2. The Evidence

3. Why EPIC? Patchy cultural awareness in mainstream mental health services Mistrust of mainstream mental health by BME communities Avoidance leads to more likelihood of access in crisis More likely to admit BME service user to hospital More likely to detain BME service user under MHA

4. Project Overview Promotional activity and awareness raising to assist in more appropriate referral of clients. Improve access to other forms of treatment by facilitating early discharge Address stereotyping and enhance professional competence Improve data collection and usage Improve relationships between statutory and non statutory services

5. Sheffield Crisis Service 1 Assessment Team 2 Home Treatment teams Roles and responsibilities ‘Crisis Hub’ during ‘out of hours’ period (AMHP’s/medics/nurses) Gate keeping of acute admissions Home Treatment as an alternative to admission Facilitation of Early Discharge to shorten stays in hospital

6. Opportunities provided by PMC Functions; weddings Training; language, IT, further education Activities; gym, arts and craft Healthy lifestyle promotion Sukhoon Clinic; women's mental wellbeing Organised shopping trips Immigration support; passports, visa Translation support Children's needs; education support, play scheme

7. Setting of First Direct Contact (Full Year) White UKBEMs Clients Home81.2% (381)18.8% (88) Police Station65.8% (25)34.2% (13) Telephone84.5% (435)15.5% (80) A&E86% (510)14% (83) Other Location84.8% (89)15.2% (16)

8. CAHT Ethnicity Distribution Compared to Sheffield Census

9. Clinical Outcomes by Ethnicity Demographic HoNOS Difference Score (Assessment – Discharge) Mean (StD) BPRS Difference Score (Assessment – Discharge) Mean (StD) Ethnicity White UK Black and Ethnic Minorities 5.9 (5.7) 7.8 (7.5) 9.3 (9.6) 12.8 (13.4)

10. Effectiveness of Home Treatment Mean difference of outcome measure between admission and discharge BME group had higher HoNOS and BPRS scores on admission to ‘Home Treatment’ BME group in ‘Home Treatment’ showed greater improvements Results are statistically significant Local sample of 123 Home Treatment clients in 2005 (20% BME)

11. Specific to EPIC Project In the 1 year period there were 54 patients (2.4%) whose ethnicity was recorded as ‘Asian or Asian British Pakistani’

12. Quantitative data being collected on effectiveness of 3 pathways 16 Pakistani In-patients identified by link worker 8/16 accessed link worker for advocacy 4/16 accessed PMC 2/16 accessed Home Treatment via ‘early discharge’ e.g. Preliminary results for period Oct ’06-Jan’07

13. Transferability Sheffield has 3 EPIC projects; Pakistani Muslim population Sheffield African Caribbean Mental Health Association (SACHMA) Somalian Mental Health Project

14. Opportunities Provided by (SACHMA) Accommodation tenants supported towards independent living Community Support collaborate approach to helping people remain independent within their community Advocacy primarily within secure/hospital. Negotiate service improvements, information, attend tribunals/CPA/ward meetings, challenge inequalities Carer Support Service assist carers to access services and make demands on upon services Resource Centre/Lunch Club arts, crafts, aromatherapy, computer studies Assertive In-reach monthly culturally specific evening in secure hospitals

15. Average Length of Stay African & Caribbean service users Initially looked at the trimmed length of stay data to compare White British with African and Caribbean (A&C) groups This data conveyed the message that you are likely to spend 3 more days on the ward if you were from an A&C ethnic group Now use untrimmed data and geographical locations This new methodology has yielded some surprises including the revelation that the wards in the North of the city have a much longer length of stay for A&C groups compared to the South (especially Black Caribbean patients) The next slide shows the startling discovery made around Black Caribbean patients and their geographical location in the city

16. Average Length of Stay cont…

17. Sustainability Awareness raising – we have placed a lot of emphasis on the analysis and interpretation of data, recognising that this can be a lever that the Trust will respond to Result : Data is now a regular part of Senior Management reporting process Shared ownership – emphasis on spreading the message across the Trust and also within the SHA Result: Harder to quantify at this point in the project Developing staff competency and awareness Result : Organisation is recognising the importance of this strategy and realising it can be a lever to promote and sustain change Securing funding for the pathway – voluntary sector partnership Result: There appears to be agreement that the Trust needs to take a more holistic view of its partnership work and how best to invest in this for the future

18. What elements could be sustained and how will this be accomplished? Data – real emphasis on sustaining and monitoring the trajectory of experience and outcome for particular user groups SHA – want to explore performance management across the region on this particular issue EPIC manual – will be developed and disseminated Developing a plan for ‘Count Me In’

19. Barriers to sustainability and strategies to navigate these Barrier 1 – TIME ! Strategy : Not sure we have a strategy for this !! Barrier 2 – Ownership Strategy: Robust promotion during 2009 & more training and development for staff Barrier 3 – Keeping this issue on the agenda Strategy: compulsory part of reporting requirements Barrier 4 – Does EPIC really work? Strategy: ensuring that we are able to respond, with evidence to this question. Barrier 5 – Funding Strategy: Structures within the Trust are being established to ensure the future of Community engagement Work

20. Questions