Devon Mental Health Strategic Framework Workshop 1 · CarnallFarrar | 3 Aims of today’s workshop...

Carnall Farrar|1

DevonMentalHealthStrategicFrameworkWorkshop1

16January2017

Carnall Farrar|2

Agenda

Welcomeandintroductions

UnderstandingwherewearenowReviewingthedata

StoriesfromacrossDevon:innovationunderway

Groupexercise:identifyingopportunities

Purposeanddevelopmentofthestrategicframework

MelanieWalker

BenRichardson

DerekOTooleDaveMcAuley

MichelleThomas

All

BenRichardson

14:00– 14:05

14:20– 14:50

15:30- 16:00

16:00- 16:50

14:05– 14:20

Gallerywalk All 14:50– 15:30

Nextsteps,wrapupandclose MelanieWalker 16:50– 16:00

Carnall Farrar|3

Aimsoftoday’sworkshop

1. Todevelopasharedunderstandingofthepurposeoftheworkunderwaytocreate astrategicframeworkformentalhealthinDevon

2. ToestablishasharedunderstandofthewidercontextoftheSTP

3. Toidentifyandagreeonasetofopportunitiestotakeforwardforassessmentofthepotentialimpact

Carnall Farrar|4

Output:strategicframeworkto

informdevelopmentoffullmentalhealthstrategyaspartof

DevonSTP

Developingthementalhealthstrategicframework:summarymethodology

1.Establishcaseforchange

2.Understandfuture

requirements

3.Identifyopportunities

4.Developforwardplan

Targetedanalyses

Baselinedatareview

Interviews

Serviceusersurvey

Projecteddemandgrowth

Requirementsemerging

fromcaseforchange

5YFVrequirements

Improvehealthandwellbeing

Integratedphysicalhealthandmentalhealthcare

3

Meet5YFVrequirements

Providerproductivity

Consistentpathways

Commissioningandinformation

2

4

5

6

1

Outlinerequirementsinkeyareas:• Resourcing• Governance• Information• Paymentmodels

Primarycare

NHSEnglandspecialised

commissioning

CAMHS

Progressfurtherworkonspecificareasasrequired,

including:

Carnall Farrar|5

Agenda






MelanieWalker

BenRichardson


MichelleThomas

All

BenRichardson

14:00– 14:05

14:20– 14:50

15:30- 16:00

16:00- 16:50

14:05– 14:20



Carnall Farrar|6

Backgroundcontext:theDevonSTP• TheDevonSustainabilityandTransformationPlan(STP)isafiveyearplantodeliverbettercare,withthetripleaimofimproving:– Populationhealthandwellbeing– Experienceofcare– Costeffectivenessperheadofpopulation

CoreprioritiesfortheSTP

• Deliveringtransformationalpreventionmodel

• Buildingcommunityresilience• Addressingplacebasedhealth• Developingapreventiveworkforce

• Reviewingstrokeservices(Nov2016-Feb2017)

• ReviewingUrgentandEmergencyCare(Jan– March2017);Maternity/Paediatrics/Neonatal(Nov2016- March2017)

• Reviewingsmallandvulnerablespecialties

• ImplementingCarterreport• Backofficerationalisation• Prescribingcontrol• Procurement• CHCspendingreview• Equitablepopulationandserviceresourceallocation

• Designingofintegratedlocalcare

• Implementingintegratedlocalcare

• Reducinghospitalbednumbers• Advancinghealthandsocialcareintegration

• Maximisingtheeffectivenessofmentalhealthspend

• Improvingpreventioninprimarycare

• ImprovingprovisionforpeoplewithSEMIandthosewithadualdiagnosis

• Developingintegratedprimarycare

• DeliveringtheGPforwardview• Supportinggeneralpractice

Organisational Development• Progressingtowardsdelegated

commissioning

Caremodelintegration Mentalhealth&learningdisabilities

Acutehospital&specialistservices Productivity

Prevention&earlyintervention Primarycare

• Ensuringaccessandsuitability• Ensuringhighquality,effectivenessandrapidresponseofservices

• Enhancingeffectivecollaborationbetweenadultandchildrens’services

Childrenandyoungpeople

• Workforcestability,redesign,anddevelopment

• EstatesStrategy• DigitalRoadMap• Communicationsand

engagement• OrganisationalDevelopment

Enablers

1 2 3 4

5 6 7

Carnall Farrar|7

Financialcontext

• TheDevonSTPfootprintfacesa£588mfinancialgapin2020/21• CurrentspendonmentalhealthinNEWDevonisc.£120mandinSouth

