Agenda item

This paper outlines what has taken place since the B&NES Mental Health Review, the changes to the range of mental health services in place for children, young people and adults, and the transformation work now underway to improve peoples’ experience of services and mental health outcomes.

The Senior Commissioning Manager for Specialist Services introduced this report to the Panel, a summary is set out below.

The B&NES Mental Health Review ran from 2017 to 2019, culminating in a

formal public consultation, then a full business case approved by the Care and

Health Board in March 2019.

The key recommendations of the Review included:

·  Improving access and care coordination.

·  Delivering a more integrated, preventative and personalised approaches that people asked for.

·  Developing a stepped approach to crisis avoidance with the creation of a B&NES Place of Calm (a comfortable and calm setting which delivers

practical and emotional support) and a Wellbeing House to provide preventative support for people with low to moderate mental health needs.

·  Adopting the Thrive model for the delivery of mental health services

An All-age Mental Health Transformation Strategy was created by commissioners, partners and people with lived experience for B&NES, Swindon and Wiltshire (BSW) in 2018/2019. The Strategy is based on the Thrive model of delivery.

The Strategy and Thrive model are delivered locally through the B&NES Mental Health Collaborative. This is the delivery group for embedding joint working across a wide range of organisations.

A Place of Calm (called Breathing Space in B&NES) was set up by Bath Mind in early 2020. Due to Covid19 and issues securing suitable premises, the service initially opened virtually, offering telephone support to those who were at risk of escalating into mental health crisis. From January 2021 the service will move to a mixed model of delivery, working from new premises.

A Wellbeing House was set up by Curo operating 5 days a week. However,

additional short term funding (BSW Winter Pressures and Covid19) has enabled both Bath Mind and Curo to work together to increase staffing, extend the opening hours and to operate the Wellbeing House as a step up /step down model catering for people with more complex needs during the pandemic. This has been very successful and a model we are keen to maintain in B&NES.

Covid19 has had a huge impact on individuals, their families and services alike

and has led to new emerging demands on services. A BSW ‘Heart of the Crisis’

virtual listening event was held in October with people with lived experience and frontline staff, to sense check how people were experiencing services during the pandemic.

During the pandemic, staff in mental health services across the statutory and

voluntary sector have regularly reported significant increases in the acuity and

severity of mental health presentations for both young people and adults. There is evidence to show that individuals being detained to inpatient settings are needing to remain there for a longer period due to the acuity on admission. Services are also seeing an increase for individuals who may have not been receiving secondary mental health services prior to detention or referral.

Locally commissioned services have reported increasing activity as children and young people have returned to school with increased levels of anxiety. Supporting data is not available for the report but is being confirmed. In response the B&NES Emotional Health and Wellbeing (EHWB) sub-group has made available one-off funding to support the development of ‘preventative and ‘targeted’ mental health support for children and young people who are anxious because of Covid19. As a result, proposals from Off the Record and the Youth Connect are being funded to provide additional support and a range of interventions to those young people disproportionally affected by COVID19 to prevent their need escalating further requiring specialist support.

24/7 helplines have been established across the BSW footprint to support people at risk of going into crisis. This includes two urgent helplines, one for adults and one for young people delivered by AWP and OHFT and a mental health line delivered by the third sector which includes Bath Mind in B&NES. This line had taken over 1,400 calls as at mid-December. These helplines will become part of the longer-term alternative to crisis model of delivery from April 2021.

A new Home Treatment and Crisis Resolution Service for children and young

people is being funded and piloted from January this year as part of CAMHs to

support the treatment of young people at home in the community and prevent

admission. Additional funding is also being made available to for the Children and Young People Eating Disorder Services (TEDS) to meet the growing demand.

All schools and colleges offered a comprehensive package of resources to help

them support the mental health and wellbeing of students and children as they

continue their education during the pandemic.

Virgin Care have been instrumental in leading the development and operation of the Community Wellbeing Hub, alongside colleagues from 3SG, their members, BSWCCG and the Council. The Hub has provided a single point of access for community response and provides the most appropriate, joined-up intervention for anyone seeking support or guidance on COVID-19.

The Hub was set up in response to COVID-19, but its effectiveness has meant

that it will now develop into an ongoing service for joined-up community

response to support the wellbeing of residents into the long term.

During the third national lockdown the Hub will again lead on behalf of the

Council, the implementation and co-ordinated delivery of the Covid-19 Guidance to local authorities on support for Clinically Extremely Vulnerable (CEV) individuals advised to shield.

