3Rd Draft Outline

Mental Health Matters

3rd Draft Outline

Mental Health Matters Programme

Big Lottery Funding Bid

September 2007

1 BID DEVELOPMENT BACKGROUND

One of the key growth areas of work for Barnardo’s Cymru over the last 5 years has been the emotional well-being and mental health of children and young people. It has seen the inception of The Caterpillar Project in Cardiff which was funded by The Big Lottery Bridging the Gap Programme in 2006. Barnardo’s Cymru also promoted this area of growth by the recruitment of an Pan Wales specialist Mental Health Development Officer Menna Thomas who has worked with the National Policy and Research Unit and in particular Dr. Sam Clutton to develop research based services in Wales.

The Youth Service in Wrexham were also successful in a similar bid under the same programme and as since developed a Hospital Based Service (Inspire) supporting children and young people who come to the attention of the health service through CAMHS or the hospital admissions route.

In 2005-06 Compass in Wrexham contributed to a Barnardo’s UK Consultation with young people using their services which focused on Emotional Well-being and Mental Health. The outcomes were clear in terms of the young people’s views about the services they had received, did not receive of would have liked to have received given a choice.

Discussion began in 2006 between Compass Managers and The LHB Strategic Manager with the LHB identifying gaps in services for 16 to 25 year olds in the Wrexham area. One of the agreed gaps in services concerned young people who fell between mental health provisions and drug and alcohol services.

BID OUTLINE

The following document outlines a proposed application to the Big Lottery Fund under the Mental Health Matters Programme. It outlines a model of service for young people in the Wrexham area who meet the programme criteria and it has been complied by Barnardo’s Cymru in collaboration with Wrexham’s Local Health Board and Housing Department. For the purpose of the document and application the service has been named The Mental Illness Drug & Alcohol Support Project (The MIDAS Project) although the service may well be changed in the future after consultation with Service User groups:

2 M H M Programme Aims to: The MIDAS Project Specifically aims To: 1 Promote the rehabilitation and Provide a community based independence of people with accommodation scheme which serious mental health offers support to young people problems aged between 16 – 25 years who are unable to live safely and independently without support 2 Support people at greatest risk of Provide a range of support service for developing serious mental young people aged 16 – 25 years health problems who do not traditionally access mainstream services either because of their chaotic lifestyle choices such as drug and alcohol dependency prohibit appropriate service use. 3 Support people at risk of suicide Provide support to those young people who display chronic and/or acute self harming behaviours M H Matters Programme Targets: The MIDAS Service will specifically target:

1 People who have serious mental Young people aged 16 – 25 who have health problems serious mental health problems and drug including alcohol addictions 2 People who are at greatest risk of Young people who are homeless or developing serious mental roofless and do not meet the health problems eligibility criteria for current support accommodation schemes in Wrexham 3 People who are at greatest risk of Those who are not covered by the suicide existing Inspire service or who choose not to engage with statutory agencies

OUTCOMES: M H M Programme Outcomes: The MIDAS Outcomes:

3 1 People with serious mental health To identify the group of young people 16 problems live fulfilling lives in – 25 who experience mental health their communities problems and who are not currently accessing CAMHS or AMHS 2 Reduced incidence of relapse or To provide a supported accommodation crisis among people with provision for young people who are mental health problems in crisis and have both mental health and drug/alcohol problems 3 Improved awareness of mental ill- To provide a range of services for young health and access to people experiencing mental health appropriate support among problems. This may also include groups at greatest risk of those whose mental health is serious mental health affected by drug and alcohol problems or suicide. problems.

THE SERVICE MODEL

The service would work along side existing services with in Compass Partnership and the wider Authority. It will provide and Early Intervention service which will assess need and make referrals or sign post young people to appropriate services In addition it will provide from an office based location within the town centre:

INDIVIDUAL SUPPORT PACKAGES: Brief Solution Focused Therapy. A holistic, accessible service available evenings and weekends providing Direct Work and Therapies including: CBT Counselling, NLP, Group Work, Relaxation sessions, Self Esteem work, Self Care Skills, cooking, washing and budgeting, access to Community Psychiatric Nursing.

GROUP WORK

Both day time and evenings focused on issues relevant to the young people but would include aspects of self esteem work, life skills workshops, peer and social support.