DevonandTorbay isc.£34m• EarlierworkfortheSuccessRegimeconcludedthatNEWDevonspending

wasbelowpeersandwouldneedtoriseby£10mtomatchpeers• SeparatelyithasbeensuggestedthatmeetingthecommitmentsintheFive

YearForwardViewwilltake£10m• Thereisacommitmenttoparityofesteemforfundingofmentalhealth

goingforwards• Akeyoutcomeofthisworkwillbetoidentifythefinancialneedsformental

healthwithinDevon

Source:NEWDevonCCGandSouthDevonandTorbayCCGfinancialreturns2015/16;CCGlistpopulation;CarnallFarraranalysis16th SeptemberDevonSTPfinancialtemplatesubmission

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• Improvedaccesstohigh-qualitycare,moreintegratedservicesandearlierinterventions

• Buildingcapacitywithincommunity-basedservicestoreducedemandforin-patientbeds

• Movingthecommissioningmodeltowardsamore‘place-based’approach

• Allareasrequiredtodelivertheactionswithintheimplementationplan,includingspecificimprovementsfor:

– Childrenandyoungpeople’smentalhealth e.g.atleast35%childrenwithadiagnosableconditionareabletoaccessservices

– Perinatalmentalhealthe.g.increasedaccesstospecialistperinatalmentalhealthsupporttoreceiveevidencebasedtreatment

– Adultmentalhealthe.g.allareaswillprovidecrisisresolutionandhometreatmentteamsdeliveringa24/7service

TheFiveYearForwardViewformentalhealth

SOURCE:NHSEnglandMentalHealthTaskforcehttps://www.england.nhs.uk/mentalhealth/taskforce/

• 1in4adultsexperiencesatleast1 diagnosablementalhealthprobleminanygivenyear

• 1in10childrenagedhasadiagnosableMHproblemyetmostchildrenandyoungpeoplegetnosupport

• 1 in5motherssuffersfromdepression,anxietyorinsomecasespsychosisduringpregnancyorinthefirstyearafterchildbirthyetmorethan40%oflocalareasprovidenoperinatalservice

• Peoplewithsevereandprolongedmentalillnessareatriskofdyingonaverage15- 20yearsearlier

• Suicideisrising,aftermanyyearsofdecline.• Bedoccupancyhasrisento94%.Peopleare

beingtransferredlongdistancesoutsideoftheirarea

• Mentalhealthaccountsfor23%ofNHSactivitybutNHSspendingonsecondarymentalhealthservicesisequivalenttojusthalfofthis

• Poormentalhealthcarriesaneconomicandsocialcostof£105billionayearinEngland

Caseforchange FiveYearForwardView(FYFV)

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Introductiontothestrategicframework• TheDevonmentalhealthstrategicframeworkwillsetoutasetofprioritiesthathave

beenquantified inimpacttheywillhave• Itwillguidethedevelopmentofmoredetailedactionplanninganddeliveryoverthe

next3-5yearswithinthecontextoftheSTP• Thisstrategicframeworkwillinclude:

- ThecurrentpositionformentalhealthacrossDevon,consideringtheneedsofthepopulation,currentoutcomes,qualityofserviceprovisionandspend

- Thekeyissuesandchallenges withregardstomentalhealthfacedbytheDevonfootprint

- Theforecastfuturedemandforservices,takingintoaccountdemographicandnon-demographicgrowthandtherequirementsoftheFiveYearForwardView(FYFV)formentalhealth

- Asmallnumberofopportunityareas,quantifiedatahigh-level- Aforwardplanfordeliveringontheopportunitiesandtherequirementsofthe

FYFV• ThefocusofthisworkisoncoreCCGspendonmentalhealthservices.Inthefuturewe

wouldseektobringinscopeallotherareasaffectingprimarycare,learningdisability,drugandalcohol,continuinghealthcare,adultsocialcareandmentalhealth(includingspecialisedservicescommissionedbyNHSEngland)

Carnall Farrar|10

Who’sinvolved

NHScommissioners

NHSproviders

Localauthorities,incl publichealth

Peoplewithlivedexperience

Widerstakeholders

• DevonPartnershipNHSTrust• LiveWell• VirginCare• TorbayandSouthDevonNHSFoundationTrust

