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Information Resource to Support Integrated Care ADULT

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Information Resource to Support Integrated Care ADULT SCOTTISH BORDERS MENTAL HEALTH SERVICES information resource to support integrated care ADULT The Community Planning Partnership is committed to improving the well-being of all children and young people across the Scottish Borders. We translate this commitment into action through the work of the Children and Young People’s Leadership Group which brings together partners from Scottish Borders Council, NHS Border CONTENTS SCOTTISH BORDERS MENTAL HEALTH SERVICES INTEGRATED CARE PATHWAY (ADULT) 1. INTRODUCTION 3 2. ACCESSING SUPPORTS AND SERVICES 5 TIERED CARE MODEL 6 TIER 1 7 GENERAL POPULATION (prevention) TIER 2 9 FRONT LINE SERVICES (urgent or early intervention) TIER 2/3 15 LINKS BETWEEN FRONT LINE AND SPECIALIST SERVICES IN THE COMMUNITY (focused work, self-management, recovery) TIER 3 22 SPECIALIST SERVICES: COMMUNITY BASED (assessment, diagnosis and treatment, recovery) TIER 4 27 SPECIALIST SERVICES: IN-PATIENT / RESIDENTIAL (acute/complex care needs – treatment/recovery/self-management/secondary prevention) 2 | SCOTTISH BORDERS MENTAL HEALTH SERVICES | INTEGRATED CARE PATHWAY (ADULT) INTRODUCTION | ACCESSING SUPPORTS AND SERVICES SCOTTISH BORDERS MENTAL HEALTH SERVICES INTEGRATED CARE PATHWAY (ADULT) 1. INTRODUCTION The ‘Mental Health Strategy: Scottish Borders’ (Scottish Borders Strategic priorities include: Health & Social Care Partnership 2017) sets out a framework for the delivery of activities and services designed to improve the mental • improving access to information and advice health and wellbeing for all ages groups in the local population. • support for self-management This strategy is part of a wider programme of integration across a • improved access to services. range of health and social care services, and describes a vision for mental health that aims to: This Integrated Care Pathway aims to support that work by mapping out what supports and services are available for adults and how to access them. • promote good mental health and wellbeing for all It is based on a ‘Tiered Care’ model that shows what is available for those • respect, protect and support people with mental health issues with different levels of need, including: and mental illness to live well • recognise, support and value families and carers • Tier 1: Self-help, prevention orientated services that enable people stay • promote partnership between services and the population they well; serve. • Tier 2: Front line services offering urgent help when problems start to develop (accessed through self-referral); • Tier 2/3: Help and support to help you managing your health (accessed through self-referral, mostly to the voluntary sector); SCOTTISH BORDERS MENTAL HEALTH SERVICES | INTEGRATED CARE PATHWAY (ADULT) | 3 • Tiers 3: Community-based care and treatment for those with more severe problems (GP referral needed); • Tier 4: Hospital in-patient care and treatment for those with more acute, severe or complex care needs Supports and services are grouped in two main categories - those specifically for individuals with mental health needs (including those around addiction or trauma) and some that might commonly be used around general health and well-being. Some services and supports have been given a place in these tables but are cross-cutting and apply at all levels, including: • health improvement (to prevent, delay or manage illness and support recovery) • suicide prevention training • housing and homelessness • financial/benefits advice • carer involvement • social connectedness • employability. 4 | SCOTTISH BORDERS MENTAL HEALTH SERVICES | INTEGRATED CARE PATHWAY (ADULT) INTRODUCTION | ACCESSING SUPPORTS AND SERVICES SCOTTISH BORDERS MENTAL HEALTH SERVICES INTEGRATED CARE PATHWAY (ADULT) 2. ACCESSING SUPPORTS AND SERVICES SCOTTISH BORDERS MENTAL HEALTH SERVICES | INTEGRATED CARE PATHWAY (ADULT) | 5 JOINT MENTAL HEALTH SERVICES (Adults) PATHWAYS TIER 4 Acute/complex care needs/treatment/recovery/ GLOSSARY SPECIALIST SERVICES: self-management/secondary prevention HOSPITAL AA/NA – Alcoholics Anonymous / HOSPITAL Narcotics Anonymous MENTAL BAS – Borders Addictions Service HEALTH WARDS BIAS – Borders Independent Advocacy Service JS – Justice Service TIER 3 MENTAL HEALTH SERVICES Assessment/ DAAS / DACS – Domestic Abuse SPECIALIST SERVICES: PSYCHOLOGY GRC diagnosis & treatment/recovery Support Services and Domestic GP OR SPECIALIST REFERRAL MATERNAL MENTAL HEALTH Abuse Community Support NEEDED DBI – Distress Brief Interventions PENUMBRA CARR GOMM JS GPs – General Practitioners GRC – Gala Resource Centre TIER 2/3 MH&WF LACT NEW HORIZONS ARTBEAT RB Managing your health and HH – Huntlyburn House CAN SELF-REFER improving your situation