Coproduction of MH

Wellbeing, Recovery and

Employment Service Review

Meeting 3

3rd July

Agenda

• Intros 3:30

• Feedback from Employment Group 3:40

• Golden Thread: Stigma 3:50

• Pathway: Primary Care 4:00

• Pathway: Young People 4:30

• BREAK (have a look at mapping on slide 6) 4:40

• Service Review: Short term 1-1 4:50

2

Tower Hamlets Mental Health Employment Support Co-production group

Headline report to Mental Health Recovery and Wellbeing review

project group (two slides with notes page)

3 July 2018

3

Mental Health Employment Support Co-production group• Six to eight members with lived experience, same number of

managers

• Survey in July: 60 organisations offer some form of mental health employment support in Tower Hamlets

• Meetings to look into two possible improvements– Social enterprise (20 July)

– Personalised Care Programme (10 August) – applies to recovery generally and also physical health – do others wish to be part of this?

• Consider how everything fits together - large scale services (such as Workpath, Ingeus, DWP), local employment and community provision, and services specially targeted to mental health need

• Recommend the future (August and September)

4

Mapping

For comment

Age UK East London Paediatric Liaison Team

Alzheimer's Society Peabody, Sundial Centre

Bangladeshi Mental Health Forum Perinatal Service (Tower Hamlets)

Beside-TH Community Mental Health POSITIVE CARE LINK

Bethlam Green CMHT Pritchard's Road Day Centre

Bow & Poplar CMHT Psychological Therapies (Older People)

BowHaven Real

Breathing Space RESET Tower Hamlets Drug and Alcohol Service

British Red Cross Rethink Mental Illness

CAMHS Community Eating Disorder Service (East London) Salvation Army

CARERS CENTRE TOWER HAMLETS SANE

Child and Adolescent Mental Health Services (CAMHS) Social Prescribing (GP Care Group)

Child and Adolescent Mental Health Services (CAMHS) St. Hilda's East Community Centre

City and East London Bereavement Service Counselling for TH Step-forward

Clozapine Clinic Stepney and Wapping CMHT

CMHT for Older People  Thames Reach

Community Dementia Care Team  THCVS

Community Options The Tower Hamlets Centre For Mental Health

Community Recovery and Rehabilitation Team THEDS- Tower Hamlets Early Detection Service

Compass Wellbeing TOGETHER for Mental Health: Bow Probation Service

Contacting Providence Row Housing Association TOGETHER for Mental Health: Tower Hamlets Probation Service

Crisis Intervention Tower Hamlets African & Caribbean MH Organisation - THACMHO

Department of Psychological Medicine (Tower Hamlets) Tower Hamlets Education Business Partnership

Early Intervention Service (Tower Hamlets) Tower Hamlets Friends & Neighbours

Headway East London Tower Hamlets Recovery College

Healthwatch Tower Hamlets Vietnamese Mental Health Services (VMHS)

Home Treatment Team (Tower Hamlets) Volunteer Centre Tower Hamlets

Housing Link Womans Trust

Inspire Mental Health Consortium Workingwell Trust

Involvment & Co-Production Service Queen Mary University- Advice and Counselling Service

Isle of Dogs CMHT MIND in Tower Hamlets & Newham Mental Health Support Service

Look Ahead NSPCC Tower Hamlets

6

Area of Focus

Stigma

Stigma

• What does it mean to me?

• What works?

• How can we change our model to make a difference?

Self stigma is where individuals with mental illness feel they are being judged by

others, so they feel disgraced, blame and isolate themselves from people. It is one of

the most harmful effects of stigma. Self stigma occurs when it alters how the person

views himself/herself. The person living with mental illness may mistakenly believe

that his/her condition is a sign of personal weakness or that s/he should be able to

control it.

Enacted stigma/Discrimination – this is where there is discrimination against

individuals living with mental illness or people who have some of the condition or

disease in their community.

Felt stigma– the perception or feeling one has towards people with same specific

disease or condition which they also have.

Types of Stigma

3 approaches to combatting stigma

• Education - challenge inaccurate stereotypes about mental illnesses, replacing them with factual information.

• Contact - interpersonal contact with members of the stigmatised group. Individuals of the general population who meet and interact with people with mental illnesses are likely to lessen their levels of prejudice.

• Protest strategies highlight the injustices of various forms of stigma and chastise offenders for their stereotypes and discrimination.

Part of the Pathway: Primary Care

What do we know? Numbers…

Primary Care

50,005 people known to the GP as having Depression, Anxiety or Serious Mental Illness

4,420 people on the Serious Mental Illness Register

700 people in Enhanced Primary Care

Secondary Care

1,767 people known to Secondary Care

Crisis

171 patients in acute care and 44 on PICU

82 new admissions in March

How are we doing working with Primary Care?

