Mental Health (Care and Treatment) () Act 2003.

Forth Valley Joint Local Implementation Plan Review

June 2005

Area-wide Elements.

1. Introduction

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This document represents the update of the Forth Valley Joint Local Implementation Plan (JLIP) describing the issues that have been agreed by partner agencies as area-wide issues. This paper should be read in conjunction with previous JLIPs, and should also be read in conjunction with the three local authority JLIPs as all four documents complement and support each other.

2. Key Principles and Priorities

As before, the continuing development of the JLIP will proceed on the principles of effective joint working (as set out under the Joint Future initiative) with reference to the duties and requirements of the new Act. The JLIP will be augmented further by the ongoing development of detailed implementation plans for each council area (Clackmannanshire, and ) which have been approved by respective Council Committees. The main priorities from previous JLIPs included the following, and actions taken to address these issues are also noted:-

Appointing a jointly funded temporary Project Manager to take forward the JLIP.

2.1.1 A Project Manager was appointed in August 2004.

2.2 Enhancing Independent Advocacy Services for all care groups.

2.2.1 Independent advocacy providers are currently being approached and requested to establish a pilot service for children and adolescents affected by mental health issues, as this group was seen as a priority. Further work is also being done to identify any other gaps in service and to ensure that all care groups have access to appropriate independent advocacy services.

2.3 Developing relevant Training Programmes for everyone involved with the new Act.

2.3.1 A Training Sub-Group has been established to address training issues. Training courses for MHOs have now been completed. Training courses for other key groups are being held during June August and September 2005, and will cover NHS staff, LA staff, and staff from the non-statutory sector. The NES web-based training will also be utilised where appropriate.

2.4 Putting in place effective joint processes and organisational structures to ensure the Act is implemented as required.

2.4.1 The Forth Valley Mental Health Act Steering Group has been established to oversee the key actions required to implement the Act. This group has delegated authority to ensure that service development priorities are identified and agreed and that the partnership funding is allocated appropriately. A number of sub-groups have been established to address specific issues such as Training, Tribunal Accommodation, Independent Advocacy for children and adolescents, Psychiatric Emergency Plan, and Advance Statements. These sub-groups report to the Forth Valley Mental Health Act Steering Group. Each local authority also has Mental Health Act Steering Groups operating on a similar basis.

2.5 Agreeing the key service development priorities and identifying bridging processes that will support extensive local redesign.

2.5.1 The Forth Valley Mental Health Act Steering Group has delegated authority to ensure that service development priorities are identified and agreed and that the partnership funding is allocated appropriately. Service developments have now been prioritised, and are highlighted below.

3. Organisational Structures and Joint Planning Context

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3.1 Joint Planning Arrangements

Forth Valley has a mature, joint planning structure which has been in place for a number of years and which has been subject to regular review. The Forth Valley wide Mental Health Strategic Implementation Group provides strategic direction and overview of the process of implementing the Framework for Mental Health Services and the local Mental Health Strategy as the vehicle for implementing the framework. The Strategy Implementation Group has recently reviewed the local strategy and agreed its key priorities for mental health.

The Strategic Implementation Group is supported by three local Framework Implementation Groups, which look to agree and implement local priorities for mental health. These groups include user and carer representatives and link directly to Joint Future Management structures.

3.2 A Joint Future for Mental Health Services

Joint Future arrangements are well developed in Forth Valley, with clear decision making structures in place. Implementation plans are in place to establish Joint Management of Mental Health Services in each of the local authority areas, and there are clear links with the local Framework Implementation Groups.

Good progress is being made in developing integrated community mental health services in each local authority area as follows:-

Falkirk A model of integrated Community Mental Health Services for adults has been approved by the Joint Executive Group and the Joint Future Management Group and this will be implemented from April 2005.

Stirling The model was circulated for comment over the winter months and was agreed by the Joint Executive Group in February 2005. It has been remitted to the Joint Future Joint Managers Group for further development commencing in September 2005.

Clackmannanshire Day services in Clackmannanshire Council area have been successfully integrated for over a year. However, work is in progress to consider how the Community Mental Health Teams might become part of the integrated model.

The Joint Future infrastructure provides a solid basis for further integrated developments to support the requirements of the Mental Health Act.

3.3 Planning for the Mental Health Act

As stated above, a Forth Valley Mental Health Act Steering Group has been established to oversee the development of this Joint Local Implementation Plan. This group reports to the Forth Valley Mental Health Strategic Implementation Group and to the Joint Future Management Groups.

