Agenda item

A report and presentation provided an overview of Mental Health Commissioning in Doncaster.  It was explained that the Panel had requested to focus on Mental Health for 2018/19 and were looking to identify focused topics and themes for future Panel meetings.

An outline was presented on the following areas as part of the 5 Year Forward View;

• Background
• Children and Young People’s mental health
• Children and Young People’s mental health: The Green Paper
• Children and Young People’s mental health: Eating Disorders
• Perinatal mental health
• Adult mental health: common mental health problems
• Adult mental health: community and acute
• Physical Health Improvement for people with Severe Mental Illness (SMI) in Primary Care
• Adult Mental Health: secure care pathway and health and justice
• Adult/Older People’s mental health: Dementia

Children and Young People’s Mental Health - It was explained that the NHS Five Year Forward View for Mental Health had consolidated national mental health policy into a cohesive investment and development package.

Reference was made to a recent Panorama programme ‘Britain’s Mental Health Crisis’ around access to crisis care for young people.  It was explained that in the Doncaster area, setting tiers had been removed and that Advice Workers were now based in all localities. Members were informed that it was critical to commence work with young people from 14 years of age and vital that intensive treatment could be undertaken to help them remain with their families.  It was explained that the biggest challenge was around the workforce and steps were being taken to address the weakest areas by working with partners within the Immediate Care Service footprint.

It was outlined that Doncaster had been involved in a pilot mental health competency framework with the aim to influence the national model.  Members were told how in every school and college there would be a Mental Health lead who would undertake low-level mental health work.  It was noted that funding was in place to provide the necessary training and support needed within the infrastructure. 

It was stated that workforce development was being carried out so that local authorities were not competing against each other although more work needed to be done across partner agencies. 

Concern was raised in relation to the LGBTQ group as it was felt that they were a particularly vulnerable group.  In terms of LGBTQ, it was explained that Young Minds had been commissioned to engage with young people and find out more about how it felt to work in Doncaster.  From this work undertaken, the aim was for schools to develop a more consistent and positive message about diversity.

Concern was raised about young people aged between 15 and 19 years of age, transitioning across secondary school to college. Members were informed that this was a significant area for development and that further work needed to be undertaken with providers and partners.  

Members were informed that young people had raised mental health as a priority area.  It was raised that there needed to be more investment in those services.  Members were reminded that £160,000 had been invested to look at the transition from primary to secondary school. 

In terms of waiting times, it was explained that on average there was a 24-hour wait, however, in an emergency RDasH could see an individual within 4 hours.

Perinatal - Members had been informed that £1.2 Million had been invested in this area mobilising a Sheffield, Rotherham and Doncaster hub approach and providing specialist support for pregnant women as well as in the year following the birth. 

Additionally, Members heard that there had been value through low level psychological intervention being provided as part of the physical health care packages with Attention Deficit Hyperactivity Disorder (ADHD) as one of the transition areas.

Acute Crisis Care - It was explained that multi-agency user groups and the voluntary sector were working to better understand issues within mental health crisis and access response.  Members were informed that proposals were being built for Doncaster that moved away from a blue light response based on a police use of Mental Health Act Section powers or attendance through Accident and Emergency services.   It was explained that a mapping exercise was being undertaken around the voluntary sector, peer support and places of safety to help build more resilience within community services to prevent hospital admissions. 

A Member raised concerns that some individuals were waiting a long time be allocated a Mental Health worker and that language used was often difficult to understand and to be used to navigate around the different services. 

Colleagues from Doncaster NHS CCG commented that they recognised the need for modernisation around acute response to crisis.  There was a brief discussion around alternative places of safety where an individual could be detained by police or Accident and Emergency, to have a safe assessment of their needs.  It was felt that there wasn’t a great deal of flexibility available and it was more about having a variety of different options depending on the degree of presentation and need.

Concern was raised that mental health and other services needed to be specific to the need of the individual, for example, substance misuse.

In response to what was being done to improve partnership working, it was explained that when the individual presented themselves to Accident and Emergency, a Section 136 (part of the Mental Health Act) could be issued and then the individual would receive an assessment.  Members were informed that timescales depended upon the needs of the individual, their circumstances and where that person was in terms of their needs being met.  It was explained that RDASH providers of mental health services were there to develop alternatives and part of that was the liaison that takes place between providers and flows through systems.

