Improving Mental Health

Introduction 1.Kim Crowe – Executive Director of Service Development and Delivery 2.Mersey Care NHS Trust 3. Service User and Carer involvement 4. Contribution to improving patient safety 5. An example of service user involvement 6. Evaluation of service user and carer involvement

1.Kim Crowe – Executive Director of Service Development and Delivery 2.Mersey Care NHS Trust 3. Service user and carer involvement 4. Contribution to improving patient safety 5. An example of service user involvement 6. Evaluation of service user and carer involvement

2. Mersey Care NHS Trust Specialist provider of Mental Health, Learning Disability and Addiction services to Merseyside in North West England. (weighted population of 1.4m) Medium secure service to Merseyside and Cheshire (weighted population size of 2.9 m) One of 3 providers of High Secure Mental Health Services in England covering North West England and Wales. (weighted population size of 6.9 m)

Demographics and Demand Some of the most deprived communities in the UK Higher than average unemployment rates Total population remains unchanged but proportion of Older People increasing Higher than average incidence of drug abuse and excessive alcohol consumption Demand for learning disability services forecast to increase over the next 10 years

Mersey Care Vision and Strategy Vision To be recognised as a leading organisation in the provision of Adult Mental Health, Learning Disability and Substance Misuse care that has at its heart health and well-being. Strategy To improve the quality and increase the value of services To enhance partnership arrangements to deliver a better range of integrated services. To consolidate, develop and expand the range of services provided. To become a better organisation by building on involvement with stakeholders and strengthening governance.

Services Provided By Mersey Care Inpatient and community based services for - Adult and older peoples mental health - Addictions – drugs and alcohol services - Learning disabilities - Brain injury - Medium secure services Inpatient High Secure service 710 Inpatient Beds 4,300 Staff 35 Sites Budget for £189m

1.Kim Crowe – Executive Director of Service Development and Delivery 2.Mersey Care NHS Trust 3. Service user and carer involvement 4. Contribution to improving patient safety 5. An example of service user involvement 6. Evaluation of service user and carer involvement

3. Service User and Carer Involvement Mersey Care established 2001 Consultation process included service user and carer views Recruitment to Board level posts of new organisation included service users and carers. Service User and Carer Forum established Involving Service Users and Carers Policy

Current Examples of Service User Involvement Trust Board All Committees of the Board Annual appraisal for Directors and Consultant Pyschiatrists Policy Formation e.g. Adverse Incidents, Suicide strategy Recruitment - Mersey Care Mersey Care posts recruited to since 2003 Universities – recruitment and training programmes. Training - induction and equality/human rights training Service development Incident reviews Evaluations – SURE Group Governance Checks for Clinical Business Units Environmental Inspections

Mersey Care NHS Trust Governance Structure

Making it Happen Data base of service users and carers Access to training opportunities Work experience Volunteer Policy Payment for contribution £12 per hour (14 euros)

1.Kim Crowe – Executive Director of Service Development and Delivery 2.Mersey Care NHS Trust 3. Service user and carer involvement 4. Contribution to improving patient safety 5. An example of service user involvement 6. Evaluation of service user and carer involvement

4. Contribution To Improving Patient Safety Performance Framework – quality and safety informed by: -National Policy -Clinical Quality Commission - inspections -Local Contract for services - core payment and quality premium -Quality Account – locally determined priorities

Performance Framework

Quality Account Local Priorities Improve the care pathway Improve patient environment Improve stakeholder engagement Reduce top 5 incidents and complaints –Incidents – violence and aggression, falls and self harm –Complaints – care and treatment, staff attitude

Director of Patient Safety Incidents Violence and Aggression Complaints Legal Claims Safety Culture Service users involved in all of the above

1.Kim Crowe – Executive Director of Service Development and Delivery 2.Mersey Care NHS Trust 3. Service user and carer involvement 4. Contribution to improving patient safety 5. An example of service user involvement 6. Evaluation of service user and carer involvement

5. An Example of Service User Involvement in Brain Injury Services Service User & Carer Away day in April 2010: –The need for a facility for service users and carers to drop in, meet, exchange information and provide peer support. –The increased use and involvement of service users and carers in the development and delivery of Brain Injury Rehabilitation Services. –Better access to timely information about Brain Injury and local services of support. –Providing a regular opportunity to feedback for service users and carers to the Brain Injury Rehabilitation Service about how it is doing by questionnaire or telephone call or group.

Achievements to date … Confidence booster A chance to learn from others and share experiences Helps to discuss different approaches to life Opportunity to talk to professionals and change services Makes you feel relaxed –stops your worries and helps you help yourself Forum for ideas

What we have achieved so far … Personal: –Brought people together –Better understand myself and others with brain injuries –Boosted confidence and people skills Group: –Raised awareness of brain injuries –Developed signposting ideas –Act as a Service User & Carer Forum –Linked up community and inpatient services –Service user and Carer committee to action and take forward the issues highlighted at the drop in centre

The Future Improve Service User involvement: –Act as service users representatives/consultants in all areas of the service –To have a voice to shape the future of the Brain Injury Rehabilitation Centre –Volunteer opportunities: Sports Programmes – swimming, fitness Mentoring/buddy programme on the ward Group co-facilitators on education and ward programmes Service User and Carer Led drop-in centre

1.Kim Crowe – Executive Director of Service Development and Delivery 2.Mersey Care NHS Trust 3. Service user and carer involvement 4. Contribution to improving patient safety 5. An example of service user involvement 6. Evaluation of service user and carer involvement

SURE comprises a small group of Service Users & Carers who have been trained to undertake audit, research and service evaluations… 6. An Evaluation of Service User & Carer Involvement in Mersey Care NHS Trust

Why Become Involved?