LACT – Local Area Co-ordinating WELLBEING COLLEGE BIAS BAS ADDACTION CHIMES Team MH&WF – Mental Health & Well- DAAS/DACS SUSOP RECONNECT MOMENTUM V1P AA/NA being Forum NHS24 /NHS Inform – Borders HELPLINES DBI (1st level) TIER 2 WELLBEING SERVICE Seeking further Emergency Care Service RB – Rediscover Borders CAN SELF-REFER TRAINING BORDERS WOMEN’S AID RAPE CRISIS GP support now/ SUSOP ongoing help – Surviors Unite Safe Oaks NHS24 /NHS INFORM ‘WHAT MATTERS’ HUBS CARERS CENTRE Project HOUSING SUPPORT EMPLOYMENT SUPPORT WELFARE BENEFITS SW – Social Work Duty Teams V1P – Veterans First Point TIER1 WELLBEING POINT ON-LINE APPS BOOK PRESCRIBING LIVE BORDERS Prevention - SELF-HELP staying well HEALTHY LIVING NETWORKS COMMUNITY LEARNING & DEVELOPMENT COMMUNITY PHARMACIES NATURE PROJECTS For further information go to the Wellbeing College website: www.wellbeingcollege.org.uk or email: [email protected] tel: 01896 807000 Information also available at the Wellbeing Point - www.nhsborders.scot.nhs.uk/six-ways-to-be-well and Scottish Borders Council - www.scotborders.gov.uk/info/20055/adults_and_older_people/370/mental_health/1 6 | SCOTTISH BORDERS MENTAL HEALTH SERVICES | INTEGRATED CARE PATHWAY (ADULT) INTRODUCTION | ACCESSING SUPPORTS AND SERVICES TIER 1 – GENERAL POPULATION (prevention) OUTCOMES: GOOD MENTAL HEALTH AND WELLBEING FOR ALL HEALTH PROMOTING COMMUNITIES SERVICES & RESOURCES SERVICE DESCRIPTION ACCESS AREAS COVERED LEAD MENTAL HEALTH Wellbeing Point NHS Borders webpage with links to Open access online. Borders-wide Wellbeing Point resources and useful information to help www.nhsborders.scot.nhs.uk/ people look after their mental health and wellbeingpoint wellbeing. Includes access to “Six Ways to Be Well” “Six Ways to Be Well” – a local information campaign promoting Joint Health Improvement Team self-help guidance to improve mental Telephone: 01835 825970 health and well-being. [email protected]. nhs.uk Online health and fitness Apps: Various apps available online Open access, widely All apps, tools and information promoting self-help tools to improve available – many are free. mental health (e.g. meditation techniques and health and fitness in general). Book prescribing service: Provides access to a range of self-help Available in all information resources. libraries. GENERIC LIVE Borders Culture, sport and leisure facilities that Open access to a range of Main Borders Live Borders support healthier lifestyles. amenities. towns. Telephone: 01896 661166 www.liveborders.org.uk/ Exercise Referral Scheme: a partnership Referral by GP, with NHS Borders to deliver physical physiotherapist or relevant activity programmes that aim to improve health professional to free health and wellbeing. or subsidised physical activity support. Healthy Living Networks Targeted health improvement in deprived Open access for residents in Galashiels Joint Health Improvement Team (HLNs) communities that promotes healthier HLN area. (Langlee), Hawick Telephone: 01835 825970 lifestyles. Aims to improve knowledge and (Burnfoot) and [email protected]. understanding, develop skills, and make Eyemouth. nhs.uk connections. SCOTTISH BORDERS MENTAL HEALTH SERVICES | INTEGRATED CARE PATHWAY (ADULT) | 7 TIER 1 – GENERAL POPULATION (prevention) OUTCOMES: GOOD MENTAL HEALTH AND WELLBEING FOR ALL HEALTH PROMOTING COMMUNITIES SERVICES & RESOURCES SERVICE DESCRIPTION ACCESS AREAS COVERED LEAD GENERIC Community Learning & A programme of community-based Access as a volunteer or client - Borders-wide based Community Learning & Development (CLD) opportunities including learning and open access for some activities, on high school Development skills development, promotion of health but some may be subject to catchment areas. Telephone: 01896 664160 and well-being, community safety and referral from partner agencies. [email protected] capacity building. Community Pharmacies Local pharmacies can offer information Open access for general advice All pharmacies Borders Alcohol & Drugs and advice on minor ailments and and prescriptions. across the Borders. Partnership prescriptions. www.nhsborders.scot.nhs.uk/badp Supervised consumption In addition, some pharmacies provide – accessed as part of services for those with addictions an agreement with GP, Only available in (e.g. smoking cessation; supervised pharmacist, and Borders certain pharmacies consumption of methadone; injecting Addictions Services. – refer to ADP equipment). Injecting equipment – open information. access, self-referral. Nature projects – e.g. Various community projects support Open access through contacting Various places Instinctively Wild community gardens, health, well-being and recovery from projects directly in each area. across the Borders – www.instinctivelywild.co.uk Instinctively Wild, Nature mental health problems through Can be accessed
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