Archived decisions

Hampshire County Council

Safe & Healthy People Select Committee Item 5

10 October 2007

Mental Health National Service Framework: Autumn Assessment 2006, Use of Mental Health Act 1983, National Mental Health Service User Survey

Report of the Director of Adult Services

Contact: Lucy Butler Ext: 01962 847213

Email: [email protected]


	How the conclusion in this report fits with the Corporate Strategy This scheme will impact on the delivery of the following Corporate Priorities: 1. Hampshire safer and more secure for all: through application of the Mental Health Act to reduce risk to, suicide prevention strategies, and implementation of Delivering Race Equality, which includes reduction in fear of services 2. Maximising wellbeing: particularly through services addressing social inclusion and the development of self-directed care.
1.		Summary

1.1		This report summarises: · The findings of the Annual Monitoring of the Mental Health National Service Framework (NSF) 2006. Progress has been made in implementing key national targets including Early Intervention in Psychosis. Plans are also in place to recruit the target number of nine black and minority ethnic community development workers by December 2007. Further work is required to meet targets for mental health services in primary care, the implementation of mental health promotion strategies, and development of a personality disorder strategy. · The use of the Mental Health Act in 2006/07 - the work undertaken by Approved Social Workers (ASWs) in relation to assessments under the Mental Health Act 1983, including the County Council's use of Guardianship under the Mental Health Act. · The National Patient Survey 2007 results for Hampshire Partnership Trust (HPT) - which showed that people who receive mental health services via HPT report better than average outcomes. · This scheme will impact on the delivery of the following Corporate Priorities: 1) Hampshire safer and more secure for all: through application of the Mental Health Act to reduce risk to, suicide prevention strategies, and implementation of Delivering Race Equality, which includes reduction in fear of services 2) Maximising wellbeing: particularly through services addressing social inclusion and the development of self-directed care.
2.		Impact Assessment

2.1		In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme. Hampshire has been identified as a `Focused Implementation Site' for early implementation of Delivering Race Equalities in Mental Health, and this is included in the Local Area Agreement.
3		Consultation with Local Members

3.1		There has been no specific consultation with local members on this County wide performance report.
4		Introduction

4.1		Mental Health NSF
4.1.1		The Mental Health NSF, published in 1999, describes the range of services required for a modern mental health service for adults of working age and spells out a ten-year programme for modernisation. Specific targets have been set in subsequent guidance. They include Assertive Outreach Teams (December 2003), Crisis Resolution and Home Treatment Teams, Early Intervention Teams, carer's support and additional staff in primary care (December 2004), Support Time and Recovery (STR) Workers (December 2006). The PCT has a target of nine community development workers for black and minority ethnic (BME) groups by December 2007. There is also a target to reduce the suicide rate by twenty per cent by 2010. A glossary of terms and abbreviations used in this report is found in Appendix 1.
4.1.2		PCTs and the County Council's Adult Services hold joint local responsibility for the implementation and monitoring of the NSF. Local Implementation Teams (LITs) based on PCT localities are the primary vehicle for achieving this. The mental health commissioners in Adult Services and the PCT are operating as a shadow joint commissioning team and are in the process of developing the first joint mental health commissioning strategy for the County.
4.1.3		This report describes the outcome of the Autumn Monitoring 2006 of the NSF in Hampshire and the Isle of Wight, with particular reference to the seven LITs within the County Council's boundary at that time, and their self assessment against twenty one target areas.
4.2		Use of Mental Health Act
4.2.1		This section of the report details statistics about the use of the Mental Health Act 1983 (MHA) and makes a comparison with previous years. The County Council has a duty under section 114 of the Mental Health Act 1983 to appoint a "sufficient number of Approved Social Workers (ASWs)" to carry out its responsibilities under the Act, namely to assess those suffering from mental disorder (as defined by the Act) for possible admission and if necessary, detention to a psychiatric hospital. The majority of Hampshire's ASWs are based in adult Community Mental Health Teams (CMHTs) which are integrated services between Hampshire Adult Services and Hampshire Partnership NHS Trust (for the most of the County) and Surrey and Borders Partnership NHS Trust for North-East Hampshire. ASWs also assess clients for possible reception into guardianship under section 7 of the Mental Health Act 1983. Guardianship provides a statutory framework to support a client's care in the community.
4.3		National Patient Survey 2007
4.3.1		The Healthcare Commission undertakes an annual survey of users of community mental health services. In 2007 the survey was completed by 69 NHS trusts and involved service users on the Care Programme Approach (CPA). Nationally, 15,900 completed questionnaires were received from service users aged 16 to 65 which represented a response rate of 38%. The 2007survey showed that people who receive mental health services via Hampshire Partnership Trust (HPT) report better than average outcomes in the following areas: · having a say in decisions about medication · purposes of medication explained · chance to discuss review beforehand and express views at meeting · had enough say in decisions about care and treatment · had out of hours crisis number · had access to talking therapies · knew who care co-ordinator was and could contact them
5		Outcome of Autumn Monitoring of Mental Health NSF