3.4 Mental Health Services in Forth Valley – Redesign Process

Mental Health Services in Forth Valley are undergoing a process of review and redesign which will see significant and far reaching changes in the way specialist mental health services are delivered.

A significant change will be the centralisation of all acute inpatient assessment beds (adults and older people) in the new acute planned for Forth Valley in 2009. However, current pressures on services, including those arising from the Mental Health Act, will require interim arrangements to be put in place within the timescale for the implementation of the Act. Consequently, the development of this local implementation plan for the Mental Health Act should be seen in the context of the overall

E:\Mike\2005-06-00 Forth Valley JLIP Update - Area Wide.doc 3 redesign of Mental Heath Services. A critical area of current activity is to consider what changes in community based services are required, arising from the redesign of acute admission services. There are significant overlaps between the priorities identified for community based services arising from the redesign process, and those identified as requirements arising from the Act.

These include crisis services (care & support), extended hours’ services, intensive home treatment and support. These key areas not only encompass specialist mental health services, but also the full range of care and support services for people in their communities. A proposed new Service Model has been jointly agreed and is supported by evidence that suggests the balance of care could move more from hospital to community-based care. These proposed changes were the subject of a formal public consultation process as a key element of Forth Valley’s Healthcare Strategy proposals, and were approved by the Forth Valley NHS Board in September 2004.

3.5 Child and Adolescent Mental Health Services and Peri-natal Services

A capital project to create appropriate mother and baby accommodation within Ward 18 at Falkirk and District Royal Infirmary will be completed by October 2005. This includes a partnership approach with the Acute Division to ensure appropriate support for mother and baby is provided from maternity/paediatric services as well as mental health specialists. Given that this mother and baby accommodation may be utilised on a limited basis, consideration will also be given to this accommodation being made available to adolescents, as appropriate – see below.

A new development of a Primary Mental Health CAMH Service is being implemented currently. This is a partnership project, jointly funded by the NHS and all 3 local authorities in Forth Valley. This will see an investment of 7 new posts across Forth Valley.

Forth Valley is part of the consortia taking forward new inpatient provision for adolescents in the West of Scotland. Locally, there is a need to ensure that adult inpatient accommodation is sufficiently flexible to ensure that any admission of adolescents is in appropriate accommodation. Consideration will also be given to using the developing mother and baby accommodation for adolescents, as appropriate – see above. This is also being taken forward through the planning of the new inpatient facility at .

An audit of Eating Disorder Services is underway currently and will inform a review of local provision to be implemented during 2005.

A service proposal/business case is currently being developed to provide services for children with a learning disability and mental health problem and/or challenging behaviour. This is currently being taken forward jointly by specialist LD services and the Children's Services Planning Group.

The JLIP links with the Forth Valley Integrated Planning Group for Child Health.

3.6 Older Peoples Mental Health Services

Older Peoples Mental Health Services are currently undergoing a review and redesign process and there are a number of areas which have been identified as requiring further attention generally and in relation to the Act., as follows:-

A capacity planning exercise which has been commissioned and has identified future planning needs for acute admission and step down/long stay bed provision.

A specific and urgent need to expand consultant numbers to a minimum of 5 WTE Consultant Psychiatrists from the existing 3.4 WTE in post currently. Through a redesign process funding has been identified which will bring this number up to 4.4 WTE and the remaining shortfall will form part of a business case to be taken forward through the health planning process.

The additional Consultant post will enable a more coherent approach to the management of and support to the graduate population, particularly those patients discharged from Bellsdyke Hospital.

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A specific need arising from the review and in relation to the Mental Health Act is the need to expand community based specialist teams, with a specific requirement to develop an additional CMHS for the North of Forth Valley. This is being taken forward in part through the redesign process and in part through the business case process.

3.7 Learning Disability Services

Joint Future arrangements for learning disability services are well developed in Forth Valley with three integrated learning disability teams within Forth Valley - Clackmannanshire, Falkirk and Stirling, providing services to people with a learning disability from age 16. Each are multidisciplinary (medical, nursing, psychology and AHP) and integrated with local authority social work services. There are clear links with the Learning Disability Partnership Group, which sets out the strategic goals for services and which are then taken forward by the Local Action Groups.

RSNH closed in 2003. Earlier that year, Loch View, a new 26 bed specialist inpatient facility, opened for assessment/treatment of patients with a learning disability.

