BME Mental Health 14 November 2018
NHS Croydon CCG Paulette Lewis Lay Member for Public and Patient Involvement • Introduction • Croydon: Population Challenges & Our Vision for Mental Health
Who is Croydon? 94,434 0-17 year olds 237,663 18-64 year olds 50,206 Aged 65+ Croydon has one of the largest populations of all the London Boroughs
Croydon’s Diversity – a reminder • A large, diverse and growing population o It will grow 12% in next 15 years • The largest London borough Around 380,000 residents – half of which are BAME o • More than 100 languages spoken o From Albanian to Yoruba • Croydon has 6,000-7,000 new immigrants from outside the UK per year o But 3,000 people emigrated from Croydon • High rates of isolation • Croydon is 19th most deprived borough in London – on current trends deprivation will increase • Risk factors for ill-health (mental & physical) is linked to deprivation
Mental ill-health increases risk of other illness/risky behaviour
Mental Health Priorities & Croydon’s Diverse Communities In July we spoke about our plans to develop mental health services that helped people to: • live longer, healthier lives • to make their own choices • enjoy high quality outcomes • access services before crises happened In addition we wanted services that addressed specific gaps, were responsive to community needs & were culturally appropriate. The next presentation will tell you what we have been doing … 6
NHS Croydon CCG Marlon Brown Head of Mental Health Commissioning A new way to deliver Mental Health services
Current System: The ‘As Is’ Pathway Map • In May- 18, we developed ‘As Is’ pathway to take stock of the current Mental Health offer, identifying issues, gaps and potential solutions 8
Problems with current model • Barriers for patients travelling between the green, yellow & red silos • Lack of joined-up approaches within the silos • High A&E attendance • Physical health problems for those with undiagnosed severe mental illness • GPs unable/unwilling to accept stable people with severe mental illness o This results in people spending too long in secondary care o It places more pressure on the Trust and creates longer waiting times • The voluntary sector lacks capacity to help • People suitable for primary care not discharged because lack of community resources • Impact on wider determinants on mental health 9
New System: ‘As Will Be’ Pathway Map
Aims of the new system • To create a single point of entry to the mental health ‘system’, via a cross - agency ‘front door’ approach • To give equal weight to the social, physical and mental health needs as defined by the service user, carer and their GP • To create a diverse range of timely, accessible services that support recovery, resilience and instil hope • To reduce mental health crisis escalations and reliance on urgent care, in so doing. • To provide a proactive, valued resource for its members that encourages them to use the service proactively, supporting their self-efficacy to manage their continued recovery and avoid crises • To integrate service delivery across existing providers and General Practice, including a single assessment, care plan and care record with EMIS at its heart • To co-locate and deliver services across a number of community-based ‘Hubs’ and spokes, to ensure maximum accessibility and joint working with existing community groups.
High Level Description of Integrated Mental Health & Well-Being ‘ Building Blocks ’ Provider Assessment, Clinical Case Management, GP Liaison/Advice Line. TBC Psychiatrists and CPNs/SWs/OTs. The single MDT ‘ way in ’ to access all primary and secondary MH services. Rapid triage, assessment, formulation and care planning/treatment entry (directly to secondary care if indicated). Key offer: case management & brief intervention (up to 6 sessions) & advice line/liaison for GPs. Navigators TBC Team of expert health and social care navigators to work alongside the clinical team within the MDT approach. Coordinates and supports delivery of social elements of care and support (housing, debt, welfare, employment, training, CAB etc). Typically 2-3 contacts max. Employment Support TBC Expert service to support people to keep jobs, re-join the workforce, train or volunteer. Provides 121 mentoring and workplace support, help with applications, CVs, interview support, group training. Coordinates link to wider employment initiatives across the Borough in pursuit of ‘ no wrong front door ’ approach. Psychological Therapies TBC Direct access to Step 2, 3 and 4 psychology from Primary Care and the Hub. Using a reciprocal ‘ hub and spoke ’ approach, existing services delivered in Hubs and other community settings, including larger GP Practices. Promotes access to ‘ IAPT ’ services via better community integration and targeting of 65+ and key LTC groups. Peer Support TBC Centrally located development workers who will provide a range of peer support activities including time- banking, mentoring programmes, skills-swaps, befriending, a volunteer pool, and coordination of activities. Self Help/Self Care TBC Literature, group-based (guided) and on-line self-help to support and maintain recovery and well-being. A range of coordinated self-care activities such as gym/swimming club membership/passes and also massage, acupuncture, mindfulness meditation to be made available at Hubs and existing community settings. Connected: Social Activities TBC Coordination and promotion of a range of supportive activities that reduce social isolation and support mental health and well-being through participation, creativity, achievement and ‘ belonging ’ (e.g. yoga, gardening, walks, social and community events such as theatre, arts trails, etc). Web-based platform for booking. GP Enhanced Care TBC A new GP specification will be the bedrock of a proactive/preventive population-based approach. An annual ‘ Well-Being & Recovery ’ Review and Plan (Bio-Psycho-Social) for all those with long-term complex mental health needs (SMI + Complex Non-psychotic needs). Extended appointment times up to 3 x 30 minutes.
Social Prescribing Brian Dickens Croydon Social Prescribing Community Engagement Team
Where are we: The Journey July 2017 – 1 Practice July 2018 – 42 Practices Why? How? Impact?
Community Engagement Why • Practices have increasing and unmanageable patient lists • Increasing complexity of medical care provided by GP’s • 20% of GP consultations do not require clinical intervention • Currently practices have a few patients taking up 90% of practice time • Those who need to engage do not attend or manage their own health • Shortage of GPs fuelled in part by pressures of workload • Reducing available NHS Budget • Need to change patient and community behaviour around health self management for more effective use of resources
Community Engagement Why • We are in the thick of it • Majority of our area and some patients are in either from 5%-10% most deprived in the country of 10%-20% • We deal with a cohort that includes health issues such as 2 in 3 adults, roughly 181,000 Croydon are obese / overweight • Half the number of women giving birth are overweight / obese / morbidly obese and 5% of these are diabetic • 23% of children live in poverty • 58% of females and 43% males are not physically active • Life expectancy is 9.1 years lower for men and 7.7 for women than the national average Social Prescribing
Community Engagement LOCAL SOCIAL ISSUES • Social Isolation • Financial / Debt advice • Health and Exercise / Health management • Diet • Mental Health issues • Community Safety / Mentoring • Unemployment Rate – Highest in London • Community Cohesion / integration Social Prescribing
Community Engagement • Need to look at long-term behavioural change • Change Patient Dependency • Capacity Build the local provider • Develop patient self referral to more community structures • Develop more holistic community interventions • Multi Agency- Multi disciplinary Approach • Community Hubs / led by the community / for the community / owned by the community / SUSTAINABLE • One stop shops for community development / health interventions Social Prescribing
Community Engagement How • All of this has been achieved • Small Dedicated community based team • A Partnership approach • Development of relationships with GP practice’s • Small Localized Funding – and Community Support • No NHS Support or Funding • Because • No Barriers • No Delays • No Red Tape • This was always about Doing! Not Waiting!
Partnerships - Opportunities • • Croydon Council Croydon Voluntary Action • • Local MP Croydon BME Forum • • Local Councillors Various Local Churches and • Croydon Commissioning Group Community organisations • • GP Practices We have delivered partnerships • Christians Against Poverty that includes support from • • Nike / Brand Jordan: Practical Statutory Sector / Public Sector / partners in positive change Third Sector and the Commercial • Apple Sector • NHS – National Team • This is the route to sustainability • Best Start and long term impact • Crystal Palace Foundation Social Prescribing
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