• DevonCountyCouncil• PlymouthCityCouncil• TorbayCouncil

• Thecommunityandvoluntarysector• Housing• Employment• Academics/researchers

• NEWDevonCCG• SouthDevonandTorbayCCG

• Peoplewhouseorhaveusedmentalhealthservices• Carers

Carnall Farrar|11

Output:strategicframeworkto

informdevelopmentoffullmentalhealthstrategyaspartof

DevonSTP

Developingthementalhealthstrategicframework:summarymethodology

1.Establishcaseforchange

2.Understandfuture

requirements

3.Identifyopportunities

4.Developforwardplan

Targetedanalyses

Baselinedatareview

Interviews

Serviceusersurvey

Projecteddemandgrowth

Requirementsemerging

fromcaseforchange

5YFVrequirements

Improvehealthandwellbeing


3



Consistentpathways

Commissioningandinformation

2

4

5

6

1

Outlinerequirementsinkeyareas:• Resourcing• Governance• Information• Paymentmodels

Primarycare

NHSEnglandspecialised

commissioning

CAMHS

Progressfurtherworkonspecificareasasrequired,

including:

Carnall Farrar|12

Nov Dec Jan Feb Mar

Developingthestrategicframework:timescales

Gatherdata

Understandbaselineserviceprovision

ExploreMHpopulationandcarepackagestoday

Developopportunityareas

Developforwardplan=workshop

Key

3

2

1

0

4

ReviewofStrategicFrameworkatSTPChief

Executive’smeeting

Carnall Farrar|13

Agenda






MelanieWalker

BenRichardson


MichelleThomas

All

BenRichardson

14:00– 14:05

14:20– 14:50

15:30- 16:00

16:00- 16:50

14:05– 14:20



Carnall Farrar|14

• 26systemleadersfromacrossSouthDevon&Torbay CCG,NEWDevonCCG,DevonPartnershipTrust,Livewell Southwest,PlymouthCityCouncil,DevonCountyCouncil,VirginCareandtheDevonSTPtookpartina30minuteinterview

• 233responsesfrompeoplewithlivedexperience/carerswerecollectedbyanonlinesurvey

• Theaimsoftheinterviewandsurveywereto:- understandperspectivesandinsightsintothecurrentissuesaround

mentalhealthinDevon- exploretheopportunitiesandchallenges- shareopinionaboutcurrentservicesandknowledgeaboutbest

practiceelsewhere

Weinterviewedstakeholdersacrossthesystemtogetaninitialunderstandingofthekeyopportunitiesandchallenges

Carnall Farrar|15

WhatdoyoufeelarethemostimportantissuesaffectingmentalhealthcareinyourareaandacrossDevon?

• Lackofparityofesteem• Currentmodelistoomedicalised,andreactiveratherthanpreventative

• Issueswithprimarycare(GPs):lackofcapacity,potentialinappropriatereferrals

• Servicesarefragmented• Lackofacoherent,joinedupstrategy• Changingpopulationandincreasingdemand,particularlyforCAMHSservices

• Recruitmentandretentionissues• Lotsofoutofareaplacements• Challengesaheadinimplementingaspectsofthe5YFV• Lackoftimelyaccesstoinformation• LackofawarenessandunderstandinginMentalHealthacrosswiderhealthprofessionals

Wearelackingastrategictransformationprogrammetofocusonthetotalityofthementalhealthmodelin

Devonanditslongertermsustainability

Mentalhealthisnotintegratedtootherrelatedservices.Withinmentalhealthitself

thereisfragmentationandlackofverticalintegration

Carnall Farrar|16

Whatarethebiggestproblemsorroadblocks?

• Lackofintegration• Absenceofstrategicleadership• Inadequateattentiontomentalhealth• Poordatamanagementaffectsperformancemonitoring

• Currentfundinglevelisnotenoughtoimprovehealthoutcomes

• Insufficientstaffingandcapacitytomaintainservicessustainability

• Ruralareawithcentralisedservices• Genericserviceswithinsufficientflexibility

• Transitionbetweenchildren’sandadults’services:lackofownership/accountability

ThereisalackofjointworkingbothacrosscouncilsandwithCCGS,and

betweenCCGsandproviders.PlymouthisagoodexamplewheretheCCGandCouncilhavepooledtheirhealthandsocialcarefundingandcommission

servicestogether

Weneedclearanddecisiveleadership,embeddedinsystemstomakesure

changehappens

AclearMentalHealthstrategyisneeded,takingphysicalhealthservicesinto

account

Carnall Farrar|17

Whatdoyouthinkarebigopportunitiesforimprovingmentalhealthcarethatcanbecapturedinthecomingyears?