EDUCATION

Professional training to raise awareness and eliminate the stigmatisation of the young people.

SUPPORTED ACCOMMODATION

4 Ultimately to provide a specialist supported accommodation/lodgings scheme for a small group of young people who are deemed as unsuitable for all other provisions locally as their level of need or risk is high and who otherwise may be inappropriately placed in prisons or YO Centres. The service is a peer mentoring community based model working with RSL (Housing Associations) and/or the private sector landlords who can provide 2 neighbouring separate units. One providing suitable and subsidised accommodation for a young person who has managed to turn themselves round and is able to offer a befriending and support service to another young person who is in crisis and is in need of support.

OUT OF HOURS SUPPORT

On Call weekend and evening for the supported accommodation provision

STAFFING STRUCTURE

1 x P/T Children’s Service Manager (1) 1 F/T Senior Practitioner 3 F/T Project Workers qualified and unqualified Sessional Workers Volunteers Peer Mentors Administration Worker

 Show links to other agencies.  Show links to CAMHS, AMHS and SMAT structures.  How will access to existing MHS (CAMHS and AMHS) be facilitated? Needs a liaison post.

PARTNERSHIP WORK

The MIDAS Project will work closely with the rest of the services based at Compass Partnership in particular the Tenancy & Family Support Service, The Emergency Accommodation Scheme (CEAS), The Housing Advice Service and The Care Leaver’s Support Service which currently provides services for 400 vulnerable young people annually.

In addition MIDAS will work closely with the following Partner agencies:

5 6 COMPASS PARTNERSHIP PROPOSED STAFFING STRUCTURE INCORPORATING THE MIDAS PROJECT

Children’s CSM 3 Service Assistant (37 Hrs) Administrator CSA (36.35 Hrs) (36.25 Hrs)

CSM 1 CSM 1 CSM 1 Team of 3 FT (37 Hrs) (37 Hrs) (37 Hrs) Secretarial Tenancy & Family Advice & Accommodation Care Leaver’s Support Assistants Support Service

FGM Housing MIDAS Supported Senior Team of Advice Senior Team of Lodgings Practitioner 3 FT & 1 PT Senior Practitioners 3 FTE Personal Co- T & FS (37 Hrs) Practitioner (2 x 37 Hrs) Advisors ordinator Workers (37 Hrs) (30 Hrs)

Lodgings Team of Volunteer CEAS/BOND Team of 4 FTE Team of Providers FGM Worker Co- Qualified/Unqualified Sessional Coordinators (37 Hrs) ordinator Workers Workers Sessional (37 Hrs) Workers Pool of Volunteer Team of Team of Volunteer s Supported Supported Accom Advocates Host Families Accommodation Peer Mentors Providers

7 MENTAL HEALTH MATTERS FUNDING BID SUMMARY

PROJECT NAME THE MIDAS PROJECT

PROJECT SUMMARY An early intervention and supported accommodation provision for young people in Wrexham who are experience severe mental health problems and who do not meet existing provision eligibility criteria due to their high needs and chaotic lifestyles. The level of need requiring support may include other risk factors such as drug and alcohol misuse, and/or violent and aggressive behaviours. These young people are at greatest risk and often face homelessness as well.

PROJECT LOCATION Based at COMPASS PARTNERSHIP WREXHAM with supported tenancies within the local community on a satellite service model

PROJECT BENEFICIARIES Young people aged 16 to 25 some of whom will be young parents themselves

PROJECT NEED To provide supported, safe, secure affordable accommodation for those young people whose level of need cannot be meet through current provisions. To meet the needs of young people who do not engage with statutory services and often refuse/avoid medical services.

HOW HAS THE NEED BEEN IDENTIFIED

 Wrexham SAFF Targets  The Needs Mapping Process for Wrexham’s Supporting People Operational Plans (SPOP)  Outcomes from a Barnardo’s Emotional Well-being Consultation with young people 2005/06  Service User Eviction Statistics from the current Supported Accommodation Provision in Wrexham

8 THE MAIN STAKEHOLDERS/PARTNERS

 LHB INCLUDING CAMHS & AMHS

 RSLs (Registered Social Landlord)

 Private Landlords

 LA Housing Department & Supporting People Team

 Wrexham Youth Service & Hospital Based Team (Inspire)

