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Adult mental health - Merton voice and commissioning

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.