5.1		Self Assessment The outcome is shown in Appendix 2.
5.2		The key messages from the self assessment in relation to social care needs are: -
5.2.1		During 2006 an Early Intervention in Psychosis service was introduced across Hampshire, concluding a major piece of service remodelling to ensure the key elements of the NSF are in place. The service operates an assertive, holistic approach which ensures that all aspects of care, including social needs, are met.
5.2.2		National targets that are not being met include Community Development Workers (CDW) for black and minority ethnic groups. In general, there were funded plans in place to deliver the CDWs by December 2007.
5.2.3		Mental health promotion strategies were either not in place, or not being implemented due to a lack of dedicated resource.
5.2.4		There is no personality disorder strategy, and few dedicated services for this group. This will be developed in 2007/08.
5.2.5		Local Strategic Partnerships: for a `green' rating there needs to be evidence that `LSPs have focussed on the needs of people with mental distress and social exclusion in response to the Social Exclusion Unit report and as a result there are clear action plans to benefit this group of users or potential users involving all LSPs, PCTs and local authorities.'
5.2.6		Mental health of people with learning disabilities: people need to be receiving mental health services to a standard at least equivalent to that for people without learning disabilities.
5.2.7		Advocacy services: there is a consistent view that current levels of investment are inadequate and there is inequitable provision.
5.2.8		Service user involvement and employment of service users: this is a key target area for mental health service development in 07/08 & 08/09 and will focus on involvement of service users in monitoring and review of services and development of service user led services. The development of self-directed care initiatives will also promote service user involvement.
6		Use of Mental Health Act 1983

6.1		Table 1 in Appendix 3 illustrates the number of assessments for people who may require compulsory admission to hospital under the MHA in the different areas of Hampshire. Until 2005/06 the figures were collected manually in some considerable level of detail - this was then changed to collecting data from SWIFT, which is currently being updated to provide far more detailed information for future years. The data for 2006/7 shows considerably lower levels of assessments which may in fact be indicative of incorrect/insufficient recording on SWIFT. These results need further investigation and improvements in data entry.
6.2		Table 2 in Appendix 3 show use of Guardianship. Under the MHA Guardianship provides the local authority with the powers in relation to people with mental disorder: to require residence, to require attendance at a specified time for the purpose of medical treatment, occupation, education or training, to require access by a doctor, approved social worker or other person specified by the guardian. Guardianship is used for a number of purposes e.g.: ensuring that there is a proper legal framework within which to make care decisions where a person lacks mental capacity (particularly older persons with dementia requiring residential care); encouraging younger persons with severe mental illness to stay in one place and not drop out of services; enabling access to be given to socially withdrawn individuals who would otherwise refuse services at home leading to neglect; preventing exploitation by relatives or other carers.
7		National Patient Survey 2007

7.1		See appendix 4 for details of the results of the survey for HPT - Table 3 shows above average results and table 4 shows below average results. The areas where improvement is required will go in to an Action Plan for 07/08 and this will be monitored within the adult mental health directorate and the Trust. Significant areas for improvement include access to talking therapies, having a say in decisions about medication, having a written care plan and receiving help to find a job.
8		Conclusion and next steps

8.1		Mental Health NSF
8.1.1		The autumn monitoring of the Mental Health NSF 2006 identifies progress in implementing some of the key components of modern mental health services including Early Intervention in Psychosis. Priority areas in the coming year include the development of a strategy for primary care services, recruiting the target number of Community Development Workers, implementing mental health promotion strategies, developing a strategy for people with personality disorders and promoting service user involvement through self-directed care and service user led services. These plans are included in the Adult Services Mental Health Service Plan, and will be a key feature of the joint Mental Health Commissioning Strategy that is currently being developed with Hampshire PCT. The momentum achieved for service improvement needs to be maintained in a challenging financial climate and in a period of significant organisational change.
8.2		Use of Mental Health Act
8.2.1		The work to improve collection and interpretation of MHA statistics using SWIFT needs to continue and a requirement for collection will be added to the Section 75 agreements with HPT & SABP.
8.3		National Patient Survey 2007
8.3.1		The areas where HPT scored below average need to be addressed within the Trust and monitored by commissioners.