 SMAT

 AVOW

 Wrexham’s YPP Framework

PROJECT OUTCOMES To identify the group of young people 16 – 25 who experience mental health problems and who are not currently accessing CAMHS or AMHS

To provide a supported accommodation provision for young people who are in crisis and have both mental health and drug/alcohol problems

To provide a range of services for young people experiencing mental health problems. This may also include those whose mental health is affected by drug and alcohol problems

PROJECT DELIVERY METHODS

To provide an office based early intervention outreach service from Compass (town centre base) operating between the hours of 2pm – 10pm Mon to Fri and 11 am – 6.30 pm Sat and Sun. The team would be multi-disciplinary made up of CPNs, Social Workers, Youth Workers with expertise in Alcohol/Substance

9 Misuse and Sessional Workers providing therapeutic and counselling services.

The model of service is based on the following principles:

1. A Peer Mentorship approach to service provision is affective as young people in crisis will often listen to and receive support from people of their own age rather than professionals.

2. Young People in crisis will often avoid statutory service for fear that their self determination and control will be adversely affected.

3. Volunteers have a great deal to contribute in terms of life experience, skill base and availability and young people often engage with people who they see as independent and not representing ‘the authorities’.

4. An integrated social/medical model of engagement with young people in crisis has been proven effective

5. That Children’s & Young People organisations such as Barnardo’s are best placed to provide direct services on the principle that young people with multiple needs and chaotic lifestyles are children first.

6. That young people in crisis need additional support beyond normal office hours

7. That young people in crisis need a range of holistic, accessible, responsive services which are needs lead as opposed to resource driven

OUTCOMES To identify the group of young people 16 – 25 who experience mental health problems and

10 who are not currently accessing CAMHS or AMHS

To provide a supported accommodation provision for young people who are in crisis and have both mental health and drug/alcohol problems

To provide a range of services for young people experiencing mental health problems. This may also include those whose mental health is affected by drug and alcohol problems.

PROJECT MANAGEMENT

The MIDAS Project Staff, Volunteers and Peer Mentors would be supported managed by Barnardo’s Cymru. The Health professionals would receive clinical supervision from the Trust. There would be a multi-agency strategic management group (SMG) who would meet quarterly with a clear remit for planning and monitoring/evaluating the service. The Children’s Services Manager would report back on the agreed Performance Indicators and Milestones. The Chair of the SMG would report directly to the Chair of the Healthy & Active SCOG. There would by a Service Users reference group which would be supported and facilitated by the Lead Peer Mentor. The Project would be liable to inspection and audit processes both internally and externally.

PROJECT BUDGET/FUNDING

To Follow in line with the application requirement

11 The MIDAS Project – Initial Relevant Research

1. Risk/need Homelessness almost trebles a young person’s chance of developing a mental health problem and homelessness is frequently associated with substance misuse problems.1 Homeless populations have a higher incidence of health problems than the general population, often characterised by having multiple health problems (primarily mental health disorders and alcohol and substance dependence).2 The extent of mental health problems amongst the homeless population is disproportionately high3 (both in the adult and young people populations.)4 Research carried out for the Home Office with young people under 25 years of age and in contact with homelessness services found that almost half of respondents had thought about or tried to self-harm and a slightly higher proportion had thought about or tried to commit suicide.5 Suicide is the cause of death in a quarter of deaths amongst 16 to 24 year old males.6 At the same time the limited research available suggests that levels of substance misuse amongst homeless young people are much higher than that of their peers. 7 The risk of becoming homeless is greatest for those who have experienced multiple disadvantage, among those who carry this increased 1 Social Exclusion Unit, (2005), Transition: young adults with complex needs a Social Exclusion Unit final report, London: ODPM 2 World Health Organisation, (2005), How can health care systems effectively deal with the major health care needs of homeless people, Health Evidence Network (HEN) synthesis 3 Bines,W. (1994), The Health of Single Homeless People, York: Centre for Housing Policy 4 Craig,T.Hodson,S. Woodward,S. and Richardson,S. (1996), Off to a Bad Start: A Longitudinal Study of Homeless Young People in London: London: Mental Health Foundation 5 Wincip,E;Buckland,G. and Bayliss,R. (2003), Youth homelessness and substance use: report to the drugs and alcohol research unit, Home Office Research Study 258, London: Home Office Research, Development and Statistics Directorate 6 See 1 above. 7 See 3 above.