Learning Disability services in Forth Valley are part of a regional Managed Care Network focussing on Autism Spectrum Disorder, Challenging Behaviour and Forensic. There is close working between the specialist learning disability service and the Forensic CMHT to meet the needs of people with a learning disability who offend.

There is an on-call learning disability nursing service which operates outwith business hours mainly in relation to the Loch View inpatient service, and also provides a telephone advice service to other calls from the community. On-call psychiatry is available through the MCN out of hours. Systems are in place in Forth Valley to ensure appropriate access to this service.

An Interface Agreement exists that allows for people with a learning disability to access a mental health bed appropriately and continue to receive support form specialist learning disability services. When mental health beds are centralised the current Interface Agreement will continue to be utilised.

The Joint Future infrastructure, the Learning Disability Partnership Group and the Managed Care Network provide the framework for further integrated developments.

Other issues, which require to be addressed, include how people with a learning disability access information in appropriate formats and support for communication during tribunals and understanding advance statements. Also the needs of children at the age they move from children’s to adult services and who have complex needs. This is being taken forward through Forth Valley Integrated Planning Group for Child Health.

3.8 Dual Diagnosis

The revised proposal to establish a local dual diagnosis service has been finalised and has been submitted to the Scottish Executive. This intervention and integration model which will be provided across FV and the 3 local authority areas will provide enhanced accessibility, reciprocity, and a more flexible response to individuals experiencing co-existing substance use and mental health problems. It will enhance existing services and provide an integrated pathway of treatment within and between services in the statutory and voluntary sectors, therefore reducing waiting times both for individuals requiring the dual diagnosis service and those waiting for treatment for their substance use problem, with CADS and promote and facilitate social inclusion and integration.

3.9 Mental Health Promotion

E:\Mike\2005-06-00 Forth Valley JLIP Update - Area Wide.doc 5 In the Forth Valley area we aim to ensure that all health promotion activities and programmes for all care groups maximise their potential to address mental health and wellbeing eg drug and alcohol, workplace, community, early years, and teenage transition.

Scottish Mental Health First Aid training courses are being offered from May and will run on a monthly basis throughout the year. Forth Valley currently has 5 trained and approved instructors. The link between mental health and physical activity has been identified as an area wide focus for mental health awareness week in line with the UN Mental Health Day. In addition to this, a health promotion officer (mental health health improvement) recently took up post.

3.10 Forensic Services

A comprehensive range of services for people with a mental disorder who offend is well established in the Forth Valley area. This includes a multi-disciplinary Forensic Community Mental Health Team and low secure inpatient provision locally, in addition to medium secure beds commissioned at the Orchard Clinic in Edinburgh. There are plans to further develop the Social Work input into the Forensic CMHT. Links with the National Forensic Managed Care Network have also been established.

4. JLIP Elements

Previous draft JLIPs have now been reviewed and prioritised. This exercise has resulted in a clear and agreed set of priorities, and a clear indication of which elements are essential and should be funded via Mental Health Act partnership funding, and which elements should be seen as desirable and should be considered for alternative funding mechanisms. This review of the JLIP clearly reflects this.

4.1 Crisis Response and 24 hour Service Availability

4.1.1 Intensive Home Treatment Team (IHTT) Pilot

This area-wide pilot provides an alternative to acute mental health inpatient care and treatment for people aged 19 to 64. The IHTT is specifically targeted at people who are in ‘acute mental health crisis’ at home and appear to require admission, as well as people already being cared for as inpatients and who could be discharged home with an intensive level of support. The team will consist of experienced health and social care professionals and will be integrated with existing local statutory and non-statutory services. The IHTT works with people with a dual diagnosis where the primary diagnosis is mental illness. Staff participating in the IHTT pilot have recently undergone training.

Essential/desirable Essential Cost and source of funding £440k 2004/05/06 Partnership funding (also part-funded via Scottish Executive MH Division) Lead MH Act Steering Group (via IHTT Pilot Planning Group) Timescale Pilot became fully operational in May 2005, and will be reviewed after 10 months

4.1.2 Local Psychiatric Emergency Plan

Forth Valley participates in the National PEP Group, which has recently agreed on a consistent template to be adopted to assist with the development of PEPs. A multi-agency sub-group of the Forth Valley Mental Health Act Steering Group has been established to develop a Psychiatric Emergency Plan (PEP) for the Forth Valley area.

