1. The mental health ‘stepped’ model of care
North Central London (NCL): Mental Health Crisis Care
Contact: Pippa Wady
Our population
Mental Health proposals for North Central London
The number of children with a mental health disorder is above the England average in Enfield, Haringey and Islington, which have large areas of deprivation.
Islington has the highest rate of psychotic disorders in England, and Camden the third highest. All five boroughs have a rate higher than the England average.
Islington has the highest number of people with diagnosed depression in London.
There are high rates of mental illness amongst both adults and children and many conditions go undiagnosed
50% of all mental illness in adults begins before 14 years of age and 75% by 18.
Develop a ‘stepped’ model of care supporting people with mental ill health to live well, enabling them to receive care in the least restrictive setting for their needs. We recognise the key role and accountabilities of social care for people with longstanding mental ill health and drawing on this will be central to the success of the stepped model.
Three NCL boroughs have the highest rates of child mental health admissions in London.
There are high rates of early death amongst those with mental health conditions, particularly in Haringey and Islington, and the rate of inpatient admissions amongst this population is above the national average.
85% of the mental health bed days in NCL are from patients staying over 30 days.
The mental health ‘stepped’ model of care
Improving the acute mental health pathway: building community capacity to enable people to stay well and reduce acute presentations. This includes developing alternatives to admission including strengthening crisis and home treatment teams; reviewing Health Based Place of Safety (HBPoS) provision with the view to reduce the number of units and to have a sector wide provision that meets all requirements; and investing in longer term supported living arrangements to ensure effective discharge. This will enable more people to live well in the community.
Investing in mental health liaison services: scaling up 24/7 all age comprehensive liaison to more wards and emergency departments ensuring that more people in emergency departments and on inpatient wards with physical health problems have their mental health needs assessed and supported, as identified in the Mental Health Five Year Forward View (FYFV). This will ensure that mental health needs are identified and treated as early as possible and that both physical and mental health needs are addressed.
Developing a Female Psychiatric Intensive Care Unit (PICU): we will ensure local provision of inpatient services to female patients requiring psychiatric intensive care, where currently there is none. This will enable patients to remain close to their communities, with a more streamlined and effective pathway ensuring a focus on recovery.
CAMHS and perinatal: strengthen these services by developing a specialist community perinatal mental health team that serves the NCL population and the physical health acute trusts within NCL.
Challenges
There is no high quality Health-Based Place of Safety (HBPoS) in NCL to receive people detained by the police under Section 136.
Many people receive their first diagnosis of mental illness in Emergency Departments.
High numbers of people are admitted to hospital – many under the Mental Health Act.
There is variable access to liaison psychiatry, perinatal psychiatry and child and adolescent mental health services (CAMHS) within urgent care. Most of the liaison psychiatry and CAMHS services in NCL hospitals do not see children within one hour at weekends and overnight.
There is limited perinatal community service in NCL, in the northern boroughs there is no specialist team and in the southern boroughs the service does not meet national standards.