Self -Drop in

Self -Telephon

e

Self -Email/We

bsiteGP CMHT

Socialprescribe

r

Psychological

therapiesservices

Enhanced primary

care

LookAhead

CompassWellbein

gHOST

Bowhaven

WorkingWell Hub

MiTHNFamily/Friend/Rela

tive

OtherServiceProvider- please

statebelow

Series5 49 118 11 10 25 10 5 15 20 4 8 1 1 9 9 15

15.8%

38%

3.5% 3.2%

8%

3.2%1.6%

4.8%6.4%

1.2% 2.5%0.3% 0.3%

2.9% 2.9%4.8%

0

20

40

60

80

100

120

140

Referral source

NB other = referrals from social workers probation service, Providence Row & Bromley by Bow Centre.

Self-referral breakdown:

39

30

22

16

16

12

9

8

6

6

3

2

2

2

1

1

1

1

1

0 5 10 15 20 25 30 35 40 45

Left blank

Mind

GP

Psychological therapies (welcome group)

CMHT

From a friend

Old service user

Old referral form used

Job Centre

Website

Community centre

Walk in centre

Working Well Trust

Deancross

Prison

A&E

Advocacy

Home Treatment Team

Beside

What support would we like for the 50,000

people with mental health problems in primary

care

1. What is working now?

2. What isn’t working? What is our main challenge?

3. What our ideas?

4. What would our outcomes be?

5. How would we know they are happening?

Pathway

Young People

What do we need to improve?

1.7%

6.3%

27.7%

24.2%

29.4%

10.7%

4.1% 4.4%

15.1%

26.1%

47.6%

2.3%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Other 00_19 20_24 25_34 35_44 45_64 65+

Pro

po

rtio

n o

f S

erv

ice

Use

rs

Age Band

TH GP- Registered Mental Health Flagged Population against Inspire Users in 2017/18, by Age Distribution

Tower Hamlets Inspire Users

Area of Service Review

Short-term 1:1 support

Tasks

1. Reflect on the aims – do they capture what support we

want for people in primary care? Are we measuring the

right thing?

2. What works well about the current model?

3. What improvements can we make to the current

model?

4. What do you think about the social prescribing model?

5. What can we learn from the social prescribing model

and how could we use it in our model?

Short-term Support - Aims

1. Increase number of people self-caring following period of enablement through the short term support service

2. People achieve economic wellbeing - ensuring people’s income is maximised, debts are managed and where appropriate applicable welfare benefits are accessed

3. People are appropriately supported to manage their recovery according to their own goals whether this means brief intervention or longer term support.

4. A high degree of user satisfaction is achieved throughout service delivery regardless of whether a brief intervention

Current Model

• Delivery Location –Whitehorse Lane

• % provision delivered onsite

• Opening hours – currently 9-5

• Tasks include phone line

Activity

1. Increase number of people self-caring following period of

enablement through the short term support service

Recovery star domain Number of clients

Managing mental health 68/100%

Social networks 39/56%

Responsibilities 28/40%

Living skills 25/36%

Self care/physical health 25/36%

Trust & hope 7/10%

Work 6/9%

Relationships 6/9%

Identity & self esteem 6/9%

Addictive behaviour 5/7%

Q2 Q3 Q4

Number of people

receiving FPA

support

60 68 68

Number of people

WEMWBS

completed

13

22%

12

18%

36

52%

% Improvement in

wellbeing

92% 75% 86%

Number of

Recovery Stars

completed

16

26%

10

14%

30

44%

% Improvement in

wellbeing

87% 100% 76%

2. People achieve economic wellbeing - ensuring people’s income is maximised, debts

are managed and where appropriate applicable welfare benefits are accessed

Service Outcomes

Measure Achievement

1. percentage of service users

receiving the benefit applied

for per quarter

97% of clients who have had a decision

have been awarded, or had their benefit

reinstated.

2. Income – money paid to

service users. Appeals,

Reviews and Benefits’

applications completed.

23000.00 is the amount of granted benefits

to the clients.

3. Advice for Benefits,

Housing issues, Debts,

Benefits (Severe Disability

Premium, Backdating

Payments, Freedom Passes,

Blue Badges etc).

Awarded the ESA and the HB/CTR for 41

clients regarding their Medical

Questionnaires ESA50 and awarded the UC

benefit including the housing costs to 7

clients. Awarded 2 Freedom Passes, 2 Blue

Badges, and 1 parking permit.

4. percentage of Exit interview

/ feedback at close of 1:1 work

giving positive feedback per

quarter

99.9% of client’s state their satisfaction for

the welfare advice work on their behalf.

3. People are appropriately supported to manage their

recovery according to their own goals whether this means

brief intervention or longer term support.

• Out of 29 surveys completes in Q4 2017/18 the service has enabled:

4 A high degree of user satisfaction is achieved throughout

service delivery regardless of whether a brief intervention

Target Q1 Q2 Q3 Q4End of service surveys completed 50% of people

receiving 1:1

support

43 24

40%

28

41%

29

42%

% of people whose wellbeing has

improved due to the service

97% 100% 92% 100%

% of people that would

recommend the service to other

97% 95% 96% 100%

Opportunities

Alternative Models

Social Prescribing

How does Social Prescribing work?

