ECRI Institute, one of the leading patient safety and medical technology research organizations, places health technology cybersecurity at the top of its just-released 2019 Top 10 Health Technology Hazards.
HB Top 10: Mental health services
At the start of the year, Prime Minister Theresa May promised to ‘transform the way we deal with mental health problems right across society’. The comment came as it emerged that one in four of us will develop a mental health problem at some point in our lives and in a climate where mental health care is facing a multitude obstacles, ranging from a lack of local support, failure to follow up after being discharged, and not forgetting a wider shortage of trained health professionals.
Ahead of Mental Health Awareness Week, taking place 8-14 May, Health Business looks to document a top 10 list* of mental health trusts which have been working particularly hard to improve the services they provide to mentally ill patients.
1) Northumberland, Tyne and Wear NHS Foundation Trust
CQC rating: Outstanding
Taking first place is Northumberland, Tyne and Wear NHS Foundation Trust, one of the largest mental health and disability trusts in England, serving a population of approximately 1.4 million. The trust launched ‘Respond’, a training scheme aimed at transforming professional responses to mental health crisis through better collaboration and knowledge. Participants in the training were presented with videos of real-life situations, in a safe environment with constant input and support from a mental health professional, police officer, paramedic, psychiatric doctor, A&E crisis nurse and, most notably, an expert by experience.
Viral Kantaria, project manager for NHS England's urgent & emergency mental health care programme, said: "Respond is clearly an impressive, innovative way that professionals from different sectors - health, social care, policing and more - can come together to better understand one another's roles, responsibilities and skills. I can see great potential in this approach if it is supported by professional bodies - it appears quite easily replicable if tailored to other local areas.”
The trust also piloted Street Triage, whereby a mental health nurse worked alongside a dedicated police officer to provide better care to individuals struggling with mental health issues. Implementation of the specialist team was found to more than halve the number of police detentions under the Mental Health Act, suggesting a potential annual savings of £1 million if the measure was put in place by large trusts.
2) East London NHS Foundation Trust
CQC rating: Outstanding
Following close behind in second place, is East London NHS Foundation Trust (ELFT), with an East London population of 750,000. The trust has set in motion a number of initiatives targeted at offering outstanding mental health services. Impressively, ELFT produced a short film with White Boat TV (WBTV) called Teenage Misadventure, aimed at transforming attitudes to self-harm among health professionals and comes as figures show a 68 per cent increase in children and young people being admitted for self-harming.
Commenting on the film, Dr Navina Evans, chief executive of ELFT, said: “This film explores some of misconceptions around self-harm that young people face. People who self-harm do so privately and fear of stigma and judgement can deter people from getting the help that they need. We will use this film to provide our staff and local partners with the skills, knowledge and support to ensure that every young person who self-harms is treated with dignity and respect.”
The trust also won the Royal College of Psychiatrists’ Award for Team of the Year for staff involved in the Newham Front Door scheme, a specialist psychiatric team at the Newham Child and Family Consultation Service. The service was credited for successfully co-developed quality improvement ideas with patients, carers and stakeholders including the production of a library of self-help resources and a telephone triage system. Waiting times for clinic based services reduced from 11 weeks to nine weeks with 45 per cent of referrals seen within five weeks for assessment.
3) Oxford Health NHS Foundation Trust
CQC rating: Good
In third place, is Oxford Health NHS Foundation Trust (OHFT), which provides physical, mental health and social care for people of all ages across Oxfordshire, Buckinghamshire, Swindon, Wiltshire, Bath and North East Somerset. The trust’s South Region Early Intervention in Psychosis (EIP) team reaches out to young people having their first episode of psychosis, and works intensively with them and their families, offering therapy and support. According to a study by the University of Oxford, the team’s efforts at sharing best practice and training others have resulted in all 16 mental health trusts across the South of England now meeting national targets for treating patients with a first episode of psychosis within 14 days; before the team’s intervention, only eight out of 16 trusts were meeting this target.
As of October 2016, 83 per cent of patients across the region are now assessed and treated within 14 days of referral, a result that is the best in the country and which far exceeds the national target of 50 per cent. The South Region EIP team has also provided training for over 180 clinicians in the specialist treatment of early psychosis, and 45 per cent of patients treated by Early Intervention in Psychosis services across the South of England are now in employment or education.
The team, which was nominated as ‘Best Mental Health Team of the Year’ by the BMJ awards, was found to have saved the NHS £4031 per year for each person treated. The research estimated that, if the service was rolled out across the country, the NHS would save a tremendous £33.5 million each year.
