MENTAL HEALTH AND WELL BEING SUPPORT GROUP REPORT OF VISIT TO FORTH VALLEY - 24 APRIL On this occasion, the Support Group was represented by:

MENTAL HEALTH AND WELL BEING SUPPORT GROUP REPORT OF VISIT TO FORTH VALLEY - 24 APRIL 2001 On this occasion, the Support Group was represented by: Mr Jim Eaglesham (User Representative and Project Development Worker, Mental Health Network Glasgow) Mr Houston Fleming (User Representative and Chair, Dykebar Hospital Patients Council) Dr Janette Gardner (Carer Representative and former Chair, NSF Scotland) Mr Brendan Gill (Director of Planning and Information, Lanarkshire Health Board) Dr John Loudon (Psychiatric Advisor, Scottish Executive Health Department) Mr David Pia (Inspector, Social Work Services Inspectorate) Dr Ian Pullen, Chairman (Consultant Psychiatrist, Borders Primary Care NHS Trust) Mr Robert Samuel (Nursing Advisor, Scottish Executive Health Department) Mrs Pat Webster (Carer Representative and Dundee Hearing Voices Network) Summary The Support Group was impressed by the enthusiasm shown by all who attended. There were 18 users and support workers, over 30 nurses and PAMs, 8 psychiatrists, several GPs, 15 social work staff together with many senior managers from the 3 local authorities present to meet the Group. Combined, the agencies are working toward a shared idea of the best arrangement for local services, care and support though some further and focussed attention is required in terms of: user and particularly, carer involvement; development of independent advocacy; reviewing how to enhance joint working and planning; prioritisation of investment to realise a comprehensive service; engaging all staff in the new direction and approaches; confidence building between primary care, secondary mental health services and social work services; reviewing service provision for opportunities to involve Voluntary and User led services; reviewing management capacity to cope with continuing change; and using existing resources to best advantage, and giving mental health services due weighting in the allocation of any health and social care resource. Background While the Framework was launched in September 1997 for a variety of local reasons it is only in recent months that a joint mental health strategy has been agreed for the area. The Support Group hopes that implementation on the basis of agreed plans can now take place to catch up on time lost. Managing change is not easy. The first template point in the Framework indicates the importance of the interface between primary care, secondary care, and social work. There is still the need for 1

initial confidence building between these components and to engage all staff in making a commitment to the required changes. Findings There was much for the Support Group to commend, including: The new Health Promotion Officer will provide a clear strategic thread to link good initiatives to develop mental health and well being; Well joined-up services to provide care for the older person involving liaison with the primary health care teams, careful joint working with social work services and sensitively tuned leadership; Development of a service for Mentally Disordered Offenders, provided by a multi-disciplinary team with a comprehensive skills mix and a healthy partnership with local authorities and criminal justice agencies; Forth Valley is one of the pilot sites for the psychological therapies Waiting Times Initiative supported by the Glasgow Institute of Psychosocial Interventions and the Scottish Development Centre for Mental Health Services, through funding provided by the Mental Health and Well Being Development Fund; Well developed approach to the detection and treatment of Post Natal Depression and the creation of an Integrated Care Pathway; Procedures for the Care Programme Approach well developed with work on continuing quality improvement; Good working relationship between professions at the service provision level; Commissioning and roll-out of the PIMS information system throughout the Trust on a 3-year programme basis, with an awareness of how this will help compliance with Clinical Standards Board for Scotland requirements, and other national quality initiatives; and Ready availability of training and educational opportunities for Trust staff. The Support Group had concerns about issues in the following areas and while not attaching individual timetables for action in each case, it will expect to see early attention being given and recorded in the response to its request for a 6 month progress report, which will issue at the end of October. Although the number of users attending was an indication of their involvement, this is at different stages in different localities. Opportunities should be found for each district to give each a similar chance to develop and to ensure a decentralised support system; Information flow, especially to the average user, appears to be limited. Most of those present had not heard of the Framework template and only Falkirk User Network seemed to have been involved at a strategic level; Community based user relationships with local authorities were described as easiest, with relations with Health Board mixed and relations with the Trust less easy. Funding in partnership with user or voluntary organisations was seen as carefully guarded by vested (professional) interests and joint funding initiatives were not seen to be encouraged; 2