Recommendation(s)
That:

1	The Safe & Healthy People Select Committee are asked to note and comment on the contents of this report.

Section 100 D - Local Government Act 1972 - background documents

The following documents discuss facts or matters on which this report, or an important part of it, is based and have been relied upon to a material extent in the preparation of this report.

NB: the list excludes:

1. Published works

Mental Health Act Annual Assessment

Health care Commission ( 2007) Community mental health services. The views of mental health service users. Key findings from the 2007 survey.

2. Documents which disclose exempt or confidential information as defined in the Act.

None

LINK(S) TO CORPORATE STRATEGY	Yes	No
Hampshire safer and more secure for all	_
Maximising well-being	_
Enhancing our quality of place

Appendix 1 - Glossary

Assertive Outreach	An active form of care and treatment for people with severe and persistent mental disorder who have difficulty in maintaining lasting and consenting contact with services.
BME	Black and Minority Ethnic group
BVH	Blackwater Valley and Hart
CMHT	Community Mental Health Team
CPA	1) Care Programme Approach - joint health and social care mental health assessment process 2) Corporate Performance Assessment
Crisis Resolution and Home Treatment (CRHT)	For adults with severe mental illness with an acute psychiatric crisis of such severity that without the intervention of a CRHT team would require hospitalisation.
Dual Diagnosis	(Also know as Co-Morbidity) A broad spectrum of Mental Health and Substance Misuse problems that an individual might experience concurrently.
Early Intervention in Psychosis	A service designed to intervene at an early stage in first episode psychosis for people aged 14 to 35. This is important as the first four years of psychosis carry the highest risk of serious sustained physical, social and legal harm.
EH	East Hants
ETVS	Eastleigh and Test Valley South
F&G	Fareham and Gosport
Gateway Workers	Work with Primary Care Teams, NHS Direct, accident and emergency and specialist services to respond to people with mental health problems who need immediate help.
Graduate Primary Care Mental Health Workers	Employed in Primary Care to support the delivery of brief, evidence-based effective interventions and self-help for people with common mental health disorders of all ages.
HPT	Hampshire Partnership Trust
IOW	Isle of Wight
LIT	Local Implementation Team
LSP	Local Strategic Partnership
MH	Mid Hants
NF	New Forest
NH	North Hants
NSF	National Service Framework
PC	Portsmouth City
SABP	Surrey and Borders Partnership Trust
SC	Southampton City
SHA	Strategic Health Authority
STR Workers	Support Time and Recovery Workers help services users to have an ordinary life, assisting them with their every day, practical needs in whatever setting they find themselves to facilitate recovery.

Appendix 2 - Mental Health Autumn Assessment 2006

		IoW	Mid Hants	So'ton	NF	N Hants	F&G	EH	Ports	NE Hants	ETVS	Total	Total	Total
		06/02/2007	07/02/2007	08/02/2007	08/02/2007	09/02/2007	13/02/2007	13/02/2007	13/02/2007	09/02/2007	07/02/2007	R	A	G
1	Graduate Workers											7	0	3
2	Primary - secondary interface											0	7	3
3	Key Services - Crisis Intervention											0	0	10
4	Early Intervention in Psychosis											0	1	9
5	Secure Places / Intensive Care											0	2	8
6	STaR Workers											0	2	8
7	Social Inclusion - Local Strategic Partnerships											0	8	2
8	The Mental Health of People with Learning Disabilities											0	7	3
9	Vocational Support											0	1	9
10a	Delivering Race Equality - Black & Minority Ethic People's Services											0	1	9
10b	Implementing the policy "Delivering Race Equality in Mental Health Care"											0	1	9
10c	Community Development workers (Black and Minority Ethnic Communities)											7	1	2
11	Planning and Integration of care - coordination between age specific services											0	1	9
12	Governance											0	0	10
13a	Service User Involvement											0	3	7
13b	Carer Involvement											0	4	6
13c	Not for profit Sector involvement											0	0	10
14	Employment of Service Users											1	2	7
15	Other priorities - Suicide Prevention											0	4	6
16	Advocacy											1	5	4
17	Mental Health Promotion - Standard one strategy											5	3	2
18a	Specialist Services											0	2	8
18b	Specialist Services - Personality Disorder											5	4	1
19	Mental Health Act 1983 Section 135 / 136 / Places of Safety											0	7	3
20	Improving Access to Psychological Therapies											0	9	1
21	Choice											0	7	3
												26	82	152
	Total Red	2	3	0	3	2	4	4	1	3	4	26
	Total Amber	9	6	5	9	8	11	9	9	9	7	82
	Total Green	15	17	21	14	16	11	13	16	14	15	152

