Mental Health Services Older People

Appendix 2

Middlesbrough

Service Plan 2008-2013

1 Executive Summary

Middlesbrough Council, Middlesbrough Primary Care Trust (PCT) and Tees, Esk and Wear Valleys (TEWV) NHS Foundation Trust believe that the promotion of good mental health for people living and working in Middlesbrough is our shared responsibility. The partners in this process include people who use services, carers, the communities they live in and the statutory and voluntary services that serve their needs.

Older people with mental health problems have complex needs and the services they require need to be of a high quality. They also need to work smoothly and consistently across all health and social care organisations. This service plan explains how Mental Health Services for Older People in Middlesbrough will play their part in providing services for this vulnerable and often socially excluded group of people.

This document is a summary of how Mental Health Services for Older People in Middlesbrough will develop over the next 5 years. It also provides an outline of the Service Vision that we would like to achieve by 2013.

National Guidance

In recent years the Government and Department of Health have produced guidance to support the development and delivery of services. This has shifted the focus away from hospital based services towards community based support that includes:  intensive home support  crisis intervention and promotes  prevention  well-being  independence, and  choice.

This change in direction recognises the rights of individuals and the needs of the broader community. It also places a stronger emphasis on involving people who use services and their carers in service improvement, commissioning and partnership working.

2 Demand

From national research, we have estimated that at the current time there are 1,671 people over 65 with dementia in Middlesbrough. There are an estimated number of 239 new people being diagnosed with dementia each year. There are also around 45 younger people with dementia in Middlesbrough. These figures are set to rise to approximately 1,840 in 2010.

The factors that people with dementia and their carers say are important to them are:  an early diagnosis  access to specialist advice and information  help and support to stay at home, and  help with more difficult to manage aspects of dementia, such as challenging behaviour.

Using national research, we have estimated that in Middlesbrough there are 3,017 people over 65 who have depression. Of those, 1,006 will have the most severe forms of depression. These figures are anticipated to rise to 1,145 for severe forms of depression in 2010 and 3,435 for all forms of depression.

One of our main roles is to support primary care services, such as GPs and nurse practitioners, in managing milder forms of depression. Mental Health Services will see those people with more severe forms of depression, e.g. those associated with psychosis, risk of suicide or illnesses which do not readily respond to treatment.

From national prevalence rates it is estimated that 220 people over 65 have schizophrenia and 220 people have bi-polar affective disorder in Middlesbrough. These figures are anticipated to rise to 230 for both conditions by 2010.

People over the age of 65 who develop schizophrenia and bipolar affective disorder require early identification and rapid access to services. Mental Health Services for Older People in Middlesbrough will work with primary care teams to enable them to identify quickly older people developing these conditions.

Once referred into the mental health service, people will be treated according to national guidance, with due emphasis being placed on the psychological and social aspects of treatment in addition to medicines and drugs. Older people repeatedly express a preference to be treated at home, as far as this is possible. Therefore, there will be an increased demand on community services and day hospitals.

3 Mental Health Services for Older People have received funding for a number of service developments within the past five years as a result of investment from the NHS. Such investment has mainly related to improving hospital facilities to appropriate standards and some funding has been invested in providing community support.

Service Vision

Our vision is that by working with service users, carers and other agencies, we will provide specialist mental health services of the highest quality to older people. This will promote health, well-being, independence and inclusion by providing care tailored to their individual needs and enabling them to enjoy choice, dignity and respect in old age.

Our aims are:

 To combat the negative stereotypes of mental illness and ageing, promote positive attitudes and reduce the stigma attached to mental health problems.  To provide better prevention and early intervention for improved health, independence and well-being.  To tackle inequalities and improve access to services.  To provide access to appropriate information and support to make decisions at all stages.  To provide access to specialist expertise, particularly at critical times.  To provide advice and advocacy, which is accessible regardless of diagnosis, age or location.  Wherever possible, services will be provided in a service user's home and help will be provided to support them to live at home for as long as possible.  To provide high quality specialist care, treatment, assessment, diagnosis and information to service users and their carers.  To have the right staff with the right skills in the right place.  To ensure that our hospital-based services are of a high quality and provided in modern, accessible buildings.  To ensure financial balance year on year.  To ensure that the most effective treatments are consistently available to everyone.  To provide more choice and a stronger voice for individuals and communities.  To provide more support for people with long term needs.  Develop and increase service user input into Planning and Commissioning activities.  To work towards a complete system of care, one that is based around individual needs and not around fitting individuals to the services that are available. A system which ensures organisations work together without discrimination or exclusion, to ensure the best possible outcomes for service users.

