03.06.16
Collaboration key to improving frontline mental health services
Source: NHE May/Jun 16
James Cook, director at Grant Thornton, looks at how greater collaboration between public sector partners can deliver efficiencies and improvements in mental health services.
One in four adults experience at least one diagnosable mental health problem in any given year. Yet despite its severity and prevalence, there is still a lack of understanding about mental illness and a stigma associated with it. Responding to an underlying mental illness does not solely sit within the remit of health professionals. Many parts of the public sector need to respond and with each of them facing significant financial pressures, collaboration around this issue is essential if savings are to be found and the best care provided for the individual.
Gaining access to mental health services when they are needed can often be a challenge due to waiting lists and referral times. While this is in part due to demand on services, in some cases it is because responsibility for commissioning and providing services is fragmented.
The unpredictable nature of mental health symptoms can also mean that the first point of contact is via emergency services, with fire and rescue or police officers being present. As a result, the cost of services not being available at the right place and at the right time can be huge, in terms of the personal suffering of individuals and costs to the wider system. More broadly, people with mental health issues are also much less likely to have a job and stable housing and their life expectancy is lower. This has an impact on different parts of the public sector, including the criminal justice system, housing associations and the benefits services.
Funding disparity
Current funding for mental health still remains far behind that for physical health and both sectors are facing significant financial pressures, while demand for services increases. Furthermore, the cost of emergency hospital admissions takes first priority on the existing health budgets. These are already fully stretched, leaving limited funds available for investment in mental health prevention and treatment.
Collaboration across the wider public services – police, ambulance, fire, local authorities, NHS commissioners and providers, and the voluntary sector – is seen as a key way of focusing on prevention and early interventions. This can be effective in stopping mental health related issues escalating and can significantly improve the wellbeing and recovery of individuals. As such, it has to be far better than an emergency response when a vulnerable person has reached crisis point.
Case studies
Examples of mental health collaboration already exist across the UK in various public sector entities. Street triage teams, also known as crisis groups, are a particularly good example of positive outcomes from collaboration. These comprise mental health workers, ambulance and police working together as one team to prioritise response to mental health related crises and can be done without the need for expensive structural change.
Birmingham and Solihull Mental Health NHS FT has been involved in some of the best examples of partnership working between health, ambulance and police in the country. The effectiveness of their triage service, where they work in conjunction with West Midlands Police and ambulance service, is a great example of the effectiveness of collaboration. Mental health nurses, paramedics and police officers now respond to 999 calls together, where mental health support is needed. These interventions resulted in a 50% reduction in detentions under section 136 (s136) of the Mental Health Act between January 2015 and November 2015.
Similarly, Cheshire and Wirral Partnership NHS FT and Cheshire Police have come together to provide mental health support to relevant police call outs, which has led to a massive 92% reduction in s136 detentions, and they were honoured at the North West Coast Research and Innovation Awards 2015.
Many services are also collaborating to tackle the issues of early interventions in mental health, for example, by setting up cafes, crisis centres and drop-in centres for young sufferers. Early intervention is a crucial element in improving outcomes for people with mental health problems.
Derbyshire Healthcare NHS FT provides the Derbyshire Early Intervention Service aimed at 14-35 year olds experiencing psychosis for the first time. Individuals are assigned a case manager who can offer a range of interventions and the team remains involved for three years, monitoring and supporting recovery to try and reduce further episodes. Engagement with this model is proven to promote recovery, with 80% remissions of symptoms within six months.
The use of crisis centres and cafes also aims to reduce the amount of 999 emergency call outs and provide more appropriate care. There are already a good number of these working nationally, many of which are dependent upon collaborative working and funding from a cross sector of organisations including NHS trusts, GPs, CCGs, local authorities and the voluntary sector. Crisis point is an open-access mental health crisis centre run by social enterprise Turning Point, in Manchester. Approximately 70% of its service users would normally require an acute hospital admission and the centre offers bespoke support to resolve crises and prevent future ones.
Important fire service role
Although considered by many to be an emergency service that responds to 999 calls, the fire service has a very different response model to police and ambulance services. With the demand for dealing with emergency fire and rescue situations falling, fire services have started to play an important role in helping to tackle mental health issues in a number of ways. For example, there is now widespread recognition of the strong link between house fires and mental health issues, such as dementia and alcohol abuse.
Kent Fire and Rescue Services has emerged as the UK fire and rescue leader on dementia, offering an online training programme to all its 1,665 fire officers and support staff. This training allows them to identify people with the condition and tailor their fire safety support to them and, where appropriate, ensure they receive the necessary help from the NHS.
By adopting a different approach, setting traditional organisational boundaries to one side and putting themselves in the position of the patient, these successful collaborations have produced much better outcomes without requiring much in the way of funding or resources to drive their innovative ideas. Indeed, many of these key collaborative initiatives have avoided much larger costs being incurred by the individuals and the wider public as well as the police and criminal justice system.
There are still significant obstacles to more widespread collaboration and innovation. Increased sharing of information between public services to ensure the correct support can be provided for the patient is a top priority. There also needs to be greater recognition that different areas require different solutions; there is no one-size-fits-all solution. Better engagement between commissioners and providers to work together and draw on human and financial resources to help improve outcomes is also required.
However, there is increasing determination to overcome these barriers and the successes so far reinforce how, if frontline mental health services are to be improved, it is essential that collaboration takes place across all the wider public services.
Increased sharing of information between public services to ensure the correct support can be provided for the patient is a top priority
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