4) Worcestershire Health and Care NHS Trust
CQC rating: good
Worcestershire Health and Care NHS Trust has made strides in delivering better care to mental health patients, developing an self-help app in-house to help people maintain a good mental wellbeing. ‘Worcestershire Healthy Minds’ was developed by Worcestershire Health and Care NHS Trust’s Communications Team and its Healthy Minds service. It provides tips and techniques to help people self-manage more common mental health problems such as stress, anxiety and low mood and is accessible to all 560,000 people the trust serves.
Simona Stokes, clinical lead for Worcestershire Healthy Minds, explained: “In this age where using mobile applications is a way of life, Worcestershire Healthy Minds has developed an app to enable people to get self-help information at their fingertips about managing common mental health difficulties. The app is especially helpful for raising awareness of signs and symptoms of emotional distress and in giving people some useful tools to start managing their difficulties. The app is also a way to reach out and to engage people with early help when there may be a reluctance to seek professional support.”
The trust has also recently launched Reach4Wellbeing, a team targeted specifically at supporting young people who are experiencing anxiety, low mood and self-harm. The programmes are open to children and young people aged 5-19 years and those over the age of 13 can refer themselves onto a course. The service aims to reduce the stigma of mental health by promoting positive wellbeing in communities and offering short-term group programmes that will initially focus on anxiety and eventually progress to offer sessions on low mood and self-harm.
5) Bradford District Care NHS Foundation Trust
CQC rating: Good
Boasting a ‘whole person’ approach to caring for patients with mental health needs, Bradford District Care NHS Foundation Trust launched the First Response service, which offers mental health crisis support 24 hours a day, seven days a week to vulnerable people needing urgent crisis support. Prior to the radical redesign of urgent mental health care, patients in Bradford often had to travel a significant distance to receive mental health care at a time when they were in crisis. Following the redesign of services, patients are getting the help they need within their own communities without having to travel long distances.
First Response has made a significant difference to the local management of crisis care, in particular for the emergency services. Intervening early and signposting to the right services has reduced demand on the police, ambulance services and A&E department and achieved a significant reduction in people detained under section 136 – which gives police the power to take someone to a place of safety.
Debra Gilderdale, director of Operations and Nursing at Bradford District Care NHS Foundation Trust, said: “Our local A&E departments have reported a reduction in waiting times and West Yorkshire Police have reported a 50 per cent reduction in people sectioned under 136, of the mental health act. Officers receive immediate 24 hour access to health professionals, allowing for informed decisions to be made on how best to support people without being placed in custody and ensuring people in crisis get the help they need. ”
6) North West Boroughs Healthcare NHS Foundation Trust
CQC rating: Good
North West Boroughs Healthcare NHS Foundation Trust provides treatment for a wide range of physical and mental ill-health issues and learning disabilities in the boroughs of Halton, Knowsley, St Helens, Warrington and Wigan. It recently partnered with Wigan Council to form the Specialist Health and Resilient Environment (SHARE), which gives children and young people specialist support at a time when they have significant mental health concerns such as self-harming or thoughts about taking their own life.
As part of the project a dedicated home, which is registered with Ofsted, has been created with bedrooms that allow young people a place to stay for up to 72 hours with staff on hand 24 hours a day to offer support. It also offers them space to go and get advice and a place to talk to staff when they need it. SHARE works with young people aged from 11 to 17 over a period of at least 12 weeks including support for their family and access to psychiatry and psychological services.
The service is backed up by a team which includes a registered manager, clinical psychologist, advanced mental health practitioners, social workers, key workers and support workers.
Ian Stirton-Cook, 5 Boroughs Partnership NHS Foundation Trust’s Head of Urgent Response for Wigan, said: “This is an exciting time in the evolution of mental health care in Wigan. SHARE will provide young people with a safe place to go when they are most in need, as well as access to professional support and advice to help them and their families to understand and manage the symptoms they are experiencing.
“As Wigan’s mental health provider, we are committed to working with local people to make sure we get the right support, to the right people, at the right time, and in the right place.”
7) Cheshire and Wirral Partnership NHS Foundation Trust
CQC rating: Good
Cheshire and Wirral Partnership NHS Foundation Trust (CWP) serves a population of over one million people, within Liverpool, Sefton, Bolton, Warrington, Halton and Trafford. While it received an overall CQC rating of ‘Good’. It has been rated as ‘Outstanding’ for services for people with learning disabilities or autism during an inspection by the Care Quality Commission (CQC). Further to this, the trust has established a working relationship with the local MAPPA (Multi Agency Public Protection Arrangements) framework to improve processes and care pathways for potentially dangerous offenders. The partnership has proven so successful that the trust is now working with MAPPA to develop national guidance as part of its partnership.
