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Mental Health Prevention and Recovery and the Community Preventing Mental Illness 14 September 2015 Janet Southworth Health Improvement Principal (Public.

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Presentation on theme: "Mental Health Prevention and Recovery and the Community Preventing Mental Illness 14 September 2015 Janet Southworth Health Improvement Principal (Public."— Presentation transcript:

1 Mental Health Prevention and Recovery and the Community Preventing Mental Illness 14 September 2015 Janet Southworth Health Improvement Principal (Public Health) Janet.southworth@sheffield.gcsx.gov.uk

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4 When you have good ‘Wellbeing’ you Feel good ……. ….you can function well @ work, home, college, hobbies ……it builds your resilience and helps you help others…. Reflect…Think about the last 24 hours what things helped your wellbeing?

5 Although our genes influence about 50% of the variation in our personal happiness, our circumstances (like income and environment) affect only about 10%.As much as 40% is accounted for by our daily activities and the conscious choices we make. So the good news is that our actions really can make a difference. http://www.actionforhappiness.org/ Action for Happiness – Happiness Facts

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8 Resilience is … Ability to bounce back Capacity to recover quickly from difficulties/set backs Stay committed and increase effort when going is tough Power to return to original form after being bent or stretched Ability to cope with life’s challenges and to adapt to adversity Accepting change and looking for the opportunities Resistance to negative events

9 Wellbeing is important because…. It adds years to life Improves recovery from illness Is associated with positive health behaviours Is associated with broader positive outcomes Influences the wellbeing and mental health of those close to us Affects how staff and care providers work

10 http:/http://www.time-to-change.org.ukhttp://www.time-to-change.org.uk///www.time-to-change.org.uk/ How can you help? You can help us create a society where mental health problems are not hidden in shame and secrecy. You can ensure your friend or relative is not afraid to speak out about their problems, or is left wondering where they can turn for help.. Read our advice for friends and family. Find out how as an individual you can take action and support Time to Change.Find out how as an individual you can take action and support Time to Change. Find out how your organisation or workplace might get involved.Find out how your organisation or workplace might get involved. Read our magazine looking at how workplaces are tackling stigma on the office floorRead our magazine looking at how workplaces are tackling stigma on the office floor http://www.time-to-change.org.uk/

11 What do you currently do to promote wellbeing? …..think about your work, or your life in general. Can you think of ways you could build on this?

12 Ensure a Positive Start in Life Build Resilience & a Safe, Secure Base Integrate Physical & Mental Health & Well -Being Develop Sustainable, Connected Communities Promote Meaning & Purpose Prevent and reduce impact of Adverse Childhood Experiences: Child abuse Parental mental illness Parental substance misuse Parental Domestic Abuse Household offender Childhood bereavement Improve: Parenting & Parental Health Social and Emotional Literacy in Healthy Schools Violence & abuse prevention skills Early interventions for conduct & emotional disorders Reduce Inequalities: Unemployment Fuel Poverty Homelessness Violence and Abuse Impact of Climate Change Promote: Employment Benefits Checks Safe Green Spaces Insulated & Warm Homes Partnership Working Reduce: Smoking Alcohol Drugs Obesity Improve: Physical activity Healthy Food Sexual Health Health Checks Reduce Social Exclusion: Address Discrimination & Stigma Target High Risk Groups Enhance: Community Engagement Ecological Intelligence & Connectedness Meaning from Adversity: Post Traumatic Growth Psychological therapies Positive Reflection Cultivate purposefulness & fulfilment: In Life, Work, Education & Volunteering By Creativity, Coherence & Flow With Inclusive Beliefs and Values Reduce Risk Factors Promote Protective Factors Nurse J 2008 Create Flourishing, Connected Communities A Public Mental Health Framework for Developing Well–Being

13 Preventing mental ill health happening again Melanie Hall Strategic Commissioning Manager Mental Health

14 Making and Sustaining Change Testing out Change in Life style Change in Behaviours Change in thinking

15 Relapse prevention plans What if….. Then try… or try….. Formal Crisis contingency plans Informal ‘don’t worry mate, I will be at home if you need a chat’

16 Survivors They know themselves best What was it like? How do you cope?

17 Skills Listen Empathise Be interested Help people solve issues themselves.

18 Social contact Sense of Purpose Sense of Acceptance

19 Summary Preventing mental ill health happening again can be achieved for individuals, through acknowledging change is hard, and helping them. Remembering that people know themselves best, Listening and, Building on strengths.

20 Inspector Julian Rawthore 14.09.2015 Mental Health Crisis Care and Street Triage

21 Crisis in the Home Protocol with Sheffield Health and Social Care Officer rings 271 6310 Community Psychiatric Nurse (CPN) Approved Mental Health Practitioner (AMHP) Get the best outcome

22 Outcomes Leave them there Mental Health services will follow it up Detain under Mental Capacity Act 2005 Take to A&E by ambulance

23 Street Triage SMED Police Officer and Mental Health professional Marked Police Car attend mental health related Police incidents and assist. Cover 4pm x midnight 365 days a year.