• Embeddingpreventionandearlyinterventiontoensurepeoplereceivecarebeforetheygetsick

• Treatingpeopleholistically:assessingandtreatingboththeirmentalandphysicalhealthneeds

• Streamliningpathwaystoensurepeoplegettherightcareattherighttimeintherightplace

• Improvedmentalhealthtrainingforallstaffandprofessionalsthatcomeintocontactwithindividuals

• Commissioningbasedonoutcomesthatcanbeeasilytracked

• DeliveringontheFiveYearForwardView

ByintegratingservicesandputtingMentalHealthinthegenericphysicalcaremodel,we

canseesomeoneaswholepersonandprovidemoreholisticcare

ProvidemorespecialistsaccessiblethroughGPreferral,toassessanddiagnose,rather

thanusasindividualshavingtomakeGoogle-basedselfdiagnosestotaketoourGP!

Thereareopportunitiestousethecrisisconcordattoprovideservicesdifferentlyfor

peoplewhoneedcrisiscare

Carnall Farrar|18

HowwoulddescribeyourvisionformentalhealthcareinDevonin2021?

• Moreequitablefunding,comparedtophysicalhealthservices

• Personalisedcommissioningarrangements

• Anintegratedcaremodelwillbeusedtolookafterpeoplewithbothphysicalandmentalhealthproblems

• Moreresourceswillbeputintothethirdandindependentsector,providingmorechoiceforpatients

• Focusonwiderdeterminantsofhealthe.g.housing,education,employment,etc.

• Theworkforcewillbebettertrainedtodealwithmentalhealthpatientshavingphysicalhealthproblemsandviceversa

• Technologywillbeharnessedtoimproveserviceprovision

Thereisnostigmaattachedtomentalhealth- everyoneinthehealthcareprofessionhasaclearandbasic

understandingofmentalhealthandhowseriousanissueitcanbeforpeople.

Treatingitlikeamedicalillnessratherthana‘wetflannel’illness

Carewillshiftawayfrommedicalmodeltolookatwiderdeterminantsofhealthastheseaffectoutcomesmuchmorethan

healthinputdoes

Carnall Farrar|19

Devonhashighratesofdementiacomparedtothenationalaverage

Source:QOF2015/16,CarnallFarraranalysis

Populationthousands

913

166

393

285

69

289

146

144

1202

SouthDevon&Torbay

NEWDevon

North

East

Plymouth

Devontotal

N/A

West(exclPlymouth)

Torbay

South(exclTorbay)

Nationalaverage

75+population%overallpop

Dementiaper100,000pop.

10%

11%

11%

8%

12%

12%

12%

12%

11%

7%

889

950

964

708

1062

1091

1076

1107

938

759

75+populationandratesofdementiabylocality,2015/16

0.95correlation

Carnall Farrar|20

Plymouth&TorbayinparticularhavehighratesofdeprivationandSMI

Source:QOF2015/16,ONS;CarnallFarraranalysis

DeprivationlevelandratesofSMIbylocality,2015/16

Populationthousands

913

166

393

285

69

289

146

144

1202

SouthDevon&Torbay

NEWDevon

North

East

Plymouth

Devontotal

N/A

West(exclPlymouth)

Torbay

South(exclTorbay)

Nationalaverage

IndexofMultipleDeprivation(IMD)

Severementalillness(SMI),per100,000pop.

