1. The Health and Social Care Academy Integration Series The Power of Prevention Then gently scan your brother man, Still gentler sister woman; Tho' they may gang a kennin wrang, To step aside is human. Address to the Unco Guid, Robert Burns #HSCAcademy

2. Welcome Jill McGrath Scottish Government #HSCAcademy

3. David’s story: the cost of crisis – Ruth Campbell, Serenity Café Group exercise: put your money where your mouth is Feedback Social Impact Bonds and outcome focused prevention – Jill McGrath, Perth and District YMCA Q&A and open discussions #HSCAcademy

4. Finally lets someone into his flat – all his clothing and bedding is wet. Housing won’t engage because the call has to come from David. David’s Story Split with girlfriend Stops taking medication. Mental state deteriorates quickly. Trashes his sink and blocks up toilet, but continues to use taps and flush Flat floods Goes to local community facility in a very agitated state. His behaviour is difficult. Initially he won’t let staff see what has happened at his flat. Starts being aggressive 40 years old, problems with alcohol and also schizophrenia, living in Dumbiedykes with girlfriend but isolated from family and community

5. It is Sunday and David is back at the community project, agitated and unable to control his behaviour. David’s Story The Area Housing Manager issues a letter requiring access. David ignores the letter, the Council break down the door, condemn the flat as uninhabitable, and bar the door. David’s crisis deepens The community project phones Social Care Direct, and David’s GP and describe his behaviour – now a danger to himself and others. The GP tries to phone David. David no longer has a phone The community project finally brokers an appointment with the GP. David attends but storms off after 2 minutes. The GP refers him to the CMHT. David is increasingly aggressive Social Care Direct say if the GP is involved, there will be not further SW involvement.

6. The Police have to put David in the cells. David kicks off and gets arrested again David’s Story The community project has never succeeded in getting anyone who needs help admitted for immediate support to REH. They call the Police, to see if they would have more success The Sheriff tells David to behave himself and releases him. David has nowhere to go David ‘escapes’ to stay with his dad in a town 15 miles away. All the services switch off now the problem has relocated. David and his dad fall out

7. David disappears David’s Story Again, once released, David tries to access his flat. He can’t get in, and can’t go back to his dad. Mental health assessments fail – he turns up but is turned away because he is thought to have drug- induced psychosis. David is finally arrested for assault and sent to prison, where he spends Christmas and New Year. There was no mental health assessment in prison. Two weeks after release an Adult Protection Case Conference is called. The community organisation is not invited. Finally?

8. What do you think? Wouldn’t happen? Does happen?

9. What is the financial cost? Housing£1500 Housing repairs£1000 Changing the locks£400 Police call outs£3500 Custody£1200 Court process£4000 Prison£2000 GP £130 Social work£1000 CMHT£300 Community project£1000* *staff time, food, clothing, crisis money for electricity; none of which is paid for by statutory services in any form of grant or reimbursement

10. You have £16,000 How would you use this to intervene in David’s situation? When would you intervene, and what would you do to redirect the story? What do you want to be the final outcome, and how will you make this happen? If you allocate staff time, what are their tasks and how much time will you give?

11. Using your budget Social work£28 Community mental health worker£25 Community project£15 Housing officer£20 Housing repairs Psychiatrist£30 Hospital bed per night£273 Crisis centre per night

12. Feedback on group exercise Put your money where your mouth is #HSCAcademy

13. Final point….. Paying the Price (England) Schizophrenic disorders If early detection services could be rolled out to achieve 100 per cent coverage by 2026 then savings of £18.4 million could be realised.

14. #HSCAcademy On your £10 note tell us… What preventative work would you invest in? What funding would you cut to pay for it? Thank You! www.academy.alliance-scotland.org.uk/ academy@alliance-scotland.org.uk @HandSCAcademy