24 Sec136 of Mental Health Act 1983 In Public In need of Care and Control for their safety or safety of others. Detain them Place of Safety for the purpose of a Mental Health act assessment (AMHP and two Doctors)

25 Place of Safety Health based place of safety Maple Ward One bed Disputes over intoxication/violence. Police Custody should only be used under exceptional circumstances

26 Conveyance / Transport Police Vehicles should only be used where person is violent or highly likely to be violent. NHS patients should be transported by Yorkshire Ambulance Service or other commissioned service provider.

27 Future Increased staffing at Maple Ward should reduce the number of times it is closed, and therefore reduce the numbers that go to custody. Police are going to stop taking children to Custody….. 16 and 17yr olds. But still waiting for health based place of safety suitable for them to be provided by CAMHS.

28 Missing Mental Health patients Longley Centre and Michael Carlisle Centre are not classified as secure units, some voluntary patients, most are there under a MHA section. Granting of home leave by Clinicians (Psychiatrists)

29 STREET TRIAGE A very pragmatic Multi agency approach taken toward Mental Health Sid Fletcher Senior Approved Mental Health Practitioner Sheffield Out of Hours

30 Background The last 10 years Mental Capacity Act 2005 Mental Health Act 2007 MHA Codes of Practice Lord Bradley Report 2009 No Health without Mental Health Criminal use of Police Cells HMIC Lord Adebowale report 2013 Crisis Care Concordat 2014 The list goes on........

31 “The police are forced to mop up situations that mental health and social services should be dealing with” although colleagues in health and social care were quick to point out, that this sometimes works in reverse. I often find that police officers don’t realise where we cause chaos and confusion: the misuse and abuse of s136 MHA; the all-too-often poor response to allegations of violence or crime by people with mental health problems. It’s easy to wear blue and see the failings of a chronically under-funded health and social care system – its harder to see what’s right in front of us A lack of proper partnerships and infrastructure for mental health emergencies; a lack of parity across our society and especially within our NHS for physical and mental health care; and a police service which has been hoping that the need to deal with mental health incidents would go away, if only partners would sort their resources and their responses. Well, it won’t – it’s core police business” Insp Michael Brown AKA Mental Health Cop

32 Background The last 10 years Mental Capacity Act 2005 Mental Health Act 2007 MHA Codes of Practice Lord Bradley Report 2009 No Health without Mental Health Criminal use of Police Cells HMIC Lord Adebowale report 2013 Crisis Care Concordat 2014 The list goes on........

33 Adebowale – A waterhed moment Lord Adebowale makes 28 recommendations, falling in to three categories of business, Leadership Frontline policing Inter-agency working A lack of leadership which the report suggests needs to be rectified at the level of the Commissioner; A lack of training and effective joint protocols with health and social care organisations which leads to it being all “too common and too easy” for Police officers, AMHPs and NHS staff to have on-the-ground disputes over tactics and responsibilities. Finally, a lack of established partnership structures through which to brigade all of this across the Metropolitan Police.

34 Crisis Care Concordat A national agreement between services and agencies involved in the care and support of people in crisis. It sets out how organisations will work together better to make sure that people get the help they need when they are having a mental health crisis.

35 Mission Statement MH Concordat –Feb 2014 We commit to work together to improve the system of care and support so people in crisis because of a mental health condition are kept safe and helped to find the support they need – whatever the circumstances in which they first need help – and from whichever service they turn to first. We will work together, and with local organisations, to prevent crises happening whenever possible through prevention and early intervention. We will make sure we meet the needs of vulnerable people in urgent situations. We will strive to make sure that all relevant public services support someone who appears to have a mental health problem to move towards Recovery. Jointly, we hold ourselves accountable for enabling this commitment to be delivered across England.

36 Crisis Care Concordat Four main areas: Access to support before crisis point – making sure people with mental health problems can get help 24 hours a day and that when they ask for help, they are taken seriously. Urgent and emergency access to crisis care – making sure that a mental health crisis is treated with the same urgency as a physical health emergency. Quality of treatment and care when in crisis – making sure that people are treated with dignity and respect, in a therapeutic environment. Recovery and staying well – preventing future crises by making sure people are referred to appropriate services

37 An end to Silo working!

38 Street Triage Shared goals and culture Building of relationships and communication Avoidance of jurisdictional battles Strong, brave leadership Ownership of responsibilities Not just top down approaches

39 Street Triage A very pragmatic Multi agency approach taken toward MH For SHSC nominate an experienced MH staff member to work with and attend any Police incident where there may initially appear to be a component of Mental Health issues, at this initial point the Mental health professional and police will evaluate the situation and divert accordingly. Using the experience of the MH Professional the Police are able to take a managed and Positive risk taking approach to those who present to them with MH concerns, whilst ensuring that appropriate treatment and provision of services is provided to those in urgent need of care. The Professionals authority is backed up by Police powers and assistance. The team acts as a dedicated joint MH resource. They are not ordinarily deployable to other incidents and sit outside the duty teams. They can act as a point of contact for Police officers requesting advice and support over the phone

40 Definition of Triage The term comes from the French verb trier, meaning to separate, sift or select.French The term triage may have originated during the Napoleonic Wars and during World War I by French doctors treating the battlefield wounded behind the frontline. Those responsible for the removal of the wounded from a battlefield or their care afterwards would divide the victims into three categories: Those who are likely to live, regardless of what care they receive Those who are likely to die, regardless of what care they receive Those for whom immediate care may make a difference

41 1, 2 or 3?