20

21

17

27

18

23

26

18

21

22

873

898

828

944

771

982

1121

840

899

901

0.83correlation

Carnall Farrar|21

Localitieswithhigherlevelsofcomplexityareassociatedwithhigherspendperhead

Source:LivewellandDPTactivityandclusteredexpendituredata;PublicHealthoutcomesdata;CarnallFarraranalysis

Highercomplexityscores

Spendperhead(£)1

Plymouth

60

70

80

90

100

110

120

130

140

West(excl.Plymouth)

South(excl.Torbay)

North

East

Torbay

Indexofcomplexityvs.mentalhealthspendperhead

Carnall Farrar|22

Morecomplexlocalitiesarealsoassociatedwithpooreroutcomes

Highercomplexityscores(greatercomplexity)

Higheroutcomescores(betteroutcomes)

West(excl.Plymouth)

Torbay

Plymouth

North

East

South(excl.Torbay)

Source:LivewellandDPTactivitydata;PublicHealthoutcomesdata;CarnallFarraranalysis

Mentalhealthcomplexityvs outcomesindex

Carnall Farrar|23

Peoplewithpsychosis,CPAandMHAdetentionsaccountforhighconcentrationsofsecondarycareresourceconsumption

Psychosis MHA

OBDsPatients Contacts

1+episodes1Noepisodes

CPA

Notes: 1Patientsenteredontoclusters10-17during2015/162PatientsrecordedashavingaCPAduring2015/163PatientsdetainedundertheMHAduring2015/16

Source:DPTandLivewellproviderdata,2015/16

10%27%

53%

90%73%

47%

9%

36%57%

91%

64%43%

4%13%

72%

96%87%

28%

OBDsPatients Contacts OBDsPatients Contacts

CPA2NoCPA MHAdetention3NotMHA

CarnallFarrar|23

Shareoftotalpatients,contactsandOBDsrepresentedbythreepatientgroups

Carnall Farrar|24

TotalspendbyhealthcommissionersonmentalhealthservicesinDevon

CarnallFarrar|24

6225 37 6 10 1 35 114 59 128

29,474

73,970

136,569153,562

44,496

6,63311,755 676 1,588

41,946

11,341 5,652

Psychoticclusteredspend

Non-psychoticclustered

Clusteredblockspend

IAPT CAMHS Asessments Liaisonpsychiatry

Othernon-clusteredblock

Totalblockspend

Non-blockIPP&S117

Othernon-block

Total

£spendperhead

Source:NEWDevonCCGandSouthDevonandTorbayCCGfinancialreturns2015/16;CCGlistpopulation;CarnallFarraranalysis

CombinedMHspendforNEWDevonandSD&T,15/16(£’000)

<1

Psychoticclusteredspend

Non-psychoticclustered

Clusteredblockspend

IAPT CAMHS Assess-ments

Liaisonpsychiatry

Othernon-clusteredblock

Totalblockspend

Non-blockIPPandS117

Othernon-block

Total

Carnall Farrar|25

Summaryofwherearenow• TherearehighlevelsofdementiaacrossthewholeofDevon• SomeareasinDevonhavehighratesofdeprivation,andtheseareashave

relativelyhigherlevelsofSMI• Areaswithhigherlevelsofcomplexity(e.g.Torbay,Plymouth)areassociated

withhigherspendperheadonmentalhealthand,ingeneral,pooreroutcomesforpeople

• Someofthecurrentchallengesinclude:- Absenceofstrategy- Genericserviceprovisionwithlackofintegration- Fundinglevels- Lackofawarenessandunderstanding

• Keyopportunitiesinclude:- Preventionandearlyintervention- Holisticmodelsofcare(physicalandmentalhealthtreatment)- TheFiveYearForwardView- Newmodelsofcommissioning

Carnall Farrar|26

Agenda






MelanieWalker

BenRichardson


MichelleThomas

All

BenRichardson

14:00– 14:05

14:20– 14:50

15:30- 16:00

16:00- 16:50

14:05– 14:20



Carnall Farrar|27

InitialopportunitiestopursueImprovehealthandwellbeing


11

3

Promotinghealthandwellbeingthroughaddressingthewiderdeterminantsofhealth,especiallyemploymentandhousing

Ensuringpeoplearetreatedholistically,andthatmentalhealthneedsareassessedandtreatedalongsidephysicalhealthneedssothatwherementalhealthisthekeyissuethatistreatedandthattheimpactoftheco-morbidityofmentalhealthisaddressed



Consistentpathways

Commissioningandinformation(enablers)

2

4

5

6

Drivingqualitythroughimprovedcareconsistency,ensuringthatpeoplereceivetherightcareattherighttimewithafocusonshiftingcareupstream,preventionandearlyintervention.EnsuringbestpossibleprovisionofcoreservicesforpeoplewithSMI