• Referral to a link worker by anyone working within primary

care. You can also self-refer

• The link worker will meet with you or speak by phone and

set a number of goals with you based on your priorities

• Based on what you agree, they’ll find you support

available from a wide range of places

• They can also help you to access it

28

Who can and can’t access it?

• Currently, anyone with low level mental ill-health such as

anxiety or low-moderate depression, or patients with a

long term condition

• At the moment, there are the following exclusions:

– Serious mental ill health

– People with a learning disability

– People with multiple long term conditions

29

Case study 1:

The client had a range of emotional, physical and practical needs that had

arisen following her separation from her husband. She had be referred to DV

services and had a solicitor in place but was unsure of the roles of professionals

and how to connect with them as she was having no luck calling them to

arrange for appointments. She has ongoing physical pain that makes shopping

and carrying things difficult. She was clear that the majority of her time was

taken up with managing practical concerns e.g. the transfer of her benefits and

property into her name, managing arrears in NHS prescriptions and council tax

from the period prior to transfer into her name and managing the paperwork

demanded by other agencies.

30

What did the link worker do?

• Contacted solicitor to transfer tenancy

• Supported in decision to advice divorce proceedings and

connected to specialist agency

• Chased up IRIS (DV agency)

• Helped resolve council tax issue

• Addressed prescription fine & sorted child tax credits

31

Case Study 2

Patient was kicked out from his family home by his father

due to his sexual orientation and other family issues. Patient

currently is homeless and sleeps in his friend’s garage, he

complains the situation is very poor and needs help.

Patient has no access to basic daily living needs such as

food, drinks, money, decent place to sleep (warm & clean) is

socially isolated from friends & family.

32

What did the link worker do?

• Met for 3 face to face and 5 telephone appointments

• Helped get patient into local shelter

• Signposted and supported to access welfare and benefits

advice services

• Signposted and supported to access local mission which

helped with basic needs (food, drink, shower, clothes)

• Supported to access temporary accommodation

33

Coproduction 3

Notes

34

Golden Thread: Stigma

What does stigma mean to me?

• Shame, embarrassment, fear of disclosing mental health to employers, discrimination, mis- representation, making unfair judgements

• Stigma leads to prejudice which leads to discrimination

• People avoid difficult conversations which results in people becoming more reluctant to seek help

• Lack of awareness

• Stigma encourages people to be dishonest

What works?

• Positive campaigning

• Profile of mental health being raised (although it takes a while to filter down to daily life

• Approaching relationships in good faith

• Holistic view

What needs to change?

• People to have more of a choice

• Variety within services

• Removal of geographical boundaries – access to cross borough

• Communities and structure need to change

• Schools and curriculum – educate from a young age

• Model that is responsive and can change over time

• How do we make services more accessible?

• Do services understand your needs?

Discussion of Ideas

• Recovery college does work to educate people

• Having interventions based in the community and with the community would

contribute to: “interpersonal contact with members of the stigmatized group.

Individuals of the general population who meet and interact with people with

mental illnesses are likely to lessen their levels of prejudice.”

• Discussion around the ceramics idea for service users and the general public

at Pritchards Road as a good example

• Events to celebrate World Mental Health Day etc

Primary Care

Barriers to GP referrals:

• -GP’s have limited scope and time

• -Overload of information

• -Making a meaningful difference to peoples lives

How do we overcome barriers:

• -Outreach programme

• -Information stalls at surgeries

• -Increased presence at community gatherings and team meetings

• -Can GP’s start a conversation about MH services during a general check up

• Basing support workers within GP networks

What support would we like from the 50,000 people with mental health problems in primary care?• Pathways data base

• Social prescribing

• What’s available to help people to start a conversation

• Skilling health care professionals to do more

• Mental health champions in each GP Practice

• Work with patient groups

• Publicity – getting to the right people

• Patients own stigma

• Focus on physical health rather than mental health –there should be a holistic view

• How are people speaking to GPs about their needs are they referring else where? Ie IAPT?

• Do GPs get paid for MH Referrals?

• GP Training – GPs are not psychologists – more likely to talk about MH If it’s a passion/interest area

• Triage system

Short Term support

• Concerns about high numbers of people ‘lost’ after referral

• People who do access it have good experience

• High level of need for more work around ensuring people’s income is maximised, debts are managed and where appropriate applicable welfare benefits are accessed –high waiting list – service is famous in borough and valued by CMHTs and people who access it

• Opening times

• Good at improving confidence

and coping strategies

(internal) but could focus more

on connector role or practical

role

Social Prescribing

Good relationship with GPs –mainly because based within practices

Period of support offered too short for complex needs

Unable to accompany on visits in the community

30% of their times spent understanding the community offer