Appendix 3 - Use of Mental Health Act 1983

Table 1 - Assessments under MHA


	2003/04	2004/05	2006/07
Locality	No of Assessments	No of Assessments	No of Assessments	By Gender
East Hants	158	114	117	56F, 61M
Fareham and Gosport	123	138	139	72F, 66M, 1 N/K
Mid Hants and Eastleigh	149 (Mid Hants) 85 (Eastleigh & Romsey)	159 (Mid Hants) 71 (Eastleigh & Romsey)	136	66F, 69M, 1N/K
New Forest and Romsey	136 (New Forest)	172 (New Forest)	46	19F, 27M
North Hants	173	182	149	79F, 70M
North East Hants	70	102	100	47F, 53M
Out of Hours	221	334	262	111F, 151M

Total	1115	1272	619	289F, 328M, 2N/K

Notes

· Unfortunately the figures for 2005/06 are not currently available

· Between 2004/05 & 2006/7 the Eastleigh & Romsey locality was split between Mid Hants and New Forest so the figures are differently displayed over time

· Until 2005/06 the figures were collected manually in some considerable level of detail - this was then changed to collecting data from SWIFT, which is currently being updated to provide far more detailed information for future years

· The figures for 2006/07 are significantly lower and this may cast doubt on their accuracy

Table 2 - Use of Guardianship

	1 Apr 2004 to 31 Mar 2005	1 Apr 2005 to 31 Mar 2006	1 Apr 2006 to 31 Mar 2007
No. of applications accepted	10	10	13
Breakdown of Orders by:
1: Mental disorder
mental illness	9	10	8
mental impairment	1	0	5
severe mental impairment	0	0	0
psychopathic disorder	0	0	0
2: Gender
female	7	7	10
male	3	3	3
3: Age
over 65	7	7	9
under 65	3	3	4
4: Care Group
Older Persons	7	7	9
Mental Health	2
Learning Disabilities	1
5: Ethnicity
white British	8	10	9
white Irish	0	0	1
Black African	0	0
Black Caribbean	0	0
Black Other	0	0
Other ethnicity	2	0
No. renewed in period	2	1	0
No. discharged by Responsible Medical Officer	2	1	4
No. lapsed	1	3	1
No. deceased	1	0	0

Appendix 4 - National Patient Survey 2007 Results for HPT

Table 3 - HPT outcomes better than average

Question	HPT result	Average result
Service users reporting they definitely have a say in decisions about medication	43%	41%
Definitely had purposes of medication explained	69%	64%
Given a chance to talk to care co-ordinator before review about what would happen	62%	60%
Definitely given a chance to express views at the meeting	69%	69%
Definitely had enough say in decisions about care & treatment	46%	43%
Have the number to phone out of hours in a crisis	60%	45%
Access to talking therapies ( NHS MH Services)	39%	35%
Told who the care co-ordinator is	68%	65%
Can always contact care co-ordinator of a problem - in hours	75%	74%
Out of hours	60%	45%

Table 4 - HPT outcomes below average

Question	HPT result	Average result
Definitely told about the possible side effects of medication	36%	40%
Had a written copy of the care plan	41%	45%
Help finding jobs	9%	10%

This content is archived

How the conclusion in this report fits with the Corporate Strategy

Summary

Impact Assessment

Consultation with Local Members

Introduction

Outcome of Autumn Monitoring of Mental Health NSF

Use of Mental Health Act 1983

Conclusion and next steps