Mental Health Strategy (2016 – 2020): Planning together, for our future.

STATES OF JERSEY

MENTAL HEALTH STRATEGY (2016 – 2020): PLANNING TOGETHER, FOR OUR FUTURE

Presented to the States on 17th November 2015 by the Minister for Health and Social Services

STATES GREFFE

2015   Price code: H  R.122

REPORT

Ministerial Foreword

Mental health and wellbeing really is everyone's business. Jersey is no different. We know that –

• one in 4 people will experience a mental health problem at some point in their lifetime; one in 6 adults have a mental health problem at any one time
• one in 10 children aged between 5 and 16 years has a mental health problem; many continue to have mental health problems into adulthood
• among people under 65, nearly half of all ill-health is mental illness.

In other words, nearly as much ill-health is mental illness as all physical illnesses put together. There really is no health without mental health.

Mental health problems can have a wide-ranging impact for individuals in a number of areas  of  their  lives,  including:  housing,  education,  training,  physical  health  and relationships  with  family  and  friends.  It  affects  people  of  all  ages  and  cultural backgrounds.

Investment has already been made to improve and develop services, but addressing the impact of mental ill-health and emphasizing the importance of mental wellbeing for citizens, for local services and for the economy of our Island continues to be a priority.

This strategy sets out our vision for –

• promoting mental wellbeing
• preventing mental ill-health
• for services that will most effectively meet the needs of people with mental health conditions which can assist them in their recovery.

It identifies the areas for change needed across Jersey so that we can ensure high quality mental health services for Islanders, no matter when they need them.

As the ministerial team for Health and Social Services, we know that there has already been a considerable amount of work undertaken in producing this Strategy. We would like to thank everyone involved in contributing to its contents, and look forward to their support in the future as we begin the journey of implementation. With your help we are confident we can make a positive difference to people's lives.

Senator A.K.F. Green, M.B.E.  Minister for Health and Social Services

Deputy P.D. McLinton of St. Saviour  Assistant Minister for Health and Social Services Connétable J.M. Refault of St. Peter  Assistant Minister for Health and Social Services

Executive Summary

In 2012 the States Assembly endorsed the Strategic Plan for Health and Social Services called: Health and Social Services: A New Way Forward (P.82/2012). The vision described an integrated health and social care system and a programme of change that will meet the challenges facing the Island's Health and Social Services, whereby services are safe, sustainable and affordable; and where –

• Services are wrapped around the individual', with a single point of access for patients/service  users  and  for  care  professionals,  and  individuals  making informed choices and caring for themselves as much as possible.
• More health and social care services are available in individuals' homes, and in community and primary care settings, with services provided by a range of professionals and care designed for the individual.
• Efficient, effective, productive, integrated care which is received in the most appropriate place, provided by the most appropriate professional.
• Telehealth, telecare and telemedicine as part of an integrated set of services.
• Improved identification of those individuals who are in need or at risk, with a holistic assessment of health and social care needs.
• Care provided in less institutional settings, including an increase in fostering for children.
• Improved value for money and robust contract management. Services available from a greater range of organisations, with the Voluntary and Community Sector and other providers having opportunities to provide more care, and individuals having more choice and control over the care they receive.
• A workforce which is better developed and deployed, with more services available locally wherever practical and affordable. Patients will be encouraged to support one another, and individuals will receive care from a range of professionals, including therapists and nurses.

As part of this transformation programme, a system-wide review of mental health services has been conducted using innovative participatory approaches, which have included –

• a Citizens' Panel to identify key building blocks for the future system
• Action Learning Sets' of frontline practitioners and service users to identify practice challenges
• customer voice exercises, which enabled people who have used services to describe what went well and what could have gone better
• a system-wide engagement event, which used participatory approaches such as open space' to test and endorse the findings of the review process.

These approaches have led to new insights into the challenges facing mental health. The different dimensions of these challenges were summarized in 9 emerging themes –

• securing joint working across the mental health system
• developing the workforce
• awareness-raising, prevention, early help and support for young people and children
• improving the money-flow in the system to follow the service user
• enabling workplace mental health interventions
• building educational approaches to recovery
• improving the service environment
• developing mental health services in the criminal justice system
• establishing outcomes, quality and measurement
• culture and leadership.

This work has informed the development of 5 priorities of the Mental Health Strategy, which offers a comprehensive strategic direction for future whole system development –

1. Social Inclusion and Recovery
2. Prevention and Early Intervention
3. Service Access, care co-ordination and continuity of care
4. Quality Improvement and Innovation
5. Leadership and accountability.

Contents Ministerial Foreword Executive Summary

Section One – Here and now

1. Introduction
2. Policy and legislative précis
3. Overview of the current mental health system
4. The financial landscape

Section Two – Insights from the review process

1. Summary of the approach taken for the review
2. Key insights

Section Three – The Strategy for Mental Health: our vision for the future

1. The key strategic themes
2. Our intentions and next steps

Appendices

1. Jersey Mental Health Services Review: Report of the work of the Citizens' Panel
2. Mental Health Services Review: Action Learning Report (University of Birmingham)
3. Jersey Mental Health Services Review: Customer Voice Listening Exercise
4. Mental Health Service Review Literature Search
5. Mental Health Implementation Group – Terms of Reference.

SECTION ONE Here and now

1. Introduction

This Mental Health Strategy identifies 5 high-level priorities for –

• promoting mental wellbeing
• preventing mental ill-health
• delivering services that will most effectively meet the needs of people with mental health conditions.