Although there is a vision of advocacy across the health board area, it cannot be said to be truly independent, or sufficient. The Support Group was pleased to hear that a working group was currently examining ways in which to seek greater user and carer involvement; The appointment of a Health Promotion Officer will help the focus and co-ordination of the number of good local projects relating to health promotion and the mental health well being agenda; People who had been discharged from in-patient care were concerned that they were (or felt they were) left isolated in the community. They felt much more cared for by voluntary organisation support. Some present expressed a clear need for practical contacts to be obtained through a more simple process, including help with applications for Disability Living Allowance; The seriousness with which issues such as side effects of medication were discussed and corrected was raised and indicated a need for more sensitive reaction to such queries. Users felt that a means had to be found to enlighten attitudes held by staff; There was concern about an excessive planning and service focus on severe and enduring illness, this being seen by some as limiting the growth of a more effective comprehensive service. Our National Health calls for attention to be given to the care needs of those with anxiety and depression in the community. There is a good opportunity for joint working between all agencies, statutory and voluntary, to develop effective and efficient services. The informal support provided by the Voluntary Organisations was popular, but provision for those with sensory impairment was limited; There was a request for more meetings to be informal and for Trust and officialdom to go out to meet people in more informal settings. It was felt that there needed to be real changes. Consultation as a result of previous reports had felt like a gesture. Perhaps a clear set of objectives, which could be seen to be achieved over say a period of 6 months, would convince people to be involved more; There is very little, if any, support available for carers, especially at critical points in the care pathway, such as discharge from hospital care. The care planning arrangements prior to a discharge from hospital should be reviewed. With all this in mind the Support Group commends Allies in Change to the agencies, especially as their inclusive and supportive approach to improved and meaningful involvement has been endorsed by the Health Department as the basis for Partners in Change (Our National Health) combining as it does training for users, carers and staff; The Support Group understands that the health board is committed to a static level of funding for mental health services for the next 2 years. Against that commitment should be considered the "resource neutral" outcome of the Arbuthnott Report for Forth Valley. The potential implications from the Acute Services Review, the commitment to the care of older people and other pressures in the system may combine to take priority and prevent any prospect of new 3

mental health services development. Learning Disability is understood to be the first priority for any development opportunity that does arise; The Support Group is concerned that an opportunity for joint agency added investment may be lost unless the combined approaches of health and local authorities to service provision is reviewed and improved upon. Given that gaps exist in current service provision, the Support Group encourages the agency partners in Forth Valley to examine carefully - against assessed needs and local ambition for change - all service provision. This applies particularly to the level of in-patient care compared to the community, including not least the potential of the voluntary sector (in keeping with statements made in Our National Health). There is potential too in user-led and run organisations to complement statutory services in promoting well being, social inclusion and transitional occupation; The Framework is concerned to ensure there is a shift in resources to meet the identified needs by providing a comprehensive range of local services as outlined in the template. There are current gaps in the service provision locally which it is recognised have to be addressed. Given this, the Health Board together with their planning partners will also need to consider carefully its priorities for new investment in this National priority service. If these gaps are to be addressed within the 6 year timeframe for implementation, early action is required, especially as time has been lost with the delay in producing a joint strategy; The Support Group accepts that Health has something to learn from local authorities in the productive use that can be made of services provided by voluntary organisations on the basis of funding which is secured over a reasonable period. The Health Education Board for Scotland pilot project in Community Health is one example; and The Trust is developing an ambitious programme for redevelopment but it is not clear there is sufficient management capacity at intermediate levels to realise these ambitions and given other service pressures the clinicians/managers find the dual task difficult to meet satisfactorily. The Support Group looks for the issues identified and raised here to be addressed in the ongoing and future planned activity of all the agencies involved. As early indicated, the Support Group will request a written update on the progress made against the comments offered in this document in around 6 months. That update will be published on the web site alongside this report. Finally, the Support Group would like to thank all who attended and participated on the day and those whose contributions to the arrangements made the day and visit run smoothly. Mental Health and Well Being Support Group May 2001 4

Appendix Background and Purpose of the Support Group The Support Group was formed on 31 March 2000 to support, influence and advance the further strategic development of mental health services in Scotland. The Support Group offers advice locally and to the Scottish Executive on solutions and best practice in advancing the implementation programme of the Framework for Mental Health Services in Scotland agenda for change and improvement in mental health services. The Group also provides additional focused local activity assessments to the Scottish Executive and the agencies involved. The Support Group complements, but does not replace related activity of the Joint Future Group, the mentor and advice remits of the Scottish Health Advisory Services, the Mental Welfare Commission or the Clinical Standards Board for Scotland. Approach/Process The Support Group issues a template, for completion by the partner agencies prior to visits. The template is based on Scottish Executive guidance material, and other relevant material including: A Framework for Mental Services in Scotland (1997) Advocacy A Guide to Good Practice (1997) Mental Health Promotion in Scotland Board Position paper HEBS (1998) Services for Women in Postnatal Depression NHS MEL(1999)27 Priorities and Planning Guidance 1999-2000 for the NHS in Scotland (1998) Implementing the Care Programme Approach (SWSG/Accounts Commission Survey) (1998) A Shared Approach (Accounts Commission) (1999) Our National Health: a plan for action, a plan for change Risk Management (2000) Needs Assessment for a Comprehensive, Local Mental Health Service (2001) Annual Report Mental Health and Well Being Support Group (2001) During the visit individual members of the Support Group meet with groups of individuals, including users and carers, representing the range of stakeholder interests in the development and implementation of the joint mental health strategies in the area visited. Meetings also take place with the joint planning and implementation team and the key agency Executives. The Support Group is grateful for the co-operation and assistance of the statutory and non-statutory agencies in the area. Further information about the Support Group, including its Annual Report, can be found on its web site at http://www.show.scot.nhs.uk/mhwbsg. 5