42 So how does it work 4pm- 12 midnight 7 days a week Police sit in MH team – share info Emphasis on prompt attendance to requests Referrals are made only by Police MH worker will only deal with such referrals Secondary response Emphasis on Triage not full assessment

43 Sheffield (May – July 2014) Left at home / community 66 A+E attendance ( intoxication) 4 A+E attendance ( medical intervention) 8 A+E attendance ( further MH assessment ) 11 S136 – Maple 2 S136 – Police custody 2 S136 – A+E 1 Police arrest ( affray) 1 Telephone consultation only* 10 Other outcomes 2 Total 107 10 week period -Multiply x5.2 for 1 year

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45 Inferences *Without Street Triage we can conservatively assume that due to the low risk threshold traditionally adopted by Police - most clients would end up at Maple, custody or A+E* Over 65% of clients seen by this service are left in situ at home or in Community Under 25% require A+E attendance 4.2% due to intoxication / management 8.5% for medical intervention 11.7% for further mental health assessment The use of Police s136 powers and the use of custody as a means of disposal is drastically reduced down to 6.5% of service users seen during the hours that Street Triage is operational Our data mirrors and colludes with previous South Yorkshire Police analyses of Street Triage

46 Benefits Much better understanding across parties Greater recognition of parameter, function and role Increased communication/ contacts made More positive risk taking Crisis Care Concordat Compliant

47 Professional Feedback SHSC Management I just wanted to highlight this piece of feedback. ….. always speak highly of this project, and I think it is delivering some solid outcomes (to be evaluated), but one of the other major outcomes is the improved relationships with police, which has happened very, very quickly, and after years and years of fluctuating levels of antagonism. It strikes me that the best way to improve relationships between teams, or services, or organizations, is usually to have very clear, practical tasks that frontline staff work on together. I also think it says a lot about how ………… and the other staff who have been involved in the project have gone about their work. Police- At the recent Force wide MH meeting, it was highlighted to the group that the working and professional relationships between SYP and you and your colleagues is better than it has been in many years. The inter-agency understanding and professional relationships continue to improve and this is one of the real and tangible benefits of this project. Many thanks for your continued support for this scheme.

48 Questions please

49 The diary of a Mad Cow Kerry-anne Mulvey

50 The Beginning Kerry’s Law My brain was too full Feeling useless Avoidance Broken Isolation Unable to cope with even the small things Hopeless Suicide

51 The Road to Recovery Coping Mechanisms – I was leaning heavily on avoidance as a coping mechanism. Avoiding finances and all forms of responsibility Self Help – I tried to help myself in crazy ways that was actually setting myself up for failure. I tried to grow a bonsai tree from seed, then I tried to make jewellery which fell apart and re-enforced my feeling of being a failure

52 The Road to Recovery Sabotage Hypervigilance Taking smaller steps i.e. one thinking and then one doing action each week. Setting myself up for success Recognising I had created a little bubble where I was safe and comfortable Transactional analysis

53 Going it alone Relapse Signatures Relapse Plan Wobbles and then more wobbles and still some wobbles to this day ‘STARS CAN’T SHINE WITHOUT DARKNESS’

54 Happy Days!!! Great Manchester Run Joining a local Amateur Dramatics Group 10k Assault Course Panto (Oh yes I did) Family & Friends Jack Animal Rights ‘The journey of a thousand miles starts with a single step’

55 A New Beginning

56 PREVENTING MENTAL ILLNESS GETTING WORSE. Helen Robinson: Sheffield Mind.

57 Sheffield Mental Health Guide www.sheffieldmentalhealth.org.uk

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59 Carers In Sheffield www.sheffieldcarers.org.uk

60 S O WHAT CAN WE DO TO PREVENT MENTAL HEALTH GETTING WORSE ? Talk to your GP Talk to your care coordinator Talk to your workers in the VCF sector Talk to family & friends If things continue to deteriorate – crisis care

61 P REVENTING MENTAL ILLNESS GETTING WORSE : Recovery Agenda Symptom Education Self Help Skills Increased Resilience Sense of Purpose

62 R ECOVERY A GENDA : Belief Acceptance Hope

63 S YMPTOM EDUCATION : Educating the public. Promoting the wellbeing agenda. Understanding triggers. Exploring the options.

64 S ELF HELP SKILLS : Taking back control. Symptom management. Increased engagement. Coping skills.

65 I NCREASED RESILIENCE : Identifying and developing personal resources.

66 S ENSE OF PURPOSE : A sense of contributing; of being part of society rather than being excluded.

67 S O HOW DO WE GET THERE ? Change in attitude Joined -up working Variety of approaches: Diversity & adaptability

68 T O CONCLUDE... These are our ideas: I look forward to hearing your ideas... Promote the recovery message Education around symptoms Development of self-help skills Increased resilience Acknowledge worth and encourage a sense of purpose


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