The Commissioning Manager for Mental Health (LK) addressed the Panel in relation to the Community Mental Health Framework, a summary is set out below.

The NHS issued the new Community Mental Health Framework in early

November 2020 and required local areas to work collaboratively to develop

proposals to strengthen the local integration and coordination of community health services.

The implementation of the new model builds on the B&NES Mental Health Review which recognised the need for much stronger integration to enable all levels of mental health need to be met. It provides a national driver and funding to bring about this structural change.

The development of the model is co-ordinated by BSW using a co-production

approach with which includes people with lived experience, locality commissioners, and representatives from the local authority and from third sector organisations.

Implementation will be supported by a three-year funding allocation for new staff and contracts with the voluntary and community sector through a non-competitive process.

Councillor Liz Hardman commented that she would ask for the priority to be early intervention to avoid crisis and hospitalisation as all too often it seems that the thresholds for intervention are too high. She added that the main risks seem to be insufficient resources alongside a rapid increase in demand which will add to the pressure at a time when the new model is being implemented. 

The Senior Commissioning Manager for Specialist Services replied that the Thrive model has a stronger focus on early interventions and that some of the current thresholds are to be removed. She said that she thought the B&NES Mental Health Collaborative would be a good group to find the solutions required.

The Commissioning Manager for Mental Health (LK) added that there is an emphasis on partnerships within the new framework.

The Commissioning Manager for Mental Health (NM) said that the framework would support hospital / patient flow and that he felt that collaborative working has made a huge difference.

Councillor Alison Born asked if the timescales were known regarding the additional £10.3m from NHSE.

The Commissioning Manager for Mental Health replied that the deadline for submissions was the end of February, but the allocation date was unknown at this stage.

Councillor Andy Wait commented that he felt that the methodology behind the framework was sound. He asked how much time do the CAMHS Thrive Practitioners get to work in the 12 Secondary Schools mentioned in the report and how much time will each secondary school that isn’t a CAMHS Thrive school have for CAMHS work.

The Senior Commissioning Manager for Specialist Services replied that the take-up of the offer varies enormously between schools – some take everything offered, some only one aspect for instance when they have a particular issue in the school. The current CAMHS offer is:

1. Access to a 1.5 hour consultation each school term (6 a year up to 9 hours)
2. Three day/half day training (staff/pupils/parents) visits per year (max 12 hours over 3 visits, 2 members of CAMHS staff)
3. Ad hoc consultation by phone to discuss mental health concerns - as required, no limit.
4. Three school based group sessions (1.5 hours) for pupils with particular issues e.g. exam stress, anxiety, per year (max 4.5 hours, 2 members of staff).

She added that this is in addition to the CAMHS Mental Health Support Team which is available in targeted schools (primary and secondary) in B&NES.

The Chair asked if B&NES was disadvantaged at all by this work coming under the STP (Sustainability and Transformation Partnership).

The Senior Commissioning Manager for Specialist Services replied that there are challenges to influence what we need locally, but more of an advantage in the expertise that can be shared across the area.

The NHS BSW CCG Chief Operating Officer added that the priorities for the locality are clear.

Kevin Burnett asked who had developed the agreed outcomes following the Mental Health Review.

The Senior Commissioning Manager for Specialist Services replied that the local outcomes had been developed alongside Virgin Care.

The Commissioning Manager for Mental Health (LK) added that the Mental Health Outcomes Framework was widely used across our services.

Kevin Burnett commented that prevention work should be recognised as a priority within Primary Schools as issues are on the increase in those settings.

The Senior Commissioning Manager for Specialist Services replied that a focus on prevention work has been recognised and that equity should be sought on how physical health and mental health are addressed within schools.

The Director of Children’s Services added that schools in B&NES were consulted as part of the development of the Thrive model.

Councillor Alison Born commented that early intervention is crucial and that the problem of waiting times for assessments needs to be addressed.

The Senior Commissioning Manager for Specialist Services replied that this was an issue that she could take away and discuss further with BSW colleagues.

The Commissioning Manager for Mental Health (NM) said that locally work is carried out with partners to provide assurance of safety of an individual whilst they are waiting to be assessed.

The Panel RESOLVED to:

i)  Note the huge amount of partnership work and activity taking place to respond to Covid19; the increasing levels of engagement with adults and young people with lived experience; and the collaborative work to improve and develop services both at BSW and in B&NES.

ii)  Consider opportunities to further promote positive mental health and wellbeing and improve mental health outcomes for all ages in B&NES.

iii)  Acknowledge the role and work of front-line services and staff during the pandemic.