4 The Service Outcomes are:

 Improve the mental health and well-being of people with mental illness.  Improve access to primary health care for people with mental illness.  Reduce the levels of suicide.  Improve quality of life for carers.  Improve the levels of employment for people with disabilities.  Maximise the independence of older people.  Increase the number of older people remaining in their community regardless of their condition.  Reduce hospital admissions and stays.

Values and Principles

Mental Health Services for Older People in Middlesbrough will recognise the dignity of individual service users, respect and value their diversity as well as acknowledging their major role in the process of planning and developing services. All services will be provided in a manner that gives due regard to the individual’s gender, religious persuasion, racial origin, cultural, linguistic background and sexual orientation.

The service will be grounded in respect for all those people who engage with it, not only service users but also their supporters and carers.

We will ensure that wherever older people with mental health problems are in the system they are not discriminated against and will have their mental health needs met.

In order to produce better outcomes for older people with mental health problems, we will develop specific services where they are necessary.

The service will develop culturally appropriate services that are in line with the TEWV Strategy for Delivering Race Equality and Diversity, the PCT Single Equality Scheme Action Plan and the Social Care Diversity and Equalities Action Plan. These seek to improve performance in services and outcomes for members of potentially disadvantaged groups.

5 Commissioning Priorities

Services will be developed and commissioned for older people with mental health needs and their carers to ensure that they will:

 Have a comprehensive needs assessment undertaken by people with the right skills and competencies.  Be given an explanation of their diagnosis and their prognosis with support available.  Have a care plan that takes in to account their individual preferences and is regularly reviewed.  Be empowered to purchase their care if they wish.  Have access to technology that enhances independence and be supported in an environment that is enabling.

The following commissioning priorities have been agreed by the Middlesbrough Older People’s Mental Health Local Implementation Team:

1: Better Awareness

Information and  Ensure that older people’s issues are included in access to mental health promotion and general health services promotion.  De-stigmatise Mental Health issues and overcome barriers to services.  Provide information at appropriate venues, such as Churches, schools, community centres, shops, etc.  Have an open access Memory Clinic, similar to the flu jab process. Planning  Include older people and their carers in planning the delivery of services, including developing the roles of expert patient and expert carer. Training  Develop training for all staff who come into contact with older people with mental health problems, including independent care home and domiciliary care providers, acute staff & street wardens etc.  Include carers in the training programme.  Expand the care home liaison service to include all care homes for older people.  Provide a similar service for domiciliary care providers. Individual  Explore the use of individual budgets to provide a budgets range of community resources to enable older people to remain part of their local communities and help to prevent mental health problems. (Individual budgets are a development of direct payments, they combine a range of funding streams in order to provide service users with greater choice and control

6 over their support arrangements.)  Provide suport for older people to utilise individual budgets and consider the provision of a brokerage service.  Use the personalisation process to provide support for people with complex needs.

2: Early Diagnosis

Care Pathways  Support the development of clear care pathways to improve services and ensure service users & their carers receive timely intervention from primary care & specialist mental health services – including preventative services. Memory Initiative  Establish a Memory Initiative Service to provide a Service specialist assessment and diagnosis for people with memory problems.  This will be a single point of contact for people with dementia and their carers, as part of a joined up approach to the delivery of care.  It will also provide support, treatment and information to primary care and community based services, including the voluntary sector. Primary Care  Develop protocols (or formal guidance) to assist early screening, diagnosis and treatment in primary care and ensure that all GPs and primary care staff are offered effective support and training.  Provide mental health support workers to GPs to assist early screening, diagnosis and treatment, provide psychological therapies and to give older people and their carers clear explanations of their problems and the likely consequences. Secondary Care  Develop an Acute Liaison Service for Older People at James Cook University Hospital, to provide specialist advice on early detection, assessment, diagnosis, treatment and management of mental health problems for older patients on the medical wards and facilitate discharge from hospital. BME issues  Explore specific issues for black and minority ethnic elders with regard to the early detection of dementia and review the role of community development workers in helping to improve the delivery of services.

7 3: High Quality Treatment

Joined up  Integrate assessment, care and treatment planning working across health and social care organisations. Step-care model  Work towards a step-care model for depression, psychosis and age related complexity in line with NICE guidelines. (A step-care approach for treatment first provides patients with the simplest, least intrusive intervention and proceeds to more intense treatment if necessary.) Provide a full Ensure that older people have access to the full range of range of services mental health services at both primary and secondary care level appropriate to their needs, including:  Residential Care  Domiciliary care  Day care  Including provision for those with challenging behaviour  Psychological therapies  Alternative therapies  Advocacy  Intermediate care  Speech and language therapy  Respite care  Crisis support  End of life/palliative care