MENTAL HEALTH AND WELL BEING SUPPORT GROUP REPORT OF VISIT TO LOTHIAN – 22 MAY 2001 Report of Visit to Lothian – 22 May 2001 (Pages 1 to 4) The 6 Month Progress Report - December 2001 (Pages 5 to 24) MENTAL HEALTH AND WELL BEING SUPPORT GROUP REPORT OF VISIT TO LOTHIAN – 22 MAY 2001 On this occasion, the Support Group was represented by: • Ms Morag Brown (Principal Officer, Older People and Dementia, City of Glasgow Social Work Department) • Mrs Sheila Cooper (Carer Representative, NSF) • Mr Brendan Gill (Director of Planning and Information, Lanarkshire Health Board) • Mrs Elisabeth Hill, OBE (Tayside Alcohol & Drug Alliance) • Mr David Pia (Assistant Chief Inspector, Social Work Services Inspectorate) • Mr Simon Porter (User Representative, Glasgow Association of Mental Health) • Dr Ian Pullen, Chairman (Consultant Psychiatrist, Borders Primary Care NHS Trust) • Mr Robert Samuel (Nursing Adviser, Scottish Executive) Summary The Support Group was impressed by the enthusiasm shown and range of interests present on the day. Much progress has been achieved in reshaping mental health services during this past 3 years and the complexity of this change process is acknowledged. The resource constraints locally within mental health and lack of a local comprehensive needs assessment are major impediments to making further rapid progress in implementing the Mental Health Framework in this priority area. Findings There was much for the Support Group to commend, including: • Carers and users of services were very positive about many of the services which individual clients/patients received. • LHCCs in many parts of Lothian have positively embraced the running and management of mental health services. • In West Lothian the major resettlement programme and reconfiguration of services leading to the imminent closure of Bangour Village Hospital. It is recognised that this was achieved with only limited availability of bridging resources. • The complexity of the change process within the Lothian Health Board area and associated local authorities is acknowledged. Nevertheless, good progress has been made in many areas. • The development of new services, particularly the new Young Peoples Unit and Local Forensic Unit at the Royal Edinburgh Hospital are significant achievements. The Support Group had concerns about issues in the following areas and while not attaching individual timetables for action in each case, it will look to see early attention being given and recorded in the response to its request for a 6 month progress report. Resources 1 • Lothian Health Board’s spend per head of population on Mental Health Services is lower than the Scottish average. This should however be set against the Board’s non- gaining situation post Arbuthnott and the commissioning of the new Royal Infirmary. • The partner agencies should review the current Mental Health Joint Implementation Strategy and identify the priorities to be achieved with the resources available within the Framework for Mental Health implementation timetable (2004). Planning • It is important that all partner agencies sign up to the Joint Planning Arrangements. The planning partners should consider how local plans and the overall strategy come together so that the priorities to be achieved in moving the mental health agenda forward over the next 3 years can be addressed on an equitable basis. • A timetabled, costed plan showing what is needed and where, provided by which agency is needed. Care Programme Approach (CPA) • The Group heard concerns about the lack of implementation of CPA within the City of Edinburgh. The agencies should implement the CPA without delay and apply the arrangements to regular audit. That audit process should provide a very useful mechanism for identifying service deficits and inform how services should be reshaped to respond to such need. Ref SWSG 16/96 and Our National Health, Section 7. Needs Assessment • It is recognised that agencies across the Lothians have undertaken various pieces of needs assessment work. However a comprehensive needs assessment is now required to inform planning and other joint agency decisions. The Support Group guidance Needs assessment for a Comprehensive Local Mental Health Service is commended in this regard. • It will be important to adopt an inclusive process to ensure user/carers and partner agencies are able to contribute meaningfully to such a process. User and Carer Involvement • The Group heard throughout the day the various arrangements within each local area for engaging user and carer involvement in the planning processes and major changes. • The partner agencies should ensure that the processes in place enable users and carers to be actively and meaningfully involved in helping to shape service delivery and such involvement occurs at the right time. Advocacy • The pattern of advocacy is variable across Lothian. Some concerns were expressed about access to collective and independent advocacy by users of services. We look 2 forward to an update on progress made towards the further development of advocacy services across Lothian prior to our next visit. Psychological Therapies • Our attention was drawn to the waiting times in accessing psychological therapies. There are clearly different models and ways in which services can respond to meet such need and to make an improvement on the current position. There is a need to take a strategic view as to how these services should be structured and organised in order to make more effective use of the current limited resources available. The planned visit from the Support Group sub Group on this matter was discussed. The Support Group looks for the issues identified and raised here to be addressed in the ongoing and future planned activity of all the agencies involved. As earlier indicated, the Support Group will request a written update on the progress made against the comments offered in this document in around 6 months. That update will be published on the web site alongside this report. Finally, the Support Group would like to thank all who attended and participated on the day and those whose contributions to the arrangements made the day and visit run smoothly. Mental Health and Well Being Support Group 19 June 2001 3 Appendix Background and Purpose of the Support Group The Support Group was formed on 31 March 2000 to support, influence and advance the further strategic development of mental health services in Scotland. The Support Group offers advice locally and to the Scottish Executive on solutions and best practice in advancing the implementation programme of the Framework for Mental Health Services in Scotland agenda for change and improvement in mental health services. The Group also provides additional focused local activity assessments to the Scottish Executive and the agencies involved. The Support Group complements, but does not replace related activity of the Joint Future Group, the mentor and advice remits of the Scottish Health Advisory Services, the Mental Welfare Commission or the Clinical Standards Board for Scotland. Approach/Process The Support Group issues a template, for completion by the partner agencies prior to visits. The template is based on Scottish Executive guidance material, and other relevant material including: • A Framework for Mental Services in Scotland (1997) • Advocacy – A Guide to Good Practice (1997) • Mental Health Promotion in Scotland – Board Position paper HEBS (1998) • Services for Women in Postnatal Depression NHS MEL(1999)27 • Priorities and Planning Guidance 1999-2000 for the NHS in Scotland (1998) • Implementing the Care Programme Approach (SWSG/Accounts Commission Survey) (1998) • A Shared Approach (Accounts Commission) (1999) • Our National Health: a plan for action, a plan for change • Risk Management (2000) • Needs Assessment for a Comprehensive, Local Mental Health Service (2001) • Annual Report – Mental Health and Well Being Support Group (2001) During the visit individual members of the Support Group meet with groups of individuals, including users and carers, representing the range of stakeholder interests in the development and implementation of the joint mental health strategies in the area visited. Meetings also take place with the joint planning and implementation team and the key agency Executives. The Support Group is grateful for the co-operation and assistance of the statutory and non- statutory agencies in the area. Further information about the Support Group, including its Annual Report, can be found on its web site at http://www.show.scot.nhs.uk/mhwbsg. 4 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 VISIT REPORT PROGRESS REPORT AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / TIMESCALE INDIVIDUAL Resources • We have undertaken the attached analysis which shows that in terms of % of total funds available Lothian is not below Lothian Health Board’s spend per head of the average. population on Mental Health Services is lower than the Scottish average. This should • It is widely recognised how imprecise these national however be set against the Board’s non- comparisons are as no two Boards include the same services gaining situation post Arbuthnott and the or costs in their figures. commissioning of the new Royal Infirmary. • A further complication is the transfer of resources to the LAs, making comparisons between NHS Boards alone inappropriate. • We will continue to keep our spending under review in Lothian NHS Board Ongoing and reviewed comparison