Draft - Swansea Mental Health Strategic Commissioning Strategy Action Plan What Needs to Change to deliver the Outcomes? What is happening already? What would success look like? Actions Person Responsible &Timescale Stigma and discrimination still exists From public From general health settings LA Developing Advise and Information services (DEWIS) is eliminated People no longer feel stigma from the public and in general health settings Develop a LA corporate plan to contribute to raising public awareness of Mental health issues and protective preventative factors Review the balance of output from Information and Advice services in relation to physical and mental wellbeing. Strengthening and development of additional primary care services. General Practitioners act as a There is access to an increased range of primary
Predicted to be Increasing demand for support in the community. gateway to primary care services. Services are accessible via GP referrals care interventions. The waiting times are reduced and the length of the intervention time is based evidenced of effectiveness. No further cuts to secondary care A Western Bay Commissioning Board has been established City & County of Swansea undertaking a commissioning review. An appropriate range of financially sustainable .services are in place. Consider how extra resources can be provided Not just money Assets of the community Exploring new models of provision Lamberth Council as an example Simplified eligibility & access to sustainable services which focus on prevention early intervention, and recovery. Segregation between primary and secondary care has a negative effect on eligibility and Review LA commissioned services for effectiveness. by
access. Not all services are accessible to everyone. Single point of access being implemented for secondary Mental Health Services Bureaucracy of referral & assessment for LA provided and commissioned services compared to universal services e.g. No-one needs a referral or assessment just walk in when you need it. Tier 1 Tier 2 Tier 3 Tier 4 An appropriate and timely response when someone is in a mental health crisis Crisis support too frequently equates to Make support for crisis available when needed in Review of LA services flexibility to and
Developing services to achieve self- management through encouragement. The Recovery Model Living Well programme evaluation New and innovative treatments are introduced into current practice. E.g. therapies rather than the medical model. Establish a research to identify new models of support focusing on early intervention and the recovery model. Investment has to be shifted to prevention but to be flexible. Prevention services also on Mental Health and are not just looking at older persons. Reduce the waiting time for Counselling and increase the length of intervention. Waiting times are long and support period is too short. CBT only 6 sessions. Counselling is one element of talking therapy. Access to the range of formal and informal counselling services is rapid delivering on early intervention and prevention Increase understanding of evidence (analyse data) for offering the appropriate format of talking therapies, promptly and for the optimum period for effectiveness. (is it formal
counselling or other ) Lack of move on within and from supported housing Move On Strategy exists from temporary accommodation into Social Housing and private rented Social Lettings Agency. General rehousing application process in place. I have choices to make on where I live, in communities and with housing providers who understand and do not discriminate and support my mental wellbeing. Linking to Housing Strategy for locality and accommodation type Exploring options to tackle loneliness and isolation sharing opportunities Low floating support around clustered accommodation being considered Age appropriate options Res Care – not enough specialist provision between acute support and supported living. Limited availability of specialist sustainable Western Bay Brokerage for those above cost threshold market of providers – competition / partnership ensure Explore alternative models to residential care
provision within the City & County of Swansea E.g. Robense which is a high relational 24 hour supported living project. Currently focused on those whose needs are CHC eligible. reasonableness. Care before profit. There is a range of specialist sustainable residential care or alternative provision within the City & County of Swansea or Western Bay area. Explore Joint commissioning with Western Bay partners Engage with the local private sector market & consider role of internal services. Need for a Dom Care speciality for understanding MH and co-occurring physical health Support to people with Mental Health when delivered by Domiciliary care agencies has the necessary specialism e.g. understanding of TIA triggers, meds and their impacts and can provide seamless hands on personal care in this context. Link to Domiciliary care commissioning review and procurement. Link to review of internal provision. Gender specific provision child care
work as positive impact on a person’s quality of life and being part of recovery. Commissioning process to be Co-productive. People who use services and their carers being involved at every stage of process Staff to be involved in coproduction in designing and providing services. Limited to date, should be at all stages of the commissioning cycle. More effective commissioning decisions leading to improved delivery of outcomes for individuals stakeholders working together. Improve recruitment and retention. High of staff at strategic planning level impacts negatively on progress. Short term funding (third sector). Changes of operational worker including volunteer’s results in erratic Services. Stress on staff due to caseloads & demand Sustainable services are in A stable well trained, informed and supported staff resource is in place.
