Agenda item

To receive an update on the impact of Covid-19 on the delivery of mental health services and on the drivers of mental wellbeing and illness in the population.

Tim Miller, Joint Assistant Director for Vulnerable Adults and Children for Haringey Council and North Central London CCG, and Andrew Wright, Director for Planning and Partnerships at Barnet, Enfield & Haringey Mental Health Trust, provided an update for the Panel on adult mental health.

Tim Miller noted that, in addition to the points about mental health services that were highlighted in the slides provided, there had also been a lot of recent work in primary care including the commissioning of a new primary care service for adults with severe mental illness with a focus on physical health. Many of the services had been targeting those at greatest clinical risk from Covid and from health and social inequalities, including BAME communities and areas of greatest economic deprivation. Safe Haven, a non-clinical crisis service, had been introduced as a virtual service with Mind in Haringey. A joint effort across partners in Haringey to support people experiencing homelessness during the Covid pandemic had been effective in reaching those at greatest risk.

Andrew Wright added that demand for mental health services had decreased during the first Covid wave and then increased quite significantly over the summer. There had been only a small reduction in demand following the second lockdown. Commissioners and providers were mindful of the longer-term implications of the wider economic and societal impact on people’s mental health.

Andrew Wright also provided a brief update on Blossom Court, the new mental health inpatient unit at St Ann’s Hospital. The unit had opened in August with a ceremony attended by Cllr Peacock in her capacity as the Mayor and he thanked colleagues at the Council for their support in getting to this stage as the benefits of the new facilities for patients and staff had been huge.

Tim Miller and Andrew Wright then responded to questions from Members of the Panel:

·         Cllr Brabazon asked how services deal with complex anti-social behaviour problems arising when a person with mental ill-health lives in shared accommodation or a block of flats. She noted that Members often found it difficult to obtain multi-agency action in such circumstances when dealing with casework. Andrew Wright responded that, as the local provider, the Trust was very aware of how difficult this type of situation can be for the individual, as well as for neighbours, families and friends. He said that the Trust works closely with colleagues in social care, housing services and other partners to seek to agree solutions with the patient and their families. Cllr Brabazon explained that, from the perspective of a local Councillor, it can be difficult to establish relevant facts in such cases due to confidentiality requirements making it more difficult to get action taken. Cllr Connor added that, in her view, a single point of contact for Councillors for such cases would improve the situation. Andrew Wright said that Councillors were welcome to contact him directly if they had a specific issue and that he would provide some contact details that could be used. Cllr Brabazon said that establishing who is responsible for taking action is difficult and so a multi-agency pathway to deal with such problems should be established. She suggested that the Panel could examine this matter further at a future meeting. Rachel Lissauer, Director of Integration (Haringey) at the NCL CCG, said that local commissioners are trying to drive towards a position where all the different agencies connected with a person with complex needs are brought together on a locality basis to identify and prevent potential crises from escalating. Cllr Connor recommended that a conversation after the meeting could follow to establish contact details for Councillors and a potential pathway for action. (ACTION)

·         Helena Kania asked about difficulties with warm transfers and of passing people from the 111 team to the mental health team and whether staffing levels could be part of the problem. Andrew Wright said that the Trust’s new crisis line acts as a 24/7 access point into mental health services for service users, families, friends and GPs. This should include an interface with the 111 service and he said that he was not particularly aware of a problem in that regard but that he would be happy to look into this further. Andrew Wright suggested that he contact Helena Kania by email after the meeting to obtain further details on the matter. (ACTION)

·         Cllr Stone asked for further details on the benefits of the new services at Blossom Hill, St Ann’s Hospital. Andrew Wright said that, prior to the summer, the inpatient wards at St Ann’s Hospital had been among the worst in the country. The hospital had not been built to provide mental health services which only started there in the 1990s, many of the wards had shared bedrooms and there had been a lack of facilities such as en-suite toilets. However, the new building was purpose built, meets all of the national standards and had involved a long process involving services users, carers, staff and others to assist with the design of the facilities. Patients all had single rooms with en-suite facilities and access to outside space, and the new facilities had also improved the working environment for staff.

·         Cllr Peacock showed Members a copy of an information booklet that she had received when visiting St Ann’s Hospital which she said was very useful and recommended that copies be circulated to Members. Andrew Wright said that he would be happy to circulate this and added that he would like to invite Members to visit the facilities in future when safe enough to do so in terms of Covid. (ACTION)

·         Cllr da Costa asked about IAPT (Improving Access to Psychological Therapies) waiting times and the impact of Covid on waiting times. Tim Miller said that the local IAPT service, known as Let Us Talk, provided by Whittington Health was the largest mental health service in the Borough and treats around 7,000 Haringey residents each year. The Haringey service had for some time performed above the national standards for waiting times and had sustained that through the Covid period. However, waiting times were still an issue and could depend of the type of therapy that people want. Service users may also have preferences, for example, on the gender of their therapist, the time of day or the language for their therapy, all of which can vary the waiting time that they may experience. The number of people referred to IAPT during lockdown did fall but the service also had to adapt to providing services online and, while there had been some impact, waiting times over the period were broadly comparable. At present 95% of patients were being seen within 6 weeks (against the national target of 75%) and the average wait between the first and second appointment was around 13 weeks, though wait times could be shorter or significantly longer for certain types of therapy. Cllr da Costa asked if further information could be provided on the number of people dropping off because of frustration with waiting times. Tim Miller said that he didn’t have information on drop-offs to hand but would provide this to the Panel. (ACTION) Rachel Lissauer added that the IAPT service had been considering, through the use of workshops, how best to provide services for people experiencing anxiety/depression as a result of Covid. Cllr Connor expressed interest in exploring the data further on the long waiting times between the first and second appointments and the reasons for this. (ACTION)

·         Cllr Connor asked a new community mental health model being co-designed with BEH-MHT, the Council, the CCG and other partners which she understood to involve building the capacity of grassroots community groups that offer early help and prevention. Tim Miller said that NHS Long Term Plan includes a commitment to a new community framework for mental health. An approach to build capacity in the voluntary sector in Haringey had been ongoing for some time. The focus had been particularly on how to ensure that a range of support available to meet a range of needs is available from a better co-ordinated system. The new model was at a very early stage and there was now a working group led by BEH-MHT to look at how this might work in practice, but this would be a journey that would take a number of years. Andrew Wright added that, from the Trust’s point of view, this offers some significant changes, such as peer support workers with lived experience supporting the service. This could also involve helping with wellbeing and prevention where the voluntary sector could bring its expertise and community networking to complement other services. A paper on this was expected to be taken to the Trust’s Board in a couple of weeks’ time. Cllr Connor said that the Panel would be interested in receiving any papers on this matter that they were willing to share and recommended that the Panel continues to monitor this issue and potentially bring it back for discussion at a future Panel meeting. (ACTION)