Improvingefficiencysothatmaximumimpactcanbeachievedwithinthesameresources

Identifyingtheactivity,capacityandcostrequirementtomeettheFYFV.Reviewingandassessingtherequirementsinordertodeliverenhancedcommunitycapacity

Transformingcommissioningtoachieveimprovedoutcomesforpeopleandaddressingtheflowofdata,particularlyprimarycaredata

Carnall Farrar|28

Gallerywalk

Thereare6stationsaroundtheroomalignedtothekeyopportunityareas:• Healthandwellbeing• Consistentpathways• Integratingphysicalandmentalhealth• Providerproductivity• DeliveringtheFiveYearForwardView• Commissioningandinformation

Youhave35minutestovisitthestationsandreviewtheavailabledataandinformationinmoredepth

Youwillbeaskedlatertojoinatableofyourchoicealignedtooneoftheopportunityareasanddiscusswhatyouhaveabsorbedinmoredetail.Makesureyouhavevisitedtherelevantstation

Helpyourselvestoteaandcoffee!

Carnall Farrar|29

Agenda






MelanieWalker

BenRichardson


MichelleThomas

All

BenRichardson

14:00– 14:05

14:20– 14:50

15:30- 16:00

16:00- 16:50

14:05– 14:20



Devon Mental health WorkshopSome Examples of Success

David McAuley

January 16th 2017

Carnall Farrar|31

0

500

1000

1500

2000

2500

Num

bersEnteringTreatmen

tNEWDevonCCGIAPTaccessrates

CCGTARGET

CCG

Carnall Farrar|32

0.0%

0.5%

1.0%

1.5%

2.0%

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

2015-16 2016-17

Graph:IAPTaccessrateagainst15%prevalence(CCG)

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

2015-16 2015-16

Peopleaccessingwithin6weeks(target75%)

2015STP6Monthtotalpeopleaccessingtreatment(May-Oct):89472016STP6monthtotalpeopleaccessingtreatment(May-Oct):11020(Increaseof2073- DPT1046/LiveWell1027)

Carnall Farrar|33

PlaceofSafety(PoS)• InvestmentandoutcomesacrossSTPareawith‘allage’PoS provision24/7.• Significantreductionsinthosedetainedincustodyons.136.• Despiterisinguseofs.136byDevonandCornwallPolice,unprecedentednumberofpeople(includingchildren)arenowbeingcaredforinhealthbasedPlacesofsafetyasopposedtopolicecustody.

8

13

18

25

2223

14

21

17

25

20

23

4 45

7

32

13

4 4

10

0

5

10

15

20

25

30

AUG

SEPT

OCT

NOV

DEC

JAN

FEB

MAR APR

MAY JUN

JUL

s.136 destination comparison Aug - July 2016 (Devon/Torbay)

POS

Custody

POSTrendline

Custodytrendline

0

50

100

150

200

250

300

350

400

450

500

2009 2010 2011 2012 2013 2014 2015 2016

s.136 destination comparison 2009- 2016 (Plymouth)

Yearly136data

Custody

POS

refused

Carnall Farrar|34

PlymouthSupportedHousingScheme

• Jointlycommissioned– HealthandSocialCare• CommunityServicesupportingtransitionbetweenRecoveryunitsandcommunity• MentalHealthNursesbasedinHousingprojectssupportingindividualstomaintaintenancies

• Buildcapacityandskillsacrosshealthandhousing– twowayprocess• Putsindividualsneedsatthecentre

MENTAL HEALTH

Michelle ThomasDirector of Operations Livewell Southwest

Carnall Farrar|36

SLIDE TITLETAKING SERVICES FORWARD

Childrens Services CAMHs

• Perinatal Mental Health including Infant mental Health• Early Intervention• Childrens Place of Safety (POS)• Transition

Adults• Crisis Care concordat• POS• Liasion Core 24 lessons learnt• Robin alternatives• Links to Home Treatment • Out of hours service including telephone contact• Length of stay and delayed Transfers of care

Carnall Farrar|37

SLIDE TITLETAKING SERVICES FORWARD

Integration• Integrated working Physical Health services• Supporting General Practice

IPP• Service available to support people to come back to their home• Recovery services• Social responsibility to support people back to work• Pooled budgets

Older peoples service• Frailty• Community based offer

THANK YOU

www.livewellsouthwest.co.uk@livewellsw

AN OVERVIEW OFSOUTH DEVON & TORBAY "STEP-DOWN" HOSPITAL AND CRISIS HOUSE

DEREK O’TOOLE

Carnall Farrar|40

Acute Psychiatric Hospitals

Cypress Recovery Hospital

Community Support/ Crisis House

CYPRESSRECOVERY HOSPITALSouthDevon&Torbay"Step-down" Hospital

Cypress is a Recovery Hospital; providing support for people experiencing significant mental health difficulties and crisis to rebuild their lives and recover a sense of hope and fulfilment.

