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SRG 4 - Mental Health

The fourth Stakeholder Reference Group (SRG) for the Moving Forward Together (MFT) Programme took place on Wednesday the 24th of January. The Group of 12 patient, service user and carer representatives (details at the end) heard a presentation and engaged in discussion about how Mental Health services are undergoing transformation to meet the current and future needs of people across Greater Glasgow and Clyde.

The Co-Chair, Liz Porterfield, opened the meeting and welcomed everyone, thanking them all for their participation and input to date. Following this Dr Michael Smith, Lead Associate Medical Director and David Walker, Head of Operations (South) delivered a presentation about the Adult Mental Health Services Strategy for Great Glasgow and Clyde. Michael started by describing how mental health services had changed radically since the late 1970 and that the majority of people no longer require hospitalisation. He described the range of community services available and others planned for and said that providing more in the community had been seen as a very positive shift in terms of peoples’ experience of care and meant a huge reduction in the inpatient beds required. 

It was explained that, in line with national plans and strategies, over the next five years there was to be a continuing shift to have services provided in the community, but also there was going to be a greater focus on open access prevention and more accessible recovery services as part of this. The key role of prevention was described because for many adults mental health problems had begun by age 15 through Adverse Childhood Experiences and persist into adulthood – a factor magnified by the deprivation seen across Glasgow and Clyde. The evidence showed that things like anti-bullying and tackling disruptive behaviour in schools or barriers on bridges can provide, in monetary terms, a huge return on investment.

Recovery from mental ill health was described as more than a reduction in symptoms and it was about giving people more control with access to services when needed without them being restrictive. Recovery colleges were one such idea and based on evidence from elsewhere in the UK and models developed for addiction that aim to empower people and requires a cultural shift in how people perceive and access treatment. However, to deliver enhanced community, prevention and recovery services the specialist teams need to find new ways of working and initiatives to provide all the care a person needs and no more whilst also dealing with an annual 3% increase in demand.

For unscheduled care, Michael explained that across Greater Glasgow and Clyde there would be Crisis Resolution and Home Treatment teams and liaison services  available with improved coordination to provide support in Emergency Departments, wards, Acute Medical Units and Minor Injuries Units – all to help reduce admission to and support discharge from hospital. He said that, when compared to the rest of the UK, for its population Glasgow and Clyde has an average number of short stay inpatient mental health beds and that the proposed reduction of 53 beds would mean it has less than 75% of the UK. Although there was no information to compare service quality versus beds for most areas, it was known that the area with the least amount of beds was also the place recognised as having the best outcomes.

Michael summarised the changes taking place across Greater Glasgow and Clyde saying that to reduce inpatient beds there needs to be investment in alternative forms of health and social care. However, to implement these at the scale and pace required needs system-wide commitment and with ongoing budget pressures will require transformational monies to initiate them until they become self-financing.

Following the presentation both Michael and David took questions and engaged SRG members in discussion on several topics. Betty, Thomas, Aileen and Margaret asked about psychological support available for those with other conditions such as Huntingdon’s or diabetes. There was conversation about the need for specific support for some conditions or complexity arising from them versus open access support to all people. Aileen also asked for clarity around the evidence about return on investment and that psychological support can lead to better compliance with medication in diabetes; however acknowledged that this was not about clinical management and about prevention of mental ill health.

The group welcomed making services easier to access and that self referral to community services was positive; however Thomas questioned that if someone was unwell for the first time how would they know where to go or self refer? He stated that they would probably visit their GP possibly taking longer to get the help they want. Gordon said that there was learning curve to educating people about the services available and that the Glasgow and Clyde Mental Health Network community website was a good resource, but again without prior knowledge people did need to be signposted to it.

There was then discussion about prevention and the Group all agreed that investing in this was vital. However, martin asked about the support that is available in schools and welcomed approaches to reduce bullying, but said that policy is not enough and there needs to be something more substantial put in place. Thomas also questioned the wider role of Government and spoke about the levels of poverty that children live in and how this must have an impact on the number of adverse experiences. Gordon said that the strategy recognised this and Michael Smith said that political action could and was needed to help mitigate some of the problems that can contribute to poor mental health at a societal level.

Discussion then turned to bed closures and Anne Marie also asked how they decide what beds will be closed and the informed that this was yet to be decided; however they would probably not be in specialist services as these were highly effective and that closures would be offset with services like treatments at home. Janet asked how families could be reassured that it was better for patients not to be in hospital when situations become serious as often this is when they, the family, cannot cope and need help and was assured that there were no plans to reduce the beds available for people in crisis.

George spoke about the lack of beds in some areas and said that in Glasgow and Clyde there was often people admitted from other parts of Scotland and asked if cutting beds further could lead to a shortage for local people. Michael smith acknowledged that people do come from other areas; however this was something other Boards need to look at and can’t be seen as a reason not to implement change locally. Gordon spoke about the significant culture shift required if people are to transition from more traditional approaches to models such as recovery colleges. He also welcomed alternative ways of working using the voluntary sector or peer support, but that service users and carers need to be comfortable and feel safe with these and there was work to be done in communicating this.

Susan and Margret spoke about how the third sector could play a significant role in prevention, recovery and signposting, but they are a limited resource and funding has become very competitive. David Walker acknowledged this and agreed that how and where resources are used and services are commissioned needs considering recognising the importance of voluntary services at a community level. George said another way the community can provide support is for clients to help clients and that peer support and other networks are invaluable as a channel to communicate and provide assurance about what is available.

Susan then spoke about transition from child to adult mental health services and parents, if not included in appointments, need a source of information to better help them understand what’s happening. Barbara then queried where dementia services sit within this and Michael Smith said that technically Older People’s services where separate to this strategy. He also discussed that although there were defined age ranges for services; age was not a barrier to what a person needs and access to the most appropriate specialist service was always the key driver.

Martin stated that he welcomed being part of this group and having the opportunity to provide feedback, but as an Integrated Joint Board Service User Representative wanted to know how Health and Social Care Partnerships (HSCP) and communities were being informed. Michael Smith said that the strategy had been developed by a wide ranging group and this also included senior HSCP leadership. David Walker also said that a version of this presentation was being delivered to the Integrated Joint Boards. Liz then closed the meeting and thanked everyone for their input and reiterated that if anyone had further queries or wanted to provide feedback on any aspect of the Programme they could contact John directly.

 

In Attendance

 

Liz Porterfield (Co-Chair)

NHSGGC - MFT Core Team

John Barber (Facilitator)

NHSGGC - MFT Core Team

Deirdre MacLean

NHSGGC – Admin Support

 

Presenting

Michael Smith

Lead Associate Medical Director

David Walker

Head of Operations (South)

 

Patient, Service User and Carer Representatives

Aileen Hills

 

Anne Marie Kennedy

 

Barbara Barnes

 

Betty Graham

 

George Brown

 

Gordon McInnes

 

Janet Nicholls

 

Janice Woodburn

 

Margaret Telfer

 

Martin Brickley

 

Morag McIntosh

 

Thomas Cassidy