Essential/desirable Essential Cost and source of funding Within existing resources

E:\Mike\2005-06-00 Forth Valley JLIP Update - Area Wide.doc 6 Lead MH Act Steering Group Timescale Final draft to be completed by October 2005 (and reviewed after six months, and thereafter annually)

4.1.3 Extending the operating hours of statutory services

Community Mental Health Services and Day are considered necessary to ensure a range of responses and supports are available to people in, or approaching, crisis. These forms of service provision will compliment the proposed shift in balance of care from hospital to community and may only be achieved in part through redesign.

Essential/desirable Desirable Cost and source of funding Estimated £541k pa – future business case proposal via redesign process Lead MH Strategic Implementation Group Timescale To be confirmed

4.1.4 Health Maintenance Clinics

The existing clinics in Falkirk and Clackmannanshire have demonstrated the value of a closer interface between GP and specialist services in the joint management of people with severe and enduring mental illness, particularly those with a psychotic illness. These nurse-led clinics are currently over capacity but have an important role to fulfil for people being treated under the Act.

Essential/desirable Desirable Cost and source of funding Estimated £30k pa – future business case proposal via redesign process Lead MH Strategic Implementation Group Timescale To be confirmed

4.2 Community Services

4.2.1 Care Programme Approach

CPA systems are fully established in each council area and are supported by appropriate management arrangements. It is anticipated that the new Act will place greater demands on existing CPA systems resulting in the need for a more robust infrastructure of administration and support. This element is seen as desirable. It is anticipated that around £14k per annum will be required to meet this increased activity, and this should be funded via a future business case proposal.

Essential/desirable Desirable Cost and source of funding Estimated £14k pa – future business case proposal via redesign process Lead MH Strategic Implementation Group Timescale To be confirmed

4.2.2 Training in Therapeutic Interventions

More complex packages of care will create greater demands for a range of treatments from a range of providers. This will result in a need for easier access to evidence-based interventions which has recently been reinforced by the Clinical standards for Schizophrenia in relation to the needs of patients and their carers. This element is seen as desirable. It is anticipated that it will cost around £10k to meet this training need, and this should be funded via a future business case proposal.

Essential/desirable Desirable Cost and source of funding Estimated £10k pa – future business case proposal

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4.3 Hospital Services

4.3.1 Mother and Baby Facilities

It is proposed to redevelop an area of Ward 18 in Falkirk and District Royal Infirmary to accommodate the relatively small number of mothers and babies from the Forth Valley area who require inpatient admission.

Essential/desirable Essential Cost and source of funding £28k capital costs – partnership funding Lead MH Strategic Implementation Group Timescale October 2005

4.3.2 New Service Model for Mental Health Services in Forth Valley

Following public consultation, finalise the new Service Model for Mental Health Services in Forth Valley (including Transitional Arrangements). The redesigned model will involve the centralisation of acute admission services (adult and older people’s) and subsequent enhancement of joint community services at a local level.

Essential/desirable Essential Cost and source of funding To be confirmed – future business case proposal via redesign process Lead MH Strategic Implementation Group Timescale To be confirmed

4.3.3 Bellsdyke Hospital Reprovisioning

Complete the re-provisioning of Bellsdyke Hospital to improve the range and quality of care, treatment and facilities for adults with severe and enduring mental illness (including Mentally Disordered Offenders).

Essential/desirable Essential Cost and source of funding To be confirmed – future business case proposal via redesign process Lead MH Strategic Implementation Group Timescale To be confirmed

4.3.4 Liaison Psychiatry

The current service provides an essential and effective link between acute and specialist services. The extent of need within the acute sector exceeds the capacity of the current service for people with co-occurring illness.

Essential/desirable Desirable Cost and source of funding Estimated £85k pa – future business case proposal via redesign process Lead MH Strategic Implementation Group Timescale To be confirmed

4.4 Range of Therapies

E:\Mike\2005-06-00 Forth Valley JLIP Update - Area Wide.doc 8 4.4.1 Specialist practitioners

Appoint specialist practitioners (2 posts each for adult and older people’s services) to develop therapeutic interventions.

Essential/desirable Desirable Cost and source of funding Estimated £140k pa – future business case proposal via redesign process Lead MH Strategic Implementation Group Timescale To be confirmed

4.4.2 Relapse Minimisation

Two small pilots took place in Stirling and Clacks council areas during 2004 to test staff, patient and carer responses to evidence-based Relapse Minimisation techniques. The responses were positive and consideration is now being given to developing in-house training to develop these techniques as standard practice across community services.