Cypress provides short-term ‘step-down’ support and accommodation for people from local acute psychiatric wards who no longer require acute inpatient care, however still require a level of hospital care and support. The hospital also offers short-term crisis support and accommodation for people who require a short-term level of hospital support but do not need the facilities and level of support from an acute psychiatric ward.

Cypress is registered by the Care Quality Commission and is staffed 24 hours a day with qualified Registered Mental Health Nurses and Support Workers. It has 12 beds and can provide support for both men and women in the South Devon and Torbay area.

Currently the team consists of 10 Registered Mental Health Nurses, 9 Support Workers and an Occupational Therapist.

Cypress is part of the acute care pathway for South Devon and Torbay and is run by Community Care Trust (South West) Ltd/ St Loye's Foundation and commissioned through the South Devon and Torbay Clinical Commissioning Group.

Cypress is a Recovery Hospital. This means putting the person at the centre of what they do and not their symptoms.

Cypress supports people to recover a sense of meaning in their lives; building self-acceptance, resilience and coping strategiesfor dealing with their mental health.

Carnall Farrar|41

Facilitate early

discharge from acute psychiatric

hospital wards

Support people to re-

stabilise their lives

and mental health

Reduce avoidable

admissionsto acute

psychiatrichospital wards

Enhance the South Devon and Torbay Acute Care

Pathway

We provide a costeffective option for an

alternative model of care and support for people

We provide an alternative tier of support within the South Devon and Torbay acute care

pathway

We provide up to 28 days of overnight stay in a home-

like environment where we encourage participation in

everyday household decision making and

activities

We work jointly with Crisis Resolution and

Home Treatment teams to provide timely

assessment, admissions and

support for people experiencing crisis

We educate people on

medication and empower

people to take responsibility

for self medication

Through occupational therapy and one-to-one practical help we support people to identify and

resolve issues such as housing, finance, physical health, diet,

sleep, family difficulties, alcohol / substance misuse, etc.

We arrange tailored group

and one-to-one activities

We support people to recognise early warning

signs of their mental health decline

Arrange comprehensive and appropriate post-discharge

support

We work jointly with multi-

disciplinary team within local acute psychiatric wards to provide timely assessment, and

'step-down' support for people

who no longer need acute psychiatric

inpatient support

OUTCOMES

ACTIVITIES

CYPRESS HOSPITAL MODEL

Carnall Farrar|42

CYPRESS 'STEP-DOWN' DISCHARGE DATA

On discharge 3% of people went to stay at the South

Devon andTorbay Crisis

House

On discharge 1% of people moved into temporary accommodation

On discharge 19% of people were

admitted to Acute Psychiatric

Hospital

•On discharge 2% of people were admitted to Hospital for

physical health reasons

•On discharge 40% of people

returned back to their homes/ family homes

•On discharge 34% of people

moved into supported living

Cypress Recovery Hospital had 106 admissions between Apr 15 - Mar 1679 admissions for "step-down" support and 27 for "step-up" crisis support

Of the 79 admissions for "step-down"support:

Carnall Farrar|43

CYPRESS 'CRISIS' DISCHARGE DATA

Of the 27 admissions for crisis support at Cypress Hospital:

On discharge 40% of people returned back

to their homes/ family homes

On discharge21% of people

moved into supported living

On discharge 7% of people went to stay at the South

Devon and Torbay Crisis House

Ondischarge

25% of people were admitted to

acute psychiatric

hospital

On discharge 7% of people moved into

temporary accommodation

Carnall Farrar|44

GRANVUE CRISIS HOUSESouth Devon & Torbay Crisis House

The service is overseen and monitored by the Torbay and Teignbridge CRHT teams and delivered by Community CareTrust/ St Loye’s Foundation.