FINAL DRAFT MENTAL HEALTH & WELLBEING SUPPORT GROUP VISIT TO FORTH VALLEY Response to the Report from the Mental Health & Wellbeing Support Group and Recommendations for Action 1. Introduction The Mental Health & Wellbeing Support Group visited Forth Valley on 24 th April 2001. The Support Group exists to advise the Minister of Health on progress with the implementation of the Framework for Mental Health Services in Scotland published in 1998. The Support Group has visited all local Health Board areas, to review progress with local Mental Health Strategies; offer advice and support to Health Boards and Trusts and disseminate good practice across the service. The reports of the Support Group's visits are published normally within 4 weeks and are publicly available. The Support Group will seek a 6 month progress report on actions taken following their visit. The report of the Support Group visit to Forth Valley was received on 23 May 2001. It commends a number of local mental health initiatives including integrated services for Older People; the newly established Forensic Community Team; Care Programme Approach and work on integrated Care Pathway for post natal depression. The report also highlights a number of areas requiring further attention by all partners in Forth Valley. These include improved involvement of users & carers, including improved information flow to users & carers; the development of independent Advocacy Services, and issues around ongoing investment and resourcing of Mental Health Services given its status as a national priority. This paper proposes a joint response to the report by the Mental Health Strategy Implementation Group (MHSIG), with recommendations for further action to be taken forward either jointly or by the constituent agencies. 2. General Response to the Report MHSIG welcomes the visit by the MHWSG as an opportunity to reflect on progress with implementing the National Framework for Mental Health Services through the development of its local strategy. The external perspective of the Support Group on the provision of local services and learning from their experiences elsewhere is considered to be extremely valuable. The observations, made on the day, by those who participated in the visit are also important in reflecting an individuals experience of services. MHSIG was pleased to see the positive comments made by the Support Group in relation to the local development of services and notes the Support Groups further comments that progress is being made in a number of other areas including user & carer involvement. Visits - draft response & recomm 25 jul 01

MHSIG broadly accepts the findings of the Support Group on those areas where there are recommendations that further work or action is required. The attached Action Plan has been prepared in response to the issues raised. A number of the points raised in the report appear to reflect the individual views, perspectives & experiences of those who participated in the visit. While these views are respected and are valid in themselves, we do not believe that, in all cases, they reflect the totality of provision across Forth Valley and that progress is being made with good examples of positive initiatives being developed at local levels, reflecting joint working/funding of services, including voluntary sector initiatives. Some of these are described in the template. We recognise however, that a great deal more work needs to be done, and have tried to reflect in our action plan the key messages arising from the visit. 3. Recommendations for Action For the purposes of producing an Action Plan, the comments and observations made have been categorised into 8 broader categories, covering the principle recommendations made in the report Visits - draft response & recomm 25 jul 01

MENTAL HEALTH & WELLBEING SUPPORT GROUP RECOMMENDATIONS FOR ACTION JULY 2001 ISSUE COMMENT ACTION INITIATED/REQUIRED LEAD GROUP TIMESCALE 1. User & Carer Involvement and Participation Issues Raised: Development across Forth Valley Decentralised support system Information flow Consultation arrangements/informal Support for carers meetings Independent Advocacy MHSIG acknowledge the further worker required to support users & carer involvement and participation across Forth Valley. MHSIG would however point to the initiatives included in the template in respect of current support particularly to carers. A project to develop a strategy for user & carer involvement across Forth Valley is currently underway. It is user led and facilitated by SDC. This will make recommendations on the development of a partnership agreement and an infrastructure of support for meaningful involvement and participation. Other initiatives which will contribute to this issue is the work on clinical standards particularly in reviewing and implementing information to user & carers. The statutory agencies in Forth Valley are producing an Action Plan for the development of independent Advocacy Services. MHSIG September 2001 completion of report by SDC. 2. Voluntary and User Organisation Funding Arrangements Issues raised: Funding streams Joint resourcing Opportunity for user/voluntary led services to complement statutory services MHSIG acknowledge the pressures on voluntary organisations which arise from lack of certainty over funding streams and accepts the recommendation that more needs to be done to look at longer term funding arrangements. MHSIG also supports the view that user led services can complement statutory services. There are already examples of this across Forth Valley and we agree this needs to be encouraged further. The Trust funded Advocacy Service is moving towards independent status. Local implementation groups have produced priorities for services within their workplans, which include joint resourcing and user led/voluntary initiatives. Local Implementation Grps Ongoing Visits - draft response & recomm 25 jul 01

