Agenda item

This report provides an update on the work of the Integrated Care Partnership (ICP) Mental Health Campaign and of the implementation of the Mental Health Integrated Network Teams (MINT) across Hammersmith & Fulham.  It also includes areas yet to be developed, and offers a timetable going forward.

8.1       Councillor Richardson welcomed Helen Mangan and Dr Christopher Hilton from WLT, Gail Dearing, Wendy Lofthouse, Linda Stradins from WLT and Jo Baty who provided an update on the work of the ICP adult Mental Health Campaign (MHC) and the implementation of the Mental Health Integrated Network Teams (MINT) across H&F, and areas yet to be developed.  The committee had been expecting a fuller report which had been previously postponed in September as it was not ready, and Councillor welcomed this interim update.   

8.2       Helen Mangan provided an outline highlighting the significant work being undertaken collaboratively, post Covid, and the work that was planned through the ICP.  The MHC had met throughout the summer and the core group tasked with delivering this work comprised of mental health staff, community trust social care PCN and voluntary sector colleagues, underpinned by a wider stakeholder group. The objectives of the MHC were currently in development and emerging.  It was important to identify barriers to care for those who were passionate about working in mental health to improve the physical health care of people with serious mental illness.  The core group had developed networks, connections and built trust and these were key in ensuring a better system.  A key component of was the collaborative approach of the ICP responding to acuity of need and demand.  Helen Mangan apologised for the absence of detail in the paper but there were ongoing discussions to identify formal objectives and to agree health and social care leads which would emerge in the coming weeks, and a more detailed paper would be provided at the January meeting of the committee. 

8.3       A key outcome of the ICP was the ability to respond to demand with agility, and a positive illustration of this was the development of vaccination hubs.  It was well recognised that those service users with serious mental illnesses were also those who were likely to be vaccine hesitant. Take up within this group was about 50% and they had lobbied for a bus to be located at Charing Cross Hospital site where the WLT mental health main unit (The Claybrook) was located. The bus encouraged service users, with the support of a mental health team to make contact and get vaccinated. 12 service users had been vaccinated and this was on going work.  Most importantly, this was achieved through partnership working, bringing together colleagues from the CCG, social care, and public health and had been an invigorating approach.

8.4       Helen Mangan briefly spoke about the Children and Young People core group, the work of which was not as advanced as the mental health core group as it was started later.  Three key areas that planned to explore included pathway mapping, CAMHs (Children and adolescent mental health services) transformation funded by new money coming into the health service, and the funding of services for 16-25 year olds (transition group) which would be a new model being developed across North West London. This new model would be introduced as an initiative in H&F first.

8.5       Continuing the presentation Jo Baty explained that a stakeholder group had been established through the ICP MHC with at least 50 members drawn from the mental health community, including residents with mental health issues.  The group recognised that the only way to move forward was to work in partnership and some co-produced ideas had already begun to emerge, replicating the council’s approach to co-production, “nothing about us without us”, within the ICP.  An illustration of this was the work with black, minority ethnic communities to explore how best to allocate trust community grants, bridging a gap from the community to the decision makers. Linda Stradins reflected on the MINT project which was gaining traction and building momentum.  As part of the transition process new roles had been established and would be embedded within the teams, with peer support to successfully manage the merger of primary and secondary mental health with as a single point of access. This would allow them to manage referrals, provide consultation and opportunities to engage, with GPs networks were connected within that structure. Other operational changes that were emerging would utilise non-statutory voluntary and community sector resources, the relocation of resources within the community and outreach work building on existing networks. Specialist teams would provide an enhancement to existing provision, and also being explored was upstream intervention for individuals with eating disorders. 

8.6       Councillor Richardson sought clarification about what different MINT had made since it was established, and had it made a difference in terms of specific service and provision. Linda Stradins responded that MINT was work in progress but was breaking down barriers.  The service had gone live during the summer and the PCNs had engaged well with it. GPs regularly attended weekly network meetings which offered good opportunities for consultation and to escalate patient concerns.  The move to the use of System One would allow direct communication with GPs, to set tasks, gain access to the patient’s notes to help with decision making. 

8.7       Keith Mallinson enquired about membership of the monthly mental health stakeholder forum.  The organisation that he worked for, Shepherds Bush Families Project dealt with vulnerable families and would be interested in joining the forum.  He also shared details of a deeply concerning situation affecting a vulnerable client who had attempted to end their life on multiple occasions.  He reported that he had raised a serious safeguarding concern through PALs (Patient Advice and Liaison Service) with WLT and received responses that were entirely unhelpful and unconstructive.  Helen Mangan apologised for the experience and offered to assist.  