Brendan O’Hea, Cheshire MAPPA Coordinator, explained: “The work between CWP, MAPPA, Cheshire Police and local prisons has meant that Cheshire is ahead of the game nationally. In recent years we have strengthened relationships, removed barriers to communication and improved information sharing so that we can identify risks earlier and act accordingly.
“Through partnership working we have been able to improve public safety and develop care and support to help potentially dangerous individuals with their mental health issues. We’ve also made staff more aware of how to cater for each individual’s needs and have developed a more robust liaison service for victims.”
8) ²gether NHS Foundation Trust
CQC rating: Good
²gether NHS Foundation Trust provides specialist mental health and learning disability services to serve a combined population of 761,000 people in Gloucestershire and Herefordshire. Last summer the trust celebrated the official opening of the Fritchie Centre, its Research ²gether centre and Managing Memory base. The new centre will be a dedicated base for research, and also to respond to increased demand from those affected by dementia and other long-term mental and physical health conditions.
Genevieve Riley, head of Research and Development, Research ²gether, said: “The development of the new Fritchie Centre is an exciting time for research services in ²gether NHS Foundation Trust.
“For many years, we have had a skilled, dedicated group of clinicians who work on national research studies, as well as developing their own ideas. The Research Centre will give us a fantastic opportunity to expand our clinical trial portfolio and help us work towards our vision of being a world-class centre of practice-based research.
“We want to provide more opportunities for patients and carers to be informed about research they can participate in locally that could make a difference to their lives and the lives of others, and we will be doing this in partnership with Cobalt Health and our primary care colleagues.”
9) Berkshire Healthcare NHS Foundation Trust
CQC rating: Good
Specialising in community and mental health, Berkshire Healthcare NHS Foundation Trust provides a wide range of services to people of all ages living in Berkshire. The trust has developed a digital dashboard tool so clinicians could make sure people receive the early help they need and to evaluate performance against each National Institute for Health and Care Excellence (NICE) recommended intervention for early intervention in psychosis (EIP).
The standard, which came into force on 1 April, requires more than 50 per cent of people experiencing a first episode of psychosis to begin a NICE-recommended package of care within two weeks of referral. That includes: cognitive behavioural therapy for psychosis; family interventions; prescribing antipsychotics, if clinically indicated; education and employment support; physical health assessments; wellbeing support; and carer/family focused education and support.
In June and July 2016 the Berkshire service saw 100 per cent of its referrals within the required timeframe, up from 89 in May and 88 per cent in April. NICE interventions are offered to everyone at the outset and the service is working to ensure these are offered at timely intervals throughout the three-year treatment period because patients vary in their readiness to engage with interventions, such as cognitive behavioural therapy for psychosis and Individual Placement and Support (IPS).
The dashboard is refreshed each morning, which means up-to-date information is available to discuss during staff meetings attended by the multidisciplinary team who include a pharmacist, psychologists, IPS workers, social workers, occupational therapists, community psychiatric nurses and other care co-ordinators.
10) South London and Maudsley NHS Foundation Trust
CQC rating: Good
South London and Maudsley NHS Foundation Trust serves a local population of 1.3 million people across Lambeth, Southwark, Lewisham and Croydon. As well as being rated the top mental health trust for research, South London and Maudsley has formed CUES-Ed, an innovative project that aims to help children to improve their resilience and emotional wellbeing.
CUES-Ed has been developed as a result of direct feedback, gathered over many years from children across the country who use the Maudsley’s Children Adolescent and Mental Health Services (CAMHS.)
CUES-Ed’s 'Who I Am and What I Can: How to Keep My Brain Amazing' - a psycho-education package for children, was designed by Maudsley Clinical Psychologists and CBT therapists, and aims to help each child realise their own potential and maximise their learning. The package, consists of six sessions embedded with evidence based CBT practice, delivered to the whole class. Each session is highly interactive and draws on a range of media sources to ensure the active engagement of all the children.
The package helps children recognise how they feel, think and behave and teaches them how to talk about this with others. Staff encourage children to notice the signs (cues) when things aren’t right, such as an increase in worry, a change in appetite or sleep patterns and difficulties with friendship groups. Children are taught simple cognitive behavioural ways to cope with life's ups and downs.
*The top 10 list has been collated through examination of CQC ratings and surveys and media reports.