A Member stressed that it was essential to look at the causes and ensure that prevention was in place to stop problems from reoccurring further down the line.  Members were assured that there was a significant amount of prevention work being undertaken across Health and Social Care. 

Members heard that the Health and Wellbeing Board had considered progress against the 10 areas for development identified in the Place Plan

Wellness Recovery And Action Plan - Reference was made to the power of the community and its neighbourhoods within an individual’s recovery pathway and that there was a need to integrate with voluntary networks.  Members were also informed of the importance of the Council and Doncaster NHS CCG working together especially within a challenging funding environment.  Members were assured that prevention was considered as key in addressing this.

The Director of Public Health spoke about the impact of Adverse Childhood conditions on mental health and how consideration was being given to such things as parenting skills, having an available adult, maintaining strong relationships with adults, mindfulness and physical activity.  It was further commented that other leavers included community infrastructure, community wellbeing, community navigators and communities addressing challenges. 

Children and Young People’s Mental Health: Eating Disorders - Members spoke about Children’s and Young People’s Mental Health eating disorders and it was questioned what could be done to address the route of the causes such as bullying.  Members were informed that anxiety, stress and self-harm were the top three issues faced by children.  It was commented that there may be a way of making children more resilient through a local level campaign, raising awareness of bullying and aspirations.  It was added that South Yorkshire Eating Disorder Association (SYEDA) had been successful in receiving funding to develop eating disorder services for adults.

In terms of numbers of children affected, Members were informed that according to a national survey this ranged between 3000 to 4000 children.  Members were told that a survey had been undertaken last year and the Public Health team were waiting for those results to be able to identify gaps in the community and of those accessing services.

It was added that although the admission of children to hospital with an eating disorder was avoided, that on occasion the physical element might override that.

In respect of obesity, Members were informed that health colleagues worked more closely with Public Health colleagues on prevention by being healthy.  A Member asked the question on why obesity wasn’t treated with the same parity as bulimia and anorexia in terms of focus and funding. Is Obesity not an eating disorder?

Suicide Prevention - It was explained that forming part of mental health, suicide prevention was both a public health and local authority responsibility.  Members heard how two years ago, a local suicide conference had taken place to move forward with the local Suicide Prevention Plan.  For information, priority areas identified included men, self-harm, children and young people, acute mental health care, high frequency, reducing isolation and data and intervention.

It was further explained that a suicide audit undertaken between 2015 and 2017 revealed that a third of suicides had been of individuals bereaved by suicide or bereaved in another way.  Members were advised that a report could be made available once further work had been undertaken with colleagues. 

Reference was made to reduced resources although it was acknowledged that NHS England had pushed back cuts to Public Health.  It was further explained that £500,000 had been made available within the South Yorkshire and Bassetlaw Intermediate Care Services area for suicide prevention, with Sheffield NHS CCG as the lead and an estimate of £90,000 to spend in Doncaster on suicide prevention actions (available for the remainder of the financial year).  It was continued that money would be made available in 2020 and although it was part of a modest investment, national areas were striving to reduce suicide areas where possible. 

Veterans - A Member raised their concern around veterans in terms of mental health and suicide prevention.  Members were informed that work was being undertaken with the Stronger Communities Wellbeing Manager and specific services were being offered to veterans.

A Member queried whether specific funding could be made available by organisations who had been involved with veterans during their working life.  Although it was felt that this might not be feasible, it was commented that it was in local planning to look at veterans and consider further actions as part of a local prevention plan.  The Public Health Specialist offered to cooperate with the Stronger Communities Wellbeing Manager to consider how the funding offer could be further enhanced.  Members were also reminded that it was a target of the Mayor to provide support to veterans.

Adult Mental Health - There was a brief conversation around the Adult Mental Health Improvement Plan drafted from various stakeholder input. 

A Councillor commented that the Council was a large employer within Doncaster, and that according to statistics 1 in 4 people were affected by mental health and was therefore concerned about Council employees affected by stress.  Members were informed that discussions had taken place over the past year around Mental Health First Aiders within the Council.  It was explained that Public Health was looking at a model of first aid and had put out an expression of interest for a member of staff to be trained as a Mental Health First Aider.  Reference was also made to World Suicide Prevention Day where the Council had a stall in the atrium that had been approached by members of staff looking for support.

RESOLVED That the Panel

1. Note the information provided ; and

2. Identified the following Mental Health topics for consideration at future Panel meetings, to include;

·         Suicide Prevention

·         Mental Health Prevention

·         Dementia

·         Veterans Plan