Primary Mental Health Services Engagement for Redesign 2015
Introduction The three Clinical Commissioning Groups (CCGs) across Worcestershire, NHS Wyre Forest CCG, NHS Redditch and Bromsgrove CCG and NHS South Worcestershire CCG, with Worcestershire County Council commission the mental services for the residents of Worcestershire. Primary Care Services are the first services you visit when you feel ill. These are often local services such as those at your GP practice. Primary Mental Health Care Services are the services you receive when you first feel low or anxious. This can include a variety of services provided in the community, focusing on prevention, treatment and recovery, for example; advice on wellbeing or seeing a psychological therapist. Mental health difficulties such as problems with coping, anxiety, depression and low mood can affect any of us, at any time. This can be due to life events such as a bereavement, family breakdown, redundancy and so on. These services are not designed for people suffering from a mental health crisis. If your mental health needs cannot be supported by primary care services, you may be referred for more specialist support. This is often known as secondary care. Secondary care can include community mental health teams, hospital care or support from other mental health service providers. Locally we monitor the current services, which include feedback from clinicians and patients. There is now a greater emphasis placed on Mental Health Services by the Clinical Commissioning Groups and in light of this, and best practice models in other counties, we are redesigning our service.
Why a redesign? • Local priority: The provision of a high quality Primary Mental Health Care Service is a priority for Clinical Commissioning Groups (CCGs). • Lack of wellbeing provision: GPs are concerned with the lack of provision of local services in primary care particularly for large numbers of people who are experiencing low mood, depression or anxiety. GPs find that they have a limited range of services which can support these people in the community. 1
• Inconsistent service availability: The services available to you may depend on where you live. We want to ensure that there is the same level of service across the county. • Need for co-ordination: We would like to enable GP practices to co-ordinate care in collaboration with a variety of organisations including; employment services, Local Authorities, and the Voluntary and Community Sector (VCS). • Secondary care: Ensure those individuals with more complex mental health problems receive timely access to services and can step-up and step-down between primary and secondary care services in a way that promotes recovery. • Finances: To identify a level of savings, and where possible use savings from secondary care to invest in primary care.
What would we like to achieve? • Reducing stigma by emphasising ‘Wellbeing’ rather than the labelling of mental ‘illness’. • Provide people with information so they can help themselves or seek the help they need. • Provide better access through a variety of venues, including; GP practices, local community wellness hubs, the internet, libraries and neighbourhood centres. • Managing anxiety, depression and low mood issues within communities and providing care as close to the patient’s home as possible with the aim of this approach becoming embedded in the culture of local communities. • Actively working with the VCS to provide local services. • Linking strongly with relevant community services – such as housing, welfare and job centres. • Those people who need some help to have quick access to services such as psychological therapies. • Those people who need more intensive help can quickly step-up to secondary care services. • When people are recovering from a mental health crisis they can be cared for in primary care and access services to help them live well in the community. • Developing closer relationships with drug and alcohol services. 2
• Services for improving mental wellbeing for those with long-term medical conditions and unexplained medical problems. • Co-ordination of care by mental health workers throughout the patient journey.
What are we proposing? The redesigned service will; 1. Help people better manage their own mental wellbeing and cope with life crises. This will be achieved by developing a Worcestershire Wellness Hub to provide information including where to find help in your local community, and ways to help yourself. 2. Support GPs by providing a Single Point of Access to ensure people access the right service at the right time in the right place. 3. Provide a range of wellbeing and psychological therapy services in primary care and local communities such as;
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Wellbeing courses, exercise classes, relaxation classes, improving sleep, meditation, yoga, tai chi.
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Community therapies, painting and craft based activity, sing to relax.
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Mood master courses – a programme which aims to provide a fun, upbeat approach to working on your physical and emotional wellbeing.
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Personal development – help in managing anger, confidence building, emotional resilience, stress management.
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Lifestyle advice and guidance on healthy eating, nutrition and diet, stopping smoking, and minding what you drink.
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Helping you to connect with people around you, to share and discuss experiences with family, friends, colleagues and neighbours. Helping to build new social networks through access to support groups, activity groups such as walking groups, volunteering opportunities.
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Keeping learning – learning new skills can give a sense of achievement and a new confidence such as, cooking courses, learning to play a musical instrument, etc.
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Recovery colleges - For those who need help in their local community to recover from mental health issues/problems.
4. Join-up a range of agencies and organisations in local communities to give a advice and support on: •
Education support services
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Employment support services
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Housing
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Money matters
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Drugs and alcohol services
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Domestic violence support
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Sexual abuse
5. Ensure professional help is at hand if you need it, by providing: •
Quick access to psychological therapy services
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Mental health professionals within GP practices such as gateway workers
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Prompt step-up to secondary care services such as the local community mental health teams when needed
6. Mental Health professionals will work within GP practices to provide professional advice to GPs and primary care staff so that people who are recovering from more complex mental health problems can be cared for in primary care. 7. Support from secondary care services when appropriate. Please see diagram on following page:
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The model for Enhanced Primary Mental Health Care Services
Worcestershire Wellness Hub - Information
Community Support and Wellbeing Service
Self Referrals
Social Inclusion
Single Point of Access and Triage
Talking Therapies
Referrals from GP / Health professional working in practices or in the community
Mental Health Professional in Primary Care Secondary Care Services
Self Referrals By improving access to information about social inclusion and the availability of mental health services people will be able to self-refer into appropriate services
Single Point of Access and Triage
Referrals from GP / Health professional working in practices or in the community
All referrals will go into a single point and will be assessed by appropriate professionals
GPs and health professionals will make a referral into the single point of access
Community Support and Wellbeing Service People will be able to access local wellbeing services and community courses that will support people in their local community. This will be through selfreferral or facilitated by community workers who will provide direct support in GP practices and community venues to help people to find and access the right services to suit their needs. The service will also have a strong relationship with local specialist mental health care services, third sector and statutory services. 5
Social Inclusion To prevent people with mental health issues becoming socially isolated we will work with our stakeholders and providers to provide a range of services in order to help people with specific issues along with raising public awareness in relation to mental health issues. Such services will cover: advocacy and peer support; carer support services; mental health promotion and prevention programmes; day services in the community; employment, volunteering and education support services; domestic violence support, drugs and alcohol services; debt advice and guidance. Talking Therapies Talking therapies can help people work out how to deal with negative thoughts and feelings and make positive changes. Currently the services available; Cognitive Behaviour Therapy (CBT), psychology and counselling. You may know this as the Improving Access to Psychological Therapies service (IAPT). Mental Health Professional in Primary Care Mental health professionals in GP practices, such as gateway workers. Secondary Care Services Our local specialist mental health care services are provided by Worcestershire Health & Care Trust which include; inpatient services, community based services and specialist services.
What do you think? We would like to know your views on the current Primary Care Mental Health Service, and the proposed model. Please complete the survey at: www.southworcsccg.nhs.uk/get-involved/pmhs/ to give us your views. If you would prefer to complete a printed copy, please return to: Freepost Plus RTCU-KZKZ-EJZZ, NHS South Worcestershire CCG, The Coach House, John Comyn Drive, Worcester, WR3 7NS. If you have any additional feedback or queries please contact: ccgcomms@worcestershire.nhs.uk Please give us your views by 31 May 2015. We will review and analyse your responses and use this to shape our service specification. The new service will be in place from April 2016. If you would like to receive feedback please provide your name and contact details when completing the survey. 6