Work/Employer Schemes Occupational Health, Colleagues (work) Trade Unions Media internet/ Apps Stress Packs Online. TV Online / Physical Forums Universal – things that people can access themselves/ Spiritual Centres and facilities/Church/Libraries/ Leisure Centres/women’s institute /Workers Institute/pub Third Sector. Community groups – Singing for the Mind, Red Café, Belly Dancing Private Counselling Services Secondary -CMHT SW, CPNs, OTs, Doctors, physiologist, Nurse Therapist. Assertive outreach. Hospital/In-patient care / crisis resolution H treatment Police/Probation/Criminal Justice Services Forensic services Statutory Day Care Provision/ Cwmbwrla Day Services. Day Services/ Connect/ Mind /Hafal Community Connectors / Local Area Co-ordination Nursing Care/Res Care/Low secure units Citizen’s Advice Homelessness Services /Housing. SP funded Supported Living /Llanfair /Gofal/WISH Tenancy Support. SM Services, coat, sands, WCADA. Community based groups, Voluntary Sector e.g. mind, SCVS, Volunteering, befriending, Hafal, Alzheimer’s Society, Age Cymru, Domestic Abuse/Hafan Cymru/Carers Trust /Carers Centre EVST/Transcend Swansea Education/Student wellbeing services and all establishments/Higher / Further ED Support Services, schools colleges, universities Directories. The Group were asked to consider what they felt were the strengths and weaknesses. STRENGTHS Stigma reducing / more acceptable to ask for help around MH. Celebrities speaking out. Information more readily available. Recognition ‘we need to change’. Willingness to change and become National Health Service (free at the point of use). Free prescriptions / delivery service. Developments and progress with meds and therapies. Primary care MH Service. Primary care funding (but still not enough). Social Services influence Health with a social model of WEAKNESSES Stigma exists Public have negative perceptions of MH. Even MH stigma experienced within general health settings. Poor relationship/communication between MH and General Health Services. Lack of Information/People not aware about mental health conditions. Information not accessible to everyone services and needs regular updating. Staffing Issues High turnover of staff at strategic Planning level impacts negatively on progress.
Opportunities for Networking. Service user wants, service user led. Partnership Utilising and sharing of good practice. Skills / attributes of local communities. Volunteering (but not replacing skilled workforce) OASIS Single referral point. Mixed range / variety of accommodation based services. Allowing different levels of projects to meet different levels of need. Appropriate technology . Community Connectors and Local Area Coordination about older people not about MH. Should be age blind – issue what can we offer? No service for CAHMS, as primary care workers attached to GPS are in overload. Transitional period child / adult. *We need proper, adequate transitions. Not enough 1 – 1 working. Prevention, no system around sorting ‘me’ out! In Crisis and urgent need Crisis only in hospitals. Shortage of beds – necessitates police intervention.GP – CPN – MH Staff (G and B). Discharge – big problem. Services not available at when most needed e.g. evenings & weekends. Lack of flexible working. Flexible services when service users and carers received it (only 9-5). Joint commissioning – not always effective Service delivery hampered by funding agreements. Decision making debate while we wait. Arguments over funding between Health and Social Care due to budget pressures. Pass the buck culture between physical health and MH or LD and MH duel diagnosis. Uncoordinated and inconsistent funding postcode lottery. Transport Travelling across ABMU. Rurality – transport issues. Transportation use of ambulance services. Travelling out of Swansea area. Need 1:1 transport for 1 – 1 work.
The following was developed which summarises the priorities with an initial action plan to address those priority area - Swansea Mental Health Strategic Commissioning Strategy Action Plan What Needs to Change to deliver the Outcomes? What is happening already? What would success look like? Draft Actions Person Responsible &Timescale Stigma and discrimination still exists From public From general health settings LA Developing Advise and Information services is eliminated People no longer feel stigma from the public and in general health settings Develop a LA corporate plan to contribute to raising public awareness of Mental health issues and protective preventative factors Review the balance of output from Information and Advice services in relation to physical and mental wellbeing.
Strengthening and development of additional primary care services. Predicted to be Increasing demand for support in the community. General Practitioners act as a gateway to primary care services. Services are accessible via GP referrals There is access to an increased range of primary care interventions. The waiting times are reduced and the length of the intervention time is based evidenced of effectiveness. No further cuts to secondary care A Western Bay Commissioning Board has been established City & County of Swansea undertaking a commissioning review. An appropriate range of financially sustainable .services are in place. Consider how extra resources can be provided Not just money Assets of the community Exploring new models of provision Lamberth Council as an example Simplified eligibility & access to sustainable services focus on prevention Segregation between primary and secondary care Review LA commissioned services for effectiveness.
effectiveness. (is it formal counselling or other ) Lack of move on within and from supported housing Move On Strategy exists from temporary accommodation into Social Housing and private rented Social Lettings Agency. General rehousing application process in place. I have choices to make on where I live, in communities and with housing providers who understand and do not discriminate and support my mental wellbeing. Linking to Housing Strategy for locality and accommodation type Exploring options to tackle loneliness and isolation sharing opportunities Low level floating support around clustered accommodation being considered Age appropriate options Res Care – not enough specialist provision between acute support and supported living. Western Bay Brokerage for Mixed market of providers – competition / Explore alternative models to residential care
Limited availability of specialist sustainable provision within the City & County of Swansea those above cost threshold Robense House high relational supported living partnership ensure reasonableness. Care before profit. There is a range of specialist sustainable residential care or alternative provision within the City & County of Swansea or Western Bay area. Explore commissioning with Western Bay partners Engage with the local private sector market & consider role of internal services. Need for a Dom Care speciality for understanding MH and co-occurring physical health needs Support to people with Mental Health when delivered by Domiciliary care agencies has the necessary specialism e.g. understanding of TIA triggers, meds and impacts and can provide seamless hands on personal care in this context. Link to Domiciliary care commissioning review and procurement. Link to review of internal provision.
I get the help I need to grow up and be independent. I get care and support through the Welsh Language if I want it I contribute towards my social life and can be with the people I choose. I do not live in poverty Suitability of living accommodation. I live in a home that best supports me to achieve my well-being. I have choices to make on where I live, in communities and with housing providers who understand and do not discriminate and support my mental wellbeing.