Agenda item
Mental Health Services in Brent
The report provides an overview of the mental health services provided in Brent for people with severe mental health issues. The report is divided into two parts:
· Community Mental Health Services
· Acute Mental Health Services at Park Royal: including details of wards, structure, patient data and information on discharge/transfer delays.
Minutes:
The Chair invited a service user to describe her experience of mental health services in Brent. The service user began by informing the committee that she had extensive experience of the treatment provided by the mental health service in the borough. In her view she felt that over a period of time the service had deteriorated, particularly in terms of patient access and had become more bureaucratic with monitoring undertaken on a points based system. Whilst her condition was now improving as she steadily undertook a process of reintegration, she felt that her cause had not been helped by what she saw as a rolling back of services. A number of community services had been withdrawn and there was a lack of transitory services for patients. The service user had made a request for a community psychiatric nurse, however this had been turned down and she had been offered a social worker instead, however they lacked the medical knowledge to be able to help. The service user felt that the service focused too much on crisis intervention rather than crisis prevention and patients were taking too long to be seen. The cost reductions in mental health services were also impacting, which she suggested was a reason why she had been told she was not unwell enough to be provided with treatment, whilst she also felt that patients were discouraged from being admitted to hospital. Her own personal experience of staff in the mental health service was positive, however she felt that they were frustrated by continuous cost cutting.
The Chair thanked the service user for their contribution and asked that they liaise with mental health services to discuss their case.
Robyn Doran (Chief Operating Officer, Central and North West London NHS Foundation Trust ) welcomed discussion with the service user and their input into helping redesign the service. Robyn Doran then presented the report that had been jointly produced by Brent Clinical Commissioning Group (CCG), the council and the Central and North West London (CNWL) NHS Foundation Trust. The report mainly focused on adults, however members heard that a report on children’s mental health services could be provided at a future meeting. Members heard that around 25% of people will have mental health problems at some stage during their lives. In most cases, they would be cared for by their GP and carer and possibly a representative from the voluntary and community sector. Up to around 2,500 people may be using mental health services in Brent at any one time. Robyn Doran drew the committee’s attention to the number of patients recorded with depression and the number of new diagnosis of depression in 2012/13 in the borough. Funding in the borough was middling compared to the other London boroughs. However, there was a need to redesign the service to address issues such as waiting times, urgent care and how to ensure people who received treatment remained well. There also needed to be steps taken to improving access to psychological therapy and for the relevant organisations to work together and a process of integrated commissioning would take place.
During discussion by members, reasons were sought as to why there had been an increase in patient referrals and staff caseloads. An explanation of what was meant by repatriation of patients from out of the area in the table on page 31 of the report was requested and it was also asked how the repatriation costs were met. Another member commented on the positive experience his daughter had received from mental health services following an accident. It was queried why there was a lower rate of hospital admissions for mental health conditions in Brent compared to both the London and England average. Details were sought as to what steps would be taken to address the increase in depression in the borough. A member expressed surprise that patients had not been reviewed and discharged under Section 117 of the Mental Health Act in the past and reassurance was sought that the proper procedures were now in place and being followed. It was asked how many GP practices had a register of patients with depression and were the levels of depression on variable scales. An explanation was sought as to why depression was recorded as highest in the Kingsbury locality. Reasons for an increase in urgent referrals and how quickly these patients had been seen in November 2013 were requested. Clarification was sought in respect of funding for Improving Access to Psychological Therapies (IAPT). Further information on the carers service, including budget details, was asked and were there practical respite services provided to carers. In noting that the total CCG spend on mental health services was identified as £41.243m in the report, a member commented that an earlier report had stated around £34m and explanation for this difference was sought, whilst the amount spend on patients outside Brent was also asked for. A member also asked how rehabilitation services would link up with housing options.
In reply to the issues raised, Robyn Doran advised that the reasons for the increase in patient referrals could be attributed to the economic situation and changes to welfare benefits which were also impacting upon mental health services nationally. There were also issues that were Brent specific that contributed to staff caseloads increasing, such as the fact that a larger proportion of patients were from overseas and so possibly complicated by the fact that English was not their first language. In respect of the table on page 31 of the report, Robyn Doran explained that the CNWL was working with Brent CCG in identifying patients that had been taken out the borough in order that they could then return to the borough to receive mental health services treatment. These repatriation costs were taken into consideration as a growth area in funding for the CCGs, although no funds had been specifically allocated by the Government for this. She confirmed that the appropriate procedures were now in place in respect of patients subject to Section 117 and that Brent compared favourably in making progress in this area as opposed to other London boroughs.
Sarah Mansuralli (Deputy Chief Operating Officer, Brent Clinical Commissioning Group) added that there were cultural issues that needed to be looked at. For example, most psychological therapy was conducted through talking sessions, however English was not the first language for some patients and more imaginative ways would need to considered. Recognising the underlying causes of depression was also important and it was acknowledged that the IAPT model could not always engage in all groups in the community. Work with community groups was also being undertaken, particularly with under represented groups. Sarah Mansuralli advised that services to support carers were being commissioned alongside the council and the Independent Care Organisation (ICO) helped in matters such as accessing respite care, whilst CNWL also ran services for carers. Members heard that the CCG had allocated approximately £300-500K for carers, although this was not solely for carers looking after mental health patients. In respect of mental health services expenditure being higher than in a previous report, Sarah Mansuralli advised that the previous report had not included some services that were listed on the most recent one.
Dr Ethie Kong (Chair, Brent CCG) confirmed that over the last year, Harness and Kilburn localities had the highest rates of depression in the borough based on the number receiving treatment. She advised that Quality and Outcomes Framework figures may be lower than reality as some patients would not want their GPs to classify them as having depression and this explained why more patients were being treated for depression than those who were officially registered as having depression.
Jo Ohlson (Chief Operating Officer, Brent CCG) advised that funds had been dedicated from IAPT for repatriating costs for patients to return to Brent.
Phil Porter (Director of Adult Social Care) advised that there were also a range of specialist services provided and in the case of carers, each case would be looked at individually with solutions tailored for each following an assessment by a care coordinator and it was important that the needs of carers were met. In addition, a Care Support Bill was due in Parliament in 2015 to provide further clarity on what support carers should receive. A range of support services were also available in respect of rehabilitation services and a holistic, joined-up approach was being taken through housing services, Brent CCG and other relevant organisations working together.
The Chair requested further information on savings and how these would be achieved and on rehabilitation at a future meeting.
Supporting documents:
- 1-Mental Health Services - covering report, item 4. PDF 57 KB
- 1 - MH Community Services HOSC Paper, item 4. PDF 315 KB
- 1-Brent HOSC Report - Acute Service Park Royal final, item 4. PDF 101 KB