Agenda item

For the Health and Wellbeing Board to receive an update on the Integrated Care Partnership (ICP) priorty – improving mental health and wellbeing, and the plan for 2024-25.

Robyn Doran (Director of Transformation, CNWL, and Brent ICP Director) and Sarah Nyandoro (Head of Mental Health, Learning Disabilities and Autism – All Age – NHS NWL) introduced the report, which updated the Health and Wellbeing Board on the Integrated Care Partnership (ICP) priority area for improving mental health and wellbeing. In introducing the report, the following points were highlighted:

• The Board were reminded of the previous discussions in relation to inequalities, levelling up, and the need to have the data to back up the business case for levelling up. In terms of levelling up, Brent had historically been underfunded, and when looking at its data the problem was getting bigger and not smaller. There was disappointment that the case for levelling up had been under discussion for quite some time and despite the inclusion of data to evidence the case, the ICP had still not received an response to the business case that was put forward 6 months previously. The ICP had hoped that Integrated Care System (ICS) partners would be available to answer some of those questions during the meeting but due to the pre-elections period the ICS had not been able to attend. The ICS had committed to attend the next meeting to answer some of those questions.
• There was an ongoing area of concern regarding CAMHS and early intervention and there was now some resource being put in place around neurodiversity which was hoped would see significant progress for children and young people.
• It was highlighted that, when compared with the other 8 NWL boroughs, Brent had the highest number of people registered as having severe mental illness. When looking at those accessing mental health support, such as Talking Therapies, Brent also had the highest number of people accessing services, and the largest numbers being admitted into an inpatient unit. The report aimed to highlight that demand was outstripping capacity.
• The report demonstrated the work done by the priority groups in the Mental Health and Wellbeing ICP Subgroup including employment and housing. Within housing, as well as the support being given to people to access accommodation, there was now the addition of the Rough Sleepers Initiative focused on mental health issues, general health issues, physical health and substance misuse. The ICP were hopefully that this would enable a lot more targeted work with the homeless population. The report also detailed the work being done to improve rehabilitation services.
• Targeted work was taking place in NW2, NW10 and HA9 which the ICP now knew these were the areas with the largest proportion of those experiencing severe mental health issues . Those residents, both children and adults, were accessing services at the point they were experiencing a crisis rather than before they reached crisis point,  the ICP had developed a programme of targeted work in those neighbourhoods which they felt would make an impact to individuals in those areas. One programme was around crisis outreach through Clinical Crisis Workers, who would be reaching into those neighbourhoods with high levels of acute mental illness attendances and working with those neighbourhoods before they reached crisis to prevent escalations. Within that, there would also be Community Connectors appointed, in recognition of the fact that many of Brent’s communities knew how to work with individuals but needed additional support to understand someone’s mental illness and how to support them. This would mean that communities would be educated and empowered to be best equipped to manage individuals and would form part of the Brent Health Matters’ (BHM) inequalities work. The final part of the programme was the person-centred Thrive model, working with children and young people to provide the best help at the right time and under the right circumstances. This model differed from the medical model and focused on encouraging children and young people to ask for help at any time it was needed.

The Chair then invited contributions from those present, with the following points raised:

• It was highlighted that some communities did not recognise mental health in the same way as others and therefore may not come forward to access support. As a result, the Board raised concerns that those communities may not be reflected in the figures for those needing mental health support and therefore may not be receiving information about services. Robyn Doran assured the Board that BHM worked closely with both the Mental Health Trust and Community Services, with a team of 8 Mental Health Specialists working specifically with those communities who traditionally had not recognised mental health and may not have or use words like ‘mental health’. This work was connected to the findings in relation to NW10, NW2 and HA9 and the work was being targeted towards those communities. The IAPT team had also done some work the previous year working with communities who had usually not accessed IAPT because the traditional ways in which IAPT services were accessed were not accessible to those communities, and the IAPT team now made far more culturally appropriate interventions that the team were proud of. That work was reported within the health inequalities work and the ICP were confident that the granular information was being collected and was reliable.
• In relation to culturally competent care, it was agreed that the ICP could share some of the work done on mental health wards around the cultural competency of staff.
• Board members pointed out that there would be a migration of disabled residents from Personal Independence Payment (PIP) onto Universal Credit (UC) and asked to what degree the caseload might go up due to mental health illnesses being exacerbated by these changes, while those individuals with a disability were also being encouraged into work. The Board felt it important that partners worked strategically with the Department for Work and Pensions (DWP) to address this. Sarah Nyandoro thanked the Board for flagging that information and confirmed that the ICP did plan ahead, so as well as working with DWP to have early identification of the people impacted by those changes there was also partnership work with Sure Trust to put safety nets around those individuals early.
• The Board were interested to understand to what degree those facing mental health issues were in the private rented sector as opposed to social housing, as Brent had a high proportion of residents living in the private sector and often discharged the homelessness duty into the private sector, which was less regulated. It was felt residents in the private sector would be more likely to experience issues such as disrepair and section 21 no-fault eviction notices, which could further exacerbate mental health issues. Tom Shakespeare (Director, Integrated Care Partnership) explained that the work the ICP had done around housing had initially focused on social housing and local authority housing to build key lessons, but the intention over time was to work with housing colleagues through the working group to see how those lessons could be disseminated through the private rented sector. The community teams were supporting people in their own homes and did not exclude those with private landlords.  In addition, as part of the work the ICP were doing looking at managing the housing market they were reviewing who was receiving support and whether they had social landlords or private landlords. Once that work was done, the ICP could bring further information back to the Board specifically on those in private accommodation receiving mental health support. The ICP acknowledged that the private sector was much more complicated and there was a need to develop this work in partnership.
• Claudia Brown added that ASC was seeing an increase of new diagnoses coming through the Front Door. An area she felt needed to be addressed was supporting individuals in their homes and enabling them to stay in their current accommodation. ASC had now introduced a housing and mental health surgery, giving housing colleagues the opportunity to bring cases to the attention of ASC, and it was being found that often these cases were not known to services at all. She added that every mental health bed was a potential social care client, and if there was no evidence of the borough in which that individual was last resident then they would become a Brent client.
• Councillor Farah, as Cabinet Member for Public Safety and Partnerships, highlighted the need to work in partnership with police and the community safety team, and offered to facilitate those links.
• Simon Crawford (Deputy Chief Executive, LNWH) provided information in relation to mental health and Northwick Park Hospital. He highlighted that early post-covid, there had been an influx of mental health presentations through A & E, many of whom were not formerly known to services. Over the past 18 months, he had seen a step change in the level of support and responsiveness to mental health presentations at the hospital and the support received on a daily basis to find appropriate placements, including for rough sleepers. Robyn Doran confirmed that around 30% of presentations seen were in crisis phase and were coming predominantly through A & E and through Section 41 of the Mental Health Act, with the majority of those not known to services. That trend had continued since covid, and she felt this was due to the complexity of life during and post-covid, such as individuals losing jobs, family members, housing and having long-covid. In addition, the different communities served in Brent may not recognise mental health illness as an issue until it was acute. This was why the ICP were targeting work on the NW2, NW10 and HA9 areas where most of those acute presentations came from, and an extra 12 mental health beds had been opened in Brent as the ICP recognised the demand was so great.
• In noting the higher numbers of crisis presentations and individuals receiving mental health support in Brent, the Board asked if there was any insight into why Brent had almost double or triple the numbers of other areas. Robyn Doran explained that there were a lot less services in Brent compared to other NWL areas such as Westminster and Kensington and Chelsea, so Brent had a reliance on the third sector and community partners to bridge that support gap. As well as this, the complexity of the communities served in Brent, such as the differences in cultural perspective on mental health meaning mental health illness might not be recognised as an issue until at crisis point, meant families then turned up in crisis at emergency departments. She advised the Board that the ICP needed to focus on both ensuring there were enough beds now for the people who needed them while demand was high and in tandem focus on the levelling up case to get more resources into the borough that would allow services to target earlier interventions and reduce the number of people getting to crisis point and requiring admission to a mental health unit.
• Considering the figures in the report that compared Brent to boroughs in NWL, the Board asked for comparisons figures against more similar boroughs in terms of diversity and levels of deprivation, such as Newham and Tower Hamlets. Brent ICP confirmed this could be done.
• As part of the levelling up discussion, the Board agreed there was a need to deep dive on the data so that it was available per population rather than single figures. For the next report, the Board requested information on the ICPs plans for further work on cultural competence, a focus on those individuals affected by the changes in the benefits system and a deep dive into the data regarding mental health patients from the private rented sector. Following the analysis of that information, the Board felt it may then be appropriate for the Chair and Vice Chair of the Health and Wellbeing Board to write to the ICB to support the case for releasing levelling up resources.

In bringing the discussion to close, the Chair asked the Board to note the report and confirm support for the approach that has been taken.