Agenda item

An overview and update on mental health services in Haringey with input from the CCG, Council, Police and BEH Mental Health Trusts.

Tim Miller, Lead Commissioner for Adult Mental Health, introduced the presentation of the joint report which had also been co-authored by Dr Katrin Edelman, Clinical Director for Haringey at Barnet, Enfield & Haringey Mental Health Trust and Detective Superintendent Tony Kelly. He commented that it was a good time to have a discussion on mental health as it was around a year into the restructure of Barnet, Enfield & Haringey community services and the ongoing North Central London partnership working. Key points from the report included:

• That mental health services are mainly focused on mental ill health with conditions on a spectrum of severity. Larger services such as IAPT (Improving Access to Psychological Therapies) work with common and less severe conditions but nonetheless have a major impact on people’s lives.
• The main pathway is through the NHS, from GPs through to community and specialist services, but there are also pathways through the Council’s preventative services and social care.
• The Haringey Wellbeing Network, led by Mind in Haringey, had been commissioned last year which brings together services from a consortium of third sector providers which allows for a coordinated network with improved access and communication between each other and with statutory services.

Dr Katrin Edelman added that a lot of work had been going on to focus on networking to ensure that the most was being made of existing resources and on the restructuring of community services including to work more closely with GPs. The impact of people’s social circumstances is also important to mental health, highlighting the need to work with organisations providing services such as benefits advice.

Detective Superintendent Tony Kelly explained the new structure of policing in Haringey and Enfield which had recently moved to the Basic Command Unit (BCU) model. This includes a safeguarding strand which the policing element for mental health now comes within, whereas it previously sat within Operations and Events. Previously there was a part time officer for this role but now there is a sergeant and three constables working across both boroughs dedicated to mental health investment and enabling partnership work to reduce demand pressures on other agencies and better safeguard individuals.

In response to questions from the panel, Tony Kelly said that there are a significant number of call outs where the police come into contact with people experiencing a mental health episode. These should result in a referral but in future the aim is to develop MARACs (multi-agency risk assessment conferences) to support individuals who come into contact with the police a lot but perhaps do not meet the threshold for being sectioned.  Tim Miller concurred that the police are key partners in terms of inter-agency working. There is also work ongoing nationally to reduce the extent to which the police are a front door into mental health services and in Haringey this has involved improving access to crisis pathways such as through a single phone number for crisis services and handover arrangements from the NHS 111 service.

In response to further questions from the panel:

• Dr Edelman said that the crisis team is a relatively small team which has capacity for around 35-40 people (but sometimes has more than that) and the threshold for admission is high. 
• Dr Edelman said that a new pilot initiative was to train more people in ‘open dialogue’ which is a type of treatment developed in Finland which is focused on early intervention when someone is distressed, mobilising existing community and family support networks to support that person.
• Charlotte Pomery, Assistant Director for Commissioning, said that another partnership initiative being implemented is the Making Every Adult Matter (MEAM) approach in Haringey which focuses on individuals who may not meet the threshold for any particular service but may have multiple needs. This could include issues relating to homelessness, substance misuse, history of trauma/abuse, etc which requires various different services working together.
• In relation to a specific casework issue relating to difficulties with pharmacy prescriptions that was raised by a panel member, Tim Miller said that there had been recent training and support for General Practice across the NCL area on mental health, specialist talking therapies had been rolled out for people with physical health conditions. There was also a particular focus on trying to ensure that people get on the right pathway, efforts to build capacity in primary care to support mental health better and also the introduction of specialist pharmacy support into General Practice including on mental health and learning disabilities.
• On who Councillors can contact in relation to casework issues on mental health, Tim Miller said that he is available to help signpost Councillors. Also the Haringey Wellbeing Network is available as a front door to a range of services.
• On joined up care, Charlotte Pomery said that there is a digital programme across the NCL area including the providers and commissioners across the 5 CCGs. There is an Information Exchange which enables access to a single record of a person and a population health management system which supports planning at a population level. The LHCRE (London Health and Care Record Exemplars) aims to integrate IT systems across the area. This would enable more information to be available at the point of care and prevent people from having to give their details multiple times. This is a major programme of work likely to be a gradual process over the next couple of years.
• On social issues that can contribute towards mental health problems, Tim Miller said that there is a lot of evidence about various relevant social risk factors including poverty, discrimination, bereavement and Adverse Childhood Experiences (ACEs). Some of these can be more prevalent in areas of socio-economic deprivation but other stresses and strain can cause problems in more affluent areas too.
• On suicide prevention, Tim Miller said that Professor David Mosse had built a marvellous network of professionals across agencies along with other stakeholders who are engaged in the quarterly suicide prevention group meetings. On suicide prevention at Archway Bridge, he confirmed that proposals for new safety measures had recently been agreed.
• Charlotte Pomery said that proposals were being worked through to transform the site at Canning Crescent, which was previously a clinic base for the Mental Health Trust. The upper floors will contain supported living units for people with mental health needs. The ground floor will be used for the relocation of Clarendon Recovery College and develop a crisis café with additional funding from NHS England which will support people at risk of an inpatient admission.
• On future increased demand for mental health beds, Andrew Wright said that it would be necessary to increase the alternatives in line with the national NHS long-term plan. A small number of patients currently have to be placed in beds outside of the area so a top priority currently is to increase the number of inpatient beds within the catchment area including through the opening of an additional ward in Barnet in the summer.
• On how people being taken to Section 136 suites have their physical health needs assessed, this ought to be dealt with immediately and, if taken to A&E, patients should not be discharged until any physical injuries had been treated.
• On specialist supported accommodation, Tim Miller confirmed that there are 127 places for people with mental health needs. Improved quality of accommodation is required which the new units of Canning Crescent is contributing towards and more provision of social housing generally where people can be supported to live is also important.
• On the impact of Universal Credit changes, Tim Miller said that the joint mental health budgets were used to invest in advice services including Citizens Advice Haringey to provide benefits and other advice in health settings. The DWP supports staff in services with training on Universal Credit roll out and also co-fund specialist mental health employment services.

Cllr Connor thanked all the presenters for attending and noted that with various new projects and initiatives ongoing it would be helpful for the Panel to receive a summary list of these and how all the key agencies are connected to them. She also suggested that an update on the Open Dialogue initiative could be provided in around a year’s time.

AGREED: That the report be noted and a summary list of new projects and initiatives be provided to the Panel in writing.

AGREED: That an update on the Open Dialogue initiative be scheduled for a future meeting in approximately 12 months’ time.