It has helped me regain my sense of purpose in life and a lot of my dignity following my breakdown. To have something important to get up for in the morning became my motivation to live and carry on. I hate to think where I might otherwise have been. Being involved with MCT has changed my life. It has given me the opportunity to try and help the way service users are treated and to help change bad practices. Made me feel useful again. As if I have the ability to think and contribute. Improved self-esteem and confidence. Feeling valued which resulted in improved self-respect and respect from family and friends. Being able to 'treat' family with payment, as felt they’d earned it! My input is true, honest and if my experience can help others not do the pain I went through over the past 27 years, then so be it. I just want to be me. Helped me to meet other carers whose sons/daughters have been sectioned and been in hospital for long periods. Meetings have acted as a support group and friendships have formed. I enjoy working with fellow service users, with carers and with Mersey Care staff. I really feel listened to. Being involved with Mersey Care has transformed my life, from being in a position where I thought I had no place in life to a position of respect and responsibility.

Mental Health and Recovery

When I was at my most ill, I had no confidence, sense of purpose or motivation. Now I am out and about and involved in all sorts of meaningful activities and it is like I have a new lease of life! The day I met Lindsey changed the course of my life forever and I shall always be grateful for this. Thank you. I always thought I was a bit thick. I never went to school on a regular basis. Mersey Care has given me back my self worth and confidence. I know I will always have a mental illness but at least now I have a voice and I am valued. Overcame agoraphobia by being involved and having to face people. Made me push myself when due to be on a pre-arranged interview panel (recruitment and selection). I am involved in groups and activities I probably would not have been involved in. Apart from certain physical activities, I don't think I have a limit. Getting involved with other service users and carers and staff has allowed me to use skills I have. Involvement with Mersey Care has given me a sense of purpose, greater confidence and most importantly, the opportunity to mix with others and feel valued and respected as an equal. For many years I thought of myself as a non-person, existing not living. On being involved with Mersey Care I have found I have something to offer. Life, once more, has purpose.

Involved In Care

Changes Seen I feel service users and carer’s have largely earned the respect of Trust managers and they are much more accepted as part and parcel of the way things are done in Mersey Care. I think that the fact that Mersey Care involves service users and carer’s has made a big difference especially in treatment on the wards and around the Trust. We are now seen as people. Every month there's something new to get involved in. If you wish! Less shortlisting this year. Only had one. The other one got cancelled. Improved attitudes of staff to service users, i.e. seen as individuals. Positive effects of Reader in Residence and Everton Projects. Seeing how much effort and care that staff put into their work. I feel a bit more confident with others and have also, at all the events, been made to feel welcome (especially by the Director, Ms Lindsey Dyer - a lovely and competent woman). More emphasis on human rights.

Changes To Attitude Working with service users and carers has had such a positive change in my attitude. Would like to think I was always caring/compassionate but in this role it has heightened my sensitivity to the needs of others and inspired me to constantly assess my values and opinions. I hope that I always appreciated the qualities and potential contribution of people using services, but this continues to be reinforced by the capabilities and generosity that is shown by people I work with in Mersey Care. Made me focus on what the job is all about. Try to involve service users from older people’s services - not on database but have a big group of people with dementia and carers who have been involved in service redesign in Liverpool CBU. Increases my confidence in MCT as a whole due to the importance of service user/carer involvement. Become much more explicit that involvement is a human rights issue. It provides both a grounding and focus as to the purpose of the service we provide, and enables challenge and constructive discussion to occur which might not ordinarily flourish. Makes the service focus at all times on what's at the heart of our service - the people.

Changes To Practice I am more empathic as a person. I think I have perhaps moved away from a slightly 'protective' approach to people, which risked patronising and underestimating them. Service users now play an integral role in core business discussion, especially with any changes, and involvement on a day to day basis ensures that decisions are better informed. Made me think a lot more about how I communicate with service users. It has resulted in me thinking what additional information I can provide for hospital inpatients during their stay. More clearly linking involvement of service users/carers to a human right based approach to healthcare. There is no doubt that the comments and actions of service users and carers are currently helping shape future working practices.

Changes Seen It is now expected that there will be service user and carer involvement - whereas before it was not initially on the table. I feel now that it's not looked at as 'something to remember' but it's now always on the agenda with everything else. Increased feelings of empowerment and confidence in service users. This leads to increased job satisfaction for staff involved. I believe it really helps address staffs' negative attitudes. Allows service users to be seen in a more positive light and builds their confidence. Bravo. I have seen service users giving their own presentations at conferences, meetings and events(instead of professionals speaking for them). Improved reception area. Improved service user information. I think it has done a lot to promote the concept of recovery when staff see living examples in front of them. Service user’s expression of empowerment, having meaningful roles. Reduced anxiety amongst staff about meaningfully engaging service users in Trust business. More positive attitude amongst staff re involvement. Having service user involvement within the development of the clinical business unit has ensured the direction of the CBU is measured, and balances the strategic direction to meet service user needs along with the challenge of value for money.

Conclusions Involving Service Users and Carers improves care delivery. Culture change takes time. Benefits are worth the investment