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Current services in relation to need

Adults :: Adult mental health [Update in progress] :: Current services in relation to need

Mental health and wellbeing services are provided by a variety of agencies. They cover the spectrum of mental health and illness and are summarised below.

1. Promoting mental health and wellbeing

A partnership framework for action for Promoting Mental Health and Wellbeing in Medway is being finalised and a full-time mental health promotion specialist has been in post since April 2011 to support its development and implementation. This work is overseen by a Consultant in Public Health employed in the Medway Public Health Directorate.

The Medway Promoting Mental Health and Wellbeing Framework for Action can be found at insert link

Current key priorities which are being addressed are outlined below:

Priority 1 - Promoting Mental Health in Primary Care

About 90% of people with mental health conditions are managed in primary care. Improving the skills of primary care staff to enable them to recognise mental health conditions early, deliver appropriate treatments in a primary care setting and refer on to supporting agencies is fundamental. Ensuring primary care understand and can link to the full range of services available to support good mental health is key to a holistic approach to improving mental health. Facilitation between primary care and the voluntary sector improves outcomes [1].

Priority 2 - Promoting Mental health and Wellbeing through Employment

Unemployment is both a cause and consequence of mental health problems. Promoting healthy workplaces to ensure that people can stay in work and reducing stress related illness is an important area of mental health promotion work [2]. Work on this is already underway in Medway and includes working with businesses to raise awareness of mental health issues, reducing stigma through promotion of the Mindful Employer initiative and supporting small and medium sizes business to implement the NICE guidance on wellbeing at work.

For people with existing mental health issues there are many barriers to gaining meaningful employment, in particular discrimination, issues with benefits and lack of available opportunity. Mental health promotion strives to address some of these barriers and promote recovery through working with partners to create training and work experience opportunities.

Priority 3 - Mental Health Awareness Raising and Capacity Building in the Community.

Through a programme of Mental Health First Aid training, professionals, population groups and communities in Medway can be supported to recognise the early signs of mental distress and different types of mental illness. This training has already been delivered to the Health and Lifestyle Training Team in Medway and a programme of further courses has been planned to include carers, those working with young people and in early years settings and other frontline voluntary agencies.

Mental health promotion work will focus on campaigns supporting the Kent and Medway Live It Well strategy which raise awareness and improve understanding of how to achieve and maintain good mental health..

Priority 4 - Promoting Mental Health through Healthy Lifestyle

Having a mental health problem increases the risk of physical ill health. Depression increases the risk of mortality by 50% and doubles the risk of coronary heart disease in adults [3].People with mental health problems such as schizophrenia or bipolar die on average 16-25 years sooner than the general population. Mental health promotion work in Medway will aim to reduce this inequality in health by linking with partners such as primary care, smoking cessation services, healthy weight, physical activity teams and service users to address this important issue.

2. Mental health services

Common mental health problems

Treatment of common mental health problems is provided by GP practices and the Primary Care Psychological Therapies Service (PCPTS) which is part of the national IAPT (Improving Access to Psychological Therapies) programme that was launched in 2008.

The PCPTS is being delivered in Medway by a stepped care approach via Any Qualified Provider. The link below goes to the current list of qualified providers

Step 2 provides low intensity treatment which consists of guided self help, guided use of computerised CBT, behavioural activation, structured exercise, psycho-educational groups, face to face CBT interventions and other therapies (up to 6 sessions)

Step 3 provides high intensity treatment which normally consist of face-to-face interventions (80% CBT, 20% other therapeutic modalities) and up to 20 therapy sessions with an average of 12.

The PCPTS programme has been designed to offer evidence based intervention and treatment choice to people with common mental health problems including depression and anxiety disorders including panic disorder, obsessive compulsive disorder, social phobia, generalised anxiety disorder, specific phobias and health anxiety.

Referrals to the PCPTS can be either through primary care or via self-referral. In 2011/12 there were 6,263 people referred to the PCPTS service in Medway. Of these 3,616 entered the service. Of those having 2 or more sessions of therapy 718 had moved to recovery.

Severe mental illness

Those with more severe mental illness are referred to secondary mental health services. These are largely provided in Medway by the Kent and Medway NHS and Social Care Partnership Trust.

Secondary mental health services in Medway currently provided by KMPT consist of:

Community mental health teams (CMHTs) are provided by Kent and Medway NHS and Social Care Partnership Trust. These are split into 2 teams (Access and Recovery) who provide support for people who have just been referred to the service and for those with longer term mental disorders. As of March 2012 there were 780 patients on the caseload of the Recovery service and 686 patients on the caseload of the Access service. Since April 2013, KMPT has operated one team, Medway Integrated Team (MIT) replacing the Access and Recovery Team.

Assertive Outreach Team works closely with CMHTs and take referrals for people who are difficult to engage and hard to reach groups and provide more intensive support. As of March 2012 there were 42 patients on the caseload of this team.

Crisis Resolution Home Treatment Team which provides an intensive service to clients in crisis to help prevent hospital admissions.

Early Intervention in Psychosis Team supports those aged 14-35 presenting for the first time with a psychosis. For Medway and West Kent combined there were 280 patients on the EIP caseload as of March 2012. For Medway this probably represents 40-50 patients.

In patient services for those with mental health problems are provided largely in A block at Medway Maritime Hospital however this building is not considered to be fit for purpose in the longer term and alternative arrangements are being considered following a public consultation.

