1. Discussion & Consultation Session 16 th September 2015 Aims To consider the proposed principles & outline design to redesign of community based mental health services as part of the implementation of the Mental Health Framework. To consult & gather feedback to inform the future designs of the final proposed model 1

2. The Mental Health Framework sets out a new direction in line with Five Year Forward and has 5 agreed outcomes:  Focus on keeping People Well  Mental Health & Physical Health Services are Better Integrated  Mental Health Services are Recovery & Outcome focused  Ensure access to high quality services informed by need  Challenge stigma & discrimination Provider Partners have agreed that if we focus on the cross cutting themes below we should rebalance the system towards Prevention, Effective Care, Early Intervention & Recovery  Information  Crisis and Urgent Care  Community Based Mental Health Services  Children and Families 2

3. Focus on keeping people well – to build resilience and self-management We will challenge Stigma and Discrimination We will ensure access to high quality services informed by need Services will be transformed to be recovery and outcome focussed Mental health and physical health services will be better integrated

4. We have many high quality & valued services but feedback from users and providers also tell us that….  The system is incoherent, fragmented, diverse & often difficult to navigate  Many people arrive in the ‘wrong place’ the first time as we assess for service eligibility  People often arrive at a crisis point rather than have earlier intervention  In primary care approximately 40% of people are signposted to another service, including secondary care 1  In secondary care approximately 30% of people are signposted to another service including primary care 2  Demand for services is unlikely to decrease and many communities are becoming ever more diverse  Widely different life expectancy depending on the area you live in  Expenditure on mental health needs to be re-defined with more partnership working 1, 2 Referral & Performance data 2014-15 4

5. 5 Where have we started?  Partner discussion & events from 2013 & 14  Review of other cities, models and learned lessons  Independence consultant commissioned to review & outline high level design for consultation & coproduction

6. Requirements of any new model  Centralised Information and self- help resources  Better use of universal services to support the issues that many service users face that relate to housing, debt, employment  Principle of no wrong referral or bounce back  Focus on early intervention avoiding unnecessary pathways into secondary care  Shifts some current secondary care resource into primary care to “wrap around” GPs and contribute to the new models of care.  Uses cluster based standardised assessment process reducing the number of repeat assessments Information portal Information and advice Prevention & self management Assessment Front Door Triage accessed via call centre Crisis response & walk in Tiered assessment same day wherever possible Navigator service Primary Care Wrap around & New Models of Care 24/7 access to advice and guidance inc. psychiatrist, pharmacist Mental health long term conditions and Liaison mental health Mental Health needs based pathways

7.  Project hosted by Mhabitat LYPFT  Public access for all - Mental Health Information site in development by YOOMEE  Includes Public Health Branded Campaign Supporting Prevention  Provides directions to the right places  Links to a simple referral process  Will have several phases of development Question:  What would you find helpful?  How likely are you to use it?  Three things you would like to see? 7

8. Questions:  What would you find helpful?  How likely are you to use it?  Three things you would like to see? 8

9.  Simple points of access 24/7 for all mental health referrals  No wrong door, One number, ‘one e-button’ via portal, no bounce back & outcomes fed back to referrer  Crisis & non crisis pathways  Multi agency holistic triage  Initial contact & assessment - same day offer  Shared holistic assessment when needed- focussed by needs/clusters/ Care Act Eligibility  Stress management offer - as standard  Continuity worker when needed during transitions Questions:  What type of skill or resource would provide better outcomes for people with mental health needs?  Examples might be access to additional voluntary service skills or resource, direct referral access to specific services. access to multi- disciplinary conversations i.e. pharmacist or psychologist, 9

10. Questions:  What type of skill or resource would provide better outcomes for people with mental health needs?  Examples might be access to additional voluntary service skills or resource, direct referral access to specific services. access to multi-disciplinary conversations i.e. psychiatrist, pharmacist or psychologist, South Leeds - 23.09.1510

11.  Enhancing primary care with New Models of Care with mental health support  Long term conditions – potential to develop current resource centres provision into wider recovery college  Expanding the roles of who can deliver Care Programme Approach coordination & developing continuity workers  More recovery & self management resource including peer support  Examples of good practice Mental Health Liaison Clinicians in Integrated Neighbourhood Teams Mood Clinics- example in Canterbury. Shared Lives Support – host families for those in crisis Improved physical health, parity of esteem, supported depot administration in primary care Question:  What could enhanced primary care with mental health support look like?  What opportunities do we have to test out new models?  What mental health resource could be provided? 11

12. Questions:  What could enhanced primary care with mental health support look like?  What opportunities do we have to test out new models?  What mental health resource could be provided? 12

13.  Mental Health Clusters –“global description for groups of people with similar characteristics, identified through holistic assessment & using Mental Health Clustering Tool (MHCT)”. A payment by results system  Broad high level ‘Super Clusters’ - Non Psychosis, Psychosis & Cognitive Impairment drilled down & with levels of need/severity.  Intervention designed by need with partnership pathways supporting the wider determinants of health & need focussed on recovery, supported by NICE Guidelines  High level super clusters used in other health & social care trust focus clinical discussions about referral, triage and screening decisions  Intention to reduce variation & gaps in provision Right – person, place, first time, skills  Complex needs supported by specialist skills  Examples of needs based pathways/ services, R & R Services, Aspire & in Bristol & Wakefield 13

14. Questions:  Any examples of specific needs based designs now?  Are there areas of unmet need that you experience?  What kinds of needs based pathways could be available?  Anything else? 14

15.  Information Hub  What would you find helpful?  How likely are you to use it?  Three things you would like to see?  Single Point of Assessment  What type of skill or resource would provide better outcomes for people with mental health needs?  Examples might be access to additional voluntary service skills or resource, direct referral access to specific services. access to multi- disciplinary conversations i.e. pharmacist or psychologist  Wrap around mental health services  What would enhanced primary care mental health support look like?  What opportunities do we have to test out new models?  What mental health resource could be provided?  Needs Based Pathway Design  Any examples or specific needs based designs now?  Are there areas of unmet need that you experience?  What kinds of needs based pathways could be available? 15

16.  Jenny Thornton – Programme Manager  Jenny.thornton@nhs.net Jenny.thornton@nhs.net  Jon Woolmer – Consultant for Design  Marrisa Carroll – Project Manager Community Based Mental Health Re-design  Marrisa.carroll@nhs.net Marrisa.carroll@nhs.net  Jeannette Lawson – Project Manager Urgent & Unplanned Care- Crisis Care Concordat 16