12 risk are drug and alcohol users.8 A recent study points to the links between youth homelessness and mental health problems and suggests a ‘mutually sustaining relationship between these two attributes so that one may lead to or exacerbate the other and vice versa’.9

There is a significant overlap between substance misuse and mental health problems and individuals who misuse substances and have mental health problems provide particular challenges to services.10 The pattern of drug misuse and its impacts is different in young people compared to adults- many (some report up to 90%) adolescent drug misusers develop co-existing mental disorders.11 Research commissioned by the Home Office confirms that vulnerable groups of young people display higher levels of drug use than their non-vulnerable peers. While those who are members of more than one vulnerable group have the highest levels of drug use (5 vulnerable groups were identified: ever been in care; ever homeless; truants; those excluded from school and serious or frequent offenders).12

2. Service/support deficit

The interconnected relationship between youth homelessness, severe social exclusion and multiple disadvantage is well established. As discussed above there are a number of risk factors associated with homelessness including prevalence of mental health problems and substance misuse.13 At the same time a recent study undertaken by the Mental Health Foundation found that dual diagnosis of mental health and drug/alcohol problems was a major challenge in meeting the mental health needs of young homeless service users.14 People who use substances as well as having a mental health condition often find they do not get well integrated services.15 A recent report published by the Social Exclusion Unit16 focuses on the 16-25 age range because previous research had 8 See 3 above. 9 The Mental Health Foundation, (2006), Making the link between mental health and youth homelessness: A pan-London study, London: Mental Health Foundation 10 National Assembly for Wales, (2000), Tackling Substance Misuse in Wales, Cardiff: NAfW 11 Welsh Assembly Government , (2001), Child and Adolescent Mental Health Services (CAMHS) Strategy: Everybody’s Business, Cardiff: WAG 12 Becker,J. and Roe,S. (2005), Drug use among vulnerable groups of young people; findings from the 2003 Crime and Justice Survey, London: HMSO 13 See for example: MacDonald, R. (ed) (1997), Youth, the ‘Underclass’ and Social Exclusion, London: Routledge also Hutson,S and Liddiard,M. (1994), Youth Homelessness, Basingstoke: Macmillan 14 See 7 above. 15 LGA,NHS Confederation, Sainsbury Centre for Mental Health (SCMH) and the Association of Directors of Social Services, (2006), The Future of Mental Health: a Vision for 2015: Poliyc Paper , London : SCMH 16 See 1 above

13 identified older young adults as not being adequately catered for by services and often ignored by policy makers. The report also highlights a lack of support for the transition between youth and adult services, this is a particular issue for mental health services although in Wrexham there is a transitional protocol. Many CAMHS services in Wales continue to end provision for young people past the age of 16 years who are no longer in full-time education. This problem is further complicated by the fact that adult services are often not designed to offer appropriate support to young people. Mental health services may refuse to engage with young people who are homeless and using substances on the basis that the chaotic nature of their lifestyles does not lend itself to treatment practices. Home Office research found that homeless young people who suffered dual diagnosis (co-occurring substance misuse and mental health issues) were said to experience particular barriers to service access with no single agency prepared to take responsibility so that they ‘fell through the gap in services’.17 A pan London study18 also found that there were referral problems related to homeless young people with a dual diagnosis of mental health and substance misuse problems. Services in the study reported that the two specialisms operated to different policy and rarely worked together making it difficult to provide complete care packages.

Homeless young people are at increased risk of experiencing mental health problems and are more likely to misuse substances. At the same time their circumstances and age mean that they face barriers in accessing support. Breaking the cycle of homelessness and social exclusion requires holistic services that can manage complex problems and encourage engagement with service providers.19 Providing a young person with a tenancy and support in relation to their housing needs is only part of the solution. If young people with mental health and substance use problems are not provided with holistic support there may be real difficulties for them in sustaining a tenancy. This may lead to further incidents of homelessness which in turn increase the risk of serious mental health problems or exacerbate existing areas.

Mental health services have difficulty engaging with the young homeless and substance misusers as their chaotic lifestyle often does not fit with the provision of therapy or treatment services. In Wrexham there is a supportive outreach team aged 18 years and this project will engage with this service

17 See 5 above. 18 See 9 above 19 See 1 above.