The service is CQC regulated andstaffed24hoursadayby skilled and experienced Support Time and RecoveryWorkers (ST&R)

We focus on supporting people tobuild self-acceptance, resilience and coping strategies for dealingwith future crisistriggersWith a communal kitchen, lounge, dinning area and garden, the Crisis House offers the opportunity forpeople to take an activepart in the day-to-dayrunning of thehouse

TheCrisis Houseprovidesan alternative to hospital admissionfor people experiencing or,at risk of experiencing mental health crisis.

We offer between 3 - 10 days of residential recovery- based support for people experiencing significantdecline in their wellbeing and mental healthdistressWe offer a safe and supportivehome-likeenvironmentWe support people toidentify andaddressthe various factors which may have led them to a crisis point

We have a maximum bed occupancy of 7 beds catering for bothmale andfemale

Carnall Farrar|45

OUTCOMES

ACTIVITIES

GRANVUE CRISIS HOUSE MODEL

Improve people's self acceptance and senseof hope for the future

Provide support forpeople torecognise signs of

mental health decline

Provide support for people to analyse,

understand and address crisis triggers

De-escalate mentalhealth

distress and crisis

Provide support for people to re-

establish compliance with

medication routine

Empower people with the skills

and knowledge to manage their

mental health difficulties and

recovery

Provide support for people to

identify recovery goals

and create wellness

recovery action plans

Provide peer-ledrecovery groupson anxiety, self

harm, self awareness, selfmanagement

, etc.

Provide a safe, calm retreat for people to have time away from

every day demands

Provide early intervention support as

soon as it is identified that

a person's mental health is deteriorating

Provide support, advice and

guidance to de-stigmatise mental health difficulties

Provide up to 10 nights of

overnight stay in local home-

like setting

Carnall Farrar|46

GRANVUE CRISIS HOUSE DISCHARGE DATA

admitted to hospital

On discharge8%of people were supported into supported accommodation

On discharge11%of people were

GranvueCrisisHouselhad131 admissionsbetweenApr15- Mar16

On discharge

81%of people returned

back to their homes/ family

homes

Carnall Farrar|47

VALUEFORMONEY

Community Care Trust (South Devon) Ltd & St Loye's Foundation are dedicated toproviding value for money.

With an average 82% occupancy at Cypress Hospital throughout the year, theaverage cost at Cypress is £286 per night per person. Achieving a target of 90%bed occupancy, Cypress could reduce the cost to an average of £260 per night perperson.

Granvue Crisis House costs approximately £280 per night per person. At optimaloccupancy Granvue could cost approximately £130 per night per person.

Both the Granvue Crisis House and the Cypress "step-down" Hospital are costeffective alternatives to Haytor Unit, Torbay Hospital (£445 per night per person).

By facilitating early discharges from and reducing avoidable admissions to HaytorUnit, Torbay Hospital and other local psychiatric wards, we aim to achievesignificant savings within the acute care pathway.

Carnall Farrar|48

Agenda






MelanieWalker

BenRichardson


MichelleThomas

All

BenRichardson

14:00– 14:05

14:20– 14:50

15:30- 16:00

16:00- 16:50

14:05– 14:20



Carnall Farrar|49


Chooseatablealignedtotheopportunityareayouwouldliketodiscuss

Inyourgroups,considerthedatayouhavereviewedandthepresentationsyouhaveheard.Youhave25minutestodiscussthefollowing:• Whatarethekeyopportunitiesinthisareaweshouldexplore

throughthementalhealthstrategicframework?• Arethereanythathavebeenmissed?• Whatmightbetheimpactoftheopportunities?

Onepersonfromeachtablemustpreparetofeedbackfromthediscussionfor1-2(notmore!)minutestotherestoftheroom

GROUPEXERCISE:25minutes

FEEDBACK:25minutes

Carnall Farrar|50

Front

Discussiontables

FYFV

HealthandWellbeing

PhysicalandMentalHealth

Healthandwellbeing

Consistentpathways

LauraCommissioning

BackcornerProductivity

Alice Peter

Helen

Ben

Sarah

AnnRob

Beatrix

Victoria

Carnall Farrar|51

Agenda






MelanieWalker

BenRichardson


MichelleThomas

All

BenRichardson

14:00– 14:05

14:20– 14:50

15:30- 16:00

16:00- 16:50

14:05– 14:20



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Devon Mental Health Strategic Framework Workshop 1 · CarnallFarrar | 3 Aims of today’s workshop...

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