ISSUE COMMENT ACTION INITIATED/REQUIRED LEAD GROUP TIMESCALE 3 Promoting Positive Mental September 2001 Health 4 Planning Processes Issues: Focus on severe & enduring Opportunity for joint working Sensory Impairment Services MHSIG has already identified health promotion and the reduction of stigma as a priority and this was flagged up in the template. MHSIG agrees that there has to date been a focus on severe and enduring mental health in line with National Policy. The National Health Plan now challenges local services to develop more comprehensive mental health services. Forth Valley Primary Care Trust already has a dedicated service for people with a sensory impairment, however we acknowledge that perhaps more needs to be done to identify needs and improve access to this service. 1. Dedicated Mental Health Promotion Officer post to be established. 2. MHSIG & Local Implementation Groups are developing programmes of work aimed at promoting positive Mental Health and addressing stigma. MHSIG and Implementation Group plans need to reflect move towards more comprehensive mental health services. Current workplans and priorities for local development already reflect this. Other contributing initiatives are; the psychological therapies pilot; the development of voluntary sector led Counselling Services; the development of Healthy Living Centres; liaison psychiatry services; & health promotion post. Forth Valley Health Board MHSIG Local Implementation Grps MHSIG & Local Implementation Groups. During 2001/02 Ongoing A review of the needs of people with mental health problems and a sensory impairment to be undertaken. FVPCT During 2001/02 5 Discharge Arrangements Issues Raised: Support & information for carers Support for users contact information MHSIG notes the observations which were made on the day of the visit in respect of support to users & carers at the point of discharge & post discharge. MHSIG also acknowledges the support given by voluntary organisation to people in the Community. MHSIG supports the suggestion of using Allies in Change which has already been used successfully in some areas in Forth Valley and would wish to see this supported and enhanced. An audit of discharge arrangements to be undertaken by the Primary Care Trust to identify the extent of problems on discharge and identify areas for improvement. Work on clinical standards will also contribute to this issue. This work includes a review of information to users & carers including drug medication. FVPCT During 2001/02 Visits - draft response & recomm 25 jul 01

ISSUE COMMENT ACTION INITIATED/ REQUIRED LEAD GROUP TIMESCALE 6 Resourcing the local Mental Health Strategy: Issues Raised: Static funding (health) Competing service pressures Need for combined approach to service provision - and review of services on a joint basis 7 Gaps in Service Provision Issues Raised: Need to identify gaps in provision Identify priorities for new investment Delay in producing strategy leading to potential delays in implementing plans over 6 year period. 8 Organisational capacity Issues raised: Change agenda Mental Health Review MHSIG accepts the need to jointly review the resourcing of the strategy in the light of expected funding streams; to identify the cost associated with full implementation and to review jointly ways of addressing funding issues. MHSIG acknowledges that there are gaps in services provision. Significant work has already been done by local implementation groups to identify gaps in service and to prioritise them. Specialist sub groups are also working to identify and produce proposals to address gaps. This work needs to be linked to issue 6. MHSIG acknowledges the very major changes engendered by national and local initiatives including Joint Futures, Clinical Standards Board and the local Mental Health Review. MHSIG to review and agree a joint process for resourcing the Mental Health Strategy and for agreeing priorities for investment. Other contributing initiatives are the Review of Mental Health Services being undertaken by the Primary Care Trust and the redesign initiatives including review of Bellsdyke Accommodation; rehabilitation services and alternatives to inpatient provision. Work is ongoing at sub group level to identify gaps and agree priorities for developments. MHSIG need to agree process by which overall priorities are agreed and resourced. An organisational develop strategy to be developed to support staff. Additional funding has been made available through national and local redesign funds to support local mental health review. MHSIG FVPCT MHSIG and Implementation Groups December 2001 During 2001 + 2002 During 2001/02 FVPCT During 2001/02 Visits - draft response & recomm 25 jul 01