4.5 Workforce and Redesign

4.5.1 Project Manager

A jointly funded Project Manager has been appointed on a two-year fixed term basis to take forward the local implementation of the Act.

Essential/desirable Essential Cost and source of funding £90k in 2004/05/06 – partnership funding Lead MH Act Steering Group Timescale Ongoing

4.5.2 Joint Training and Delivery Process

Develop, deliver and evaluate relevant training programmes and consider other mechanisms for awareness raising of the new Act, ensuring the full involvement of service users and carers in this process.

Essential/desirable Essential Cost and source of funding £25k in 2004/05/06 – partnership funding Lead MH Act Steering Group (via Training Sub-Group) Timescale Ongoing

A Training Sub-Group has been established to address training issues. Training courses for MHOs have now been completed. Training courses for other key groups are taking place during June, August and September 2005, and will cover NHS staff, LA staff, and staff from the non-statutory sector. The NES web-based training will also be utilised where appropriate.

A bi-monthly newsletter is issued to all staff, and to users and carers in the Forth Valley area to keep them informed of local and national developments as we move towards implementation. A local Mental Health Act web site has also been developed to keep people informed of progress and developments.

4.5.3 Developing the Adult Mental Health Medical Workforce

Work is ongoing to ensure that the implications of the Act are reflected in new contracts, on-call arrangements, and other working arrangements in line with the recommendations of the National Mental Health Services Assessment Report published in March 2004.

4.6 Organisational Issues

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4.6.1 Advocacy

Enhance independent advocacy services for all care groups.

Essential/desirable Essential Cost and source of funding £75k in 2004/05/06 – partnership funding Lead MH Act Steering Group Timescale October 2005

Local service providers will be canvassed and asked to carry out a needs assessment of the scope and scale of the likely demand for independent advocacy services for children and adolescents in the Forth Valley area, while simultaneously providing an independent advocacy service to children and adolescents on a pilot basis. Further work is also being done to identify any other gaps in service and to ensure that all care groups have access to appropriate independent advocacy services.

4.6.2 Tribunal Accommodation

A range of suitable accommodation (both NHS and community) which could be used for Mental Health Tribunals, has now been identified by the Tribunal Sub Group in liaison with the Scottish Executive.

There is a requirement to assist as necessary in the co-ordination, management and monitoring of local tribunals, to ensure the smooth running of these events.

Essential/desirable Essential Cost and source of funding £5k in 2004/05/06 - partnership funding Lead MH Act Steering Group (via Tribunal Sub-Group) Timescale October 2005

4.6.3 Supporting Users and Carers

Continue to support users and carers to participate fully in the planning and development of mental health services across the Forth Valley area.

Essential/desirable Essential Cost and source of funding £14.5k in 2004/05/06 - partnership funding Lead MH Act Steering Group Timescale October 2005

4.7 Resourcing and Accountability

All aspects of resourcing at area-wide level have been agreed and reflected in this Joint Local Implementation Plan.

A key factor is the planned redesign of acute inpatient services. It is anticipated that this will release substantial recurring funding from the closure of 15 acute beds for the development of community services.

It has been agreed that Partnership Funding for the Act may be used to “pump-prime” the above process.

4.8 Wider Issues

Improve access to employment and other social inclusion initiatives, including identifying ways of further enhancing existing programmes.

Take forward the “see me …” approach at area-wide and local levels.

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Monitor the impact of the “Choose Life” initiatives and build on experience and good practice.

Agree with Community Health Partnerships the process of engagement with, and role of, GPs and Primary Care regarding the Act

Issues around supporting people with communication difficulties under the Mental Health Act have been raised in the Learning Disability Services section (3.7). Similar issues are also relevant for the wider population, and need to be considered.

Clinicians from all care groups have the opportunity to participate in the JLIP process on an ongoing basis.

5. SUMMARY

The following table summarises the essential and desirable elements of the JLIP.

2004/05/06 Description Essential Desirable £k £k IHTT Pilot 440 Local PEP Extending the operating hours of statutory 541 services Liaison Psychiatry 85 Health Maintenance Clinics 30 Care Programme Approach 14 Training in Therapeutic Interventions 10 Mother and Baby Facilities 28 New Service Model for MH Services Bellsdyke Hospital Reprovisioning Specialist Practitioners 140 Project Manager 90 Joint Training and Delivery Process 25 Advocacy 75 Tribunal Accommodation 5 Supporting Users and Carers 14.5 Developing the Adult Mental Health Medical To be confirmed Workforce TOTAL 677.5

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