The Medway Adult Mental Health Social Work Team has around 450 people on its caseload at any one time, and provides a Community Support and Outreach service to people with a severe mental illness living in their own homes in the community and assists with discharge and “re-ablement” following Hospital admission. A Day Resources Service is used by 80 people at any one time with a severe mental illness. The Social Work Team carry out an important statutory function in regard to assessing and detaining patients under the Mental Health Act. Currently, around 2/3 requests for assessments under the mental health act are received each day. About 60 people are assessed and supported through the Social Work team in 24 hour registered residential care placements.

Social care for those with mental health difficulties.

Current commissioned social care services for people with mental health issues are below


• Winfield Trust: IT project for people with mental health issues to obtain relevant qualifications
• The Medway 5 Carers Project is funded to provide mutual support to mental health Carers.
• Medway Carers First employs a Dual Diagnosis Carers Support Worker.
• MCCH provide supported housing for 25 people (this includes the Halpern Project). Sanctuary provide another 9 places at a higher level of weekly housing support.
• Funded annual arts event for people with mental health issues
• Supported housing
• An employment retention specialist is employed by Medway Council and attached to the KMPT Primary Care Psychological Service.
• A 24 hour/7 day a week specialist mental health helpline operated by Mental Health matters is available to users and carers.
• MEGAN (Medway user engagement and network) is an independent user-led project providing a voice to users as well as peer support groups.
• The Medway Recovery Hope Group, volunteer action co-ordinated through Rethink, has made strong links across black and other minority ethic (BME) communities and provides direct support to users from BME communities.

Currently social work mental health services are provided directly by Medway Council.

Specialist services

Offender/secure mental health services


• Custody diversion suites A custody diversion suite service has been set up in Medway. A Community Psychiatric Nurse is based at Chatham police station and is able to assess detainees immediately as referred by the police. This ensures that people with mental health issues are identified and appropriately referred. This service has been well received by the police.


• Secure facilities Low, medium and high secure forensic mental health services are commissioned for Medway residents from a range of providers. Low secure services are provided by KMPT at the Allington Centre. Medium secure services are provided by KMPT at the Trevor Gibbons Unit and high secure services are provided nationally at Rampton and Broadmoor. Commissioners report an increase in numbers of people going into medium secure services


• Mental healthcare and treatment in prisons Mental healthcare in prisons is provided by Oxleas NHS Trust and consists of a multi-disciplinary mental health team providing a range of services for prisoners with severe and common mental health issues including anxiety, alcohol, anger and sleep management support.

Maternal mental health

Perinatal mental health service

Dual Diagnosis

In response to issues identified previously, a dual diagnosis protocol has recently been completed which will clarify the arrangements for treatment of those with both substance misuse and mental health disorders.

Veterans Mental Health

Currently there are no local specialist mental health treatment services for veterans in Kent and Medway. However the following care pathway shows how veterans can access both local and national services from Medway. Veterans can access national specialised mental health assessment treatment services via the routes shown below.

Figure 1: Veterans national specialised mental health assessment treatment services pathway
Figure 1: Veterans national specialised mental health assessment treatment services pathway.

However there is a national plan for the implementation of the recommendations of the Murrison report [4] which included the launch of a 24 hour Combat Stress helpline and, the Big White Wall Online support in 2011. In the South East Coast additional veteran specific clinical posts are being established in local mental health services to improve access to and effectiveness of these services for veterans.

Eating Disorders

A review of eating disorder services has taken place across Kent and Medway. An options paper containing proposals to significantly change the service model has been produced and consultation on these will take place in 2012/13 and a business case produced.

Adult ADHD

The delivery and availability of services for adults with ADHD is variable across Kent and Medway. Current treatment services are provided by a tertiary provider, South London and Maudsley Trust who offer assessment and treatment. A review is being carried out across Kent and Medway to assess the clinical and economic case for the establishment of a comprehensive ADHD service in the Kent and Medway area for the local population. Commissioners report high levels of referral due to lack of diagnosis during childhood and adolescence.

Autistic spectrum disorder

A business case for a specialist assessment and diagnosis service in Kent and Medway with ASD/Asperger's syndrome was approved in 2011/12 and the service will now be commissioned.

Personality disorder

The Brenchley Unit provides an intensive day treatment programme for Medway residents.

Psychiatric liaison services

A psychiatric liaison service is now in place at Medway Foundation Trust provided by KMPT. This provides mental health clinical support and expertise for A&E clinical staff and also where possible to clinical staff throughout the hospital on appropriate management of presenting mental health conditions in those with physical illness. About 1,500 people a year are seen in Medway Maritime Hospital in order to improve the mental health of those presenting with mental health issues. The liaison service in Medway has been extended to reach into acute hospital wards as well as emergency departments in order to offer assessment and support to those people presenting with a physical health problem and a mental health need.


References

[1]   Grant C, Goodenough T, Harvey I, et al. A randomised controlled trial and economic evaluation of a referrals facilitator between primary care and the voluntary sector British Medical Journal 2000; 320: 419-423.
[2]   NHS Eastern and Coastal Kent. Promoting Mental Health and Wellbeing NHS Eastern and Coastal Kent 2010 v2 2010; NHS Eastern and Coastal Kent. http://www.kmpho.nhs.uk/geographical-areas/primary-care-trusts/eastern-and-coastal-kent-pct/?assetdet956088=100373 .
[3]   Department of Health. No health without mental health: a cross-government mental health outcomes strategy for people of all ages February, 2011; Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123766 .
[4]   Murrison A. Fighting Fit: A mental health plan for servicemen and veterans 2010; http://www.southofengland.nhs.uk/wp-content/uploads/2012/03/Murrison-Report-Fighting-Fit-Combat-veterans-Final2.pdf .