ACTION: Helen Mangan to contact Keith Mallinson with details of the forum and to help address the safeguarding concern outside the meeting. 

8.8       Jim Grealy noted that this was an ambitious program but lacked data which made it difficult to identify the baseline.  Given the council’s commitment to equalities it was concerning that there was an absence of poverty and ethnicity data that would be helpful in supporting sections of the community which experienced health inequality and did not trust the NHS as an institution. A final observation that it conveyed a “top down” approach, that the patient voice was absent and little co-production.  An inclusive, co-produced approach meant that service provision and decision making was better informed.  Wendy Lofthouse welcomed the observation about the report lacking data and that this would be covered as part of the work of the ICP which they would discuss with the committee at the next meeting (November 2021). She highlighted the work of Safe Space Hammersmith, a local hub that was community space offered by MIND.

8.9       Lucia Boddington reference paragraph 3.1 of the report and asked about the timeframe of a referral to CAMHs being 18 weeks for treatment.  However, realistically there were very long delays for CAMHs treatment.  She asked if WLT were recruiting more psychologists. There was a twoyear timeframe for an Autism Spectrum Disorder (ASD) or Attention Deficit Hyperactivity Disorder (ADHD) diagnosis from CAMHs. She asked about what the timeframe for support was for 18-25 year olds who were transitioning, given that a number of 17 or 18 year olds sometimes fell through the gaps in service provision, and what ongoing treatment there was once a child reached the age of 18 and if this would be provided by MINT.  Helen Mangan explained that there was a moderate amount of funding available to complete the model of care by December 2021 and a local implementation group would take this forward.  It was confirmed that MINT would pick up 18-year olds and upwards. While there was a detailed transition process this formed part of a wider discussion than could be undertaken at the meeting. Where an 18-year-old presented in advance of their 18^th birthday, it was likely that they might be picked up by adult services.  Lucia Boddington felt that this was not what happened in practice in H&F.  

ACTION: WLT to provide in formation in relation to the timeframe for treatment for ASD / ADHD similarly for 18–25-year-olds who were transitioning.  

8.10     Councillor Lloyd-Harris enquired about the eating disorder service for 18–25-year-olds and commented that in her experience, that considerable work was required if they were going to be referred to Improving Access to Psychological Therapies (IAPT), which was currently limited to six sessions which was insufficient.  She reported that many of her clients had issues that had escalated because they had not been able to access IAPT.  They were also not able to see their GPs as there appears to be a perception in some practices that an eating disorder was not a significant medical condition.  She asked the Trust (WLT) that when this work was progressed it included a review about the number of IAPT sessions available. Councillor Lloyd-Harris also sought further information about Safe Space Hammersmith. Wendy Lofthouse outlined the operational aspects of the self-referral service which was from 6-8pm, seven days a week, open to 18+ year olds and based in Lillie Road, Hammersmith. The intent was to see people who were relapsing or in danger of crises and it was hoped that this would offer a different pathway and avoid A&E. Councillor Lloyd-Harris reported anecdotally that a client contemplating ending their life had not been able to access the service and her concern that the support was not available to a young person in crises.  Linda Stradins explained that secondary care eating disorder services were provided by CNWL, from the Vincent Square site. However, the MINT service was expanding their offer to include support for people with an eating disorder in conjunction with other co-morbid conditions. 

8.11     Councillor Richardson observed that it would be helpful to have information about preventative services in the borough which would help to gain a fuller perspective as to what was available. 

ACTION: WLT to share details about the Safe Space Hammersmith service and information through a community asset mapping exercise.

8.12     Merril Hammer commented on the earlier point made about the absence of robust data which was not available.  This meant that it was not possible to identify a benchmark to compare and track progress, both in terms of service provision and take up. It was recognised that MINT was a new initiative being funded by new money but without information about what other new initiatives there were, it was hard to draw an informed comparison or to evaluate without historic data.

8.13    Councillor Richardson summarised a request to WLT based on the discussion to provide data which provided information about what services where available in the borough, the diversity and background of people accessing services, what the different types of referrals were (self-referral or GP).

8.14     Councillor Coleman focussed on specific points that had been highlighted during the meeting.  He welcomed the positive perception of the vaccination bus and how effective it had been in vaccinating groups that were resistant. This work was currently on pause due to the unavailability of enough vaccinators.  Commenting on the mental health updated provided by WLT, Councillor Coleman welcomed the insights offered by the committee members in terms of coproducing provision with programmes like Safe Space and MINT.  He felt that this important work needed to embody the ethos of doing things with people rather too them, a powerful point emphasised by the committee.

RESOLVED

That the committee noted the report and actions as set out.