of its wider good health, and a focus on improving
recovery rates following psychological therapies. Further work is also needed to understand access by
and for ethnic minorities. A health equity audit for mental health services would be useful to support
this.
Commissioners need to give consideration
to local data that has suggested a number of areas where mental health can reduce health costs and lead
to physical and mental health gains:
- High costs associated with unnecessary
and unplanned admissions amongst people with a range of LTCs could be reduced with motivational work
to support lifestyle change and psychological support to distinguish symptoms requiring medical attention
from symptoms of anxiety or depression.
- High numbers of young people and their families
presenting frequently and unnecessarily at A&E with asthma or minor injuries could be reduced with
assistance to manage anxiety and improve self-care.
- High-cost areas (mostly associated
with sheltered housing where the top 25% accounted for nearly half of cost) could be reduced with the
provision of support to staff and people living in sheltered accommodation and residential care to manage
difficult situations and distinguish symptoms requiring medical attention from symptoms of anxiety or
depression.
Recommendations from the insight
work by Resonant Media:
Resonant Media has developed recommendations
across three to address these barriers and improve the existing service provision. These will inform, encourage and support service users to
access physical health services.
Involving
the service users themselves in shaping and delivering services is key to all the recommendation areas.
This will build trust in the services and ensure that they are genuinely shaped for their needs.
GPs
Since
GP practices are so busy it can be difficult to engage with them and change their practice. The research
suggested initially developing a couple of best practice pilots. One or two selected GP surgeries would
act as pilot projects to implement improved services for those with SMI. Positive results from these
pilots, on outcomes such as do not attends (DNAs), could then be used to encourage other GP practices
to implement the improved services.
Further
training on working with those with mental health problems is also suggested for all who work in GP
practices. This should utilise existing training courses and times when the staff are already gathered
together.
System level
To
drive forward proper links locally between the physical health and mental health services, a senior
level champion needs to be identified. This champion could help with creating specific targets around
physical health for those with SMI. They would also lead on the future development of co-located services
and multidisciplinary teams.
The recommendations
address all four of the social marketing intervention modes – support; design; inform
and educate; and control – to try to increase levels of those with SMI accessing
physical health and health promotion services and thus reducing their health inequalities.
Implications
for services to reduce suicide
Commissioners need to give consideration
to the recommendations in the Department of Health’s National Suicide Prevention Strategy:
- prevention
targeted at high-risk groups e.g. those in recent contact with mental health services, those who have
self-harmed, young men and those in high-risk occupations
- reducing access to lethal
methods of self-harm, such as hanging and strangulation, in wards and prisons
- promoting
positive mental health and social inclusion, particularly among the vulnerable
- multi-faceted
strategies to prevent, identify and address behaviours linked to a high risk of suicide in school.