Building upon evidence and views gathered from practitioners, from service users and using innovative methods of public and service engagement, it sets out the challenges and the proposed transformation of services and support.

Jersey  has  a  continuously  changing  population  profile.  The  overall  population  is predicted to continue to grow over the next 10–15 years. Within that growth are some important trends, in particular that by 2030 the number of people aged 85 or over will have more than doubled. In the same timeframe, the number of people aged 65 or over will comprise just over 23% of the total population of the Island..

One in 4 people will experience a mental health problem at some point in their lifetime; and one in 6 adults have a mental health problem at any one time.1 One in 10 children aged between 5 and 16 years has a mental health problem, and many continue to have mental health problems into adulthood.2 Among people under 65, nearly half of all ill- health is mental illness. In other words, nearly as much ill-health is mental illness as all physical illnesses put together.3 People with severe mental illnesses die on average 20 years earlier than the general population.4 The increase in people living longer is likely to see an increase in the number of people living with dementia, as well as other long-term limiting conditions.

50% of lifetime mental health problems have already developed by the age of 14.5 The transitions from childhood to adulthood and then to older age are all important stages in an individual's life, perhaps even more so if they experience mental health problems.

A large body of evidence now ties experiences in early childhood with health throughout life, particularly in adulthood.6 Strong evidence also demonstrates that it is possible to turn vicious cycles into paths to health, by intervening early.7

1McManus S., Meltzer H., Brugha T. et al. (2009) Adult Psychiatric Morbidity in England,

2007: Results of a household survey Leeds: NHS Information centre for health and social care.

2Green H., McGinnity A., Meltzer H. et al. (2005) Mental Health of Children and Young

People in Great Britain, 2004 Basingstoke: Palgrave Macmillan.

3The Centre for Economic Performance's Mental Health Policy Group (2012) How Mental

illness loses out in the NHS: London School of Economics.

4 No Health without Mental Health, Department of Health 2011.

5 No Health without Mental Health, presentation, O'Connor, Dr. S. RCPsych.

6 Overcoming Obstacles to Health: Report From the Robert Wood Johnson Foundation to the

Commission to Build a Healthier America. Braveman P. and Egerter S. for the Robert Wood Johnson Foundation, 2008.

7 Issue brief 1: early childhood experiences and health, Braveman P. for the Robert Wood

Johnson Foundation, 2008.

Identifying and addressing mental and physical health needs in early years and with children and young people will help lay the foundations for improved wellbeing and reduce reliance on statutory services later in life.

Mental health problems can have a wide-ranging impact for individuals in a number of areas of their lives, including: housing, employment, education, training, physical health and relationships with family and friends. It affects people of all ages and cultural backgrounds.

Mental health problems in Jersey are present across all sectors of the population. Some of the determinants of mental ill-health are also significant across the Island. These include high levels of alcohol use, misuse of substances, social isolation and access to employment and housing.

This highlights the need to ensure that through this Strategy and its intentions, the aim should be to identify and where appropriate, address the needs of all sections of the population.

The importance of public mental health and wellbeing is now well recognized to prevent mental ill-health through population-based interventions to –

• reduce risk and promote protective, evidence-based interventions to improve physical and mental wellbeing
• create flourishing, connected individuals, families and communities.[8]
• develop population-based interventions to create conditions that promote mental health and wellbeing that enhance population wellbeing in general and reduce incidence of mental health problems more effectively then interventions targeted only at at-risk/vulnerable individuals.[9]

As well as adopting a life-course approach, this Strategy is about how the other departments, service users and the citizens of Jersey can work together to promote and improve wider public mental health and wellbeing, reduce stigma and discrimination and achieve greater equity between mental and physical health. The Strategy reflects these changes; the local imperatives as well as the policy and legislative requirements placed on health and social care.

The development of a Mental Health Strategy, which includes wellbeing, is the start of a process of development, innovation and delivery that will help to –

• promote population mental health and wellbeing
• improve the range of and access to mental health services
• achieve States of Jersey policy imperatives
• deliver good outcomes and improved value.

The priorities identified within the Strategy have been informed by other parts of the Health and Social Services transformation programme which include the Out of Hospital' System, Sustainable Primary Care and the Acute Services Strategy. Joint working established during the Strategy development period will continue into the implementation planning. In addition, the mental health legislative and estate programme plan has also been an integral part of the Strategy development process.

The Strategy has been delivered at a time of financial constraint in Jersey. The costs of mental health services and the ongoing pressure on public finances mean that all services will continue to be scrutinised for value for money as well as clinical effectiveness. To deliver effective mental health services, the Health and Social Services Department (HSSD) will develop its focus on what delivers the best outcomes, and from that make informed decisions about how best to invest the resources available. HSSD will work together with its partners to review our spending, but retain a focus on improving mental health services across Jersey.

2. Policy and legislative précis

In conducting the review and in developing this Strategy, consideration has been paid to a number of policy and reform objectives and imperatives. A short précis of the relevant areas is set out here. It is not an exhaustive list, but is intended to provide a broad view of the policy context.

Health and Social Services: A New Way Forward – P.82/2012

In common with jurisdictions and countries across the world, Jersey faces significant challenges in ensuring the availability of high-quality health and social care within a financially affordable sum. There are also some unique challenges, for example workforce pressures, limited services in the community, clinical viability and cost pressures due to diseconomies of scale. All health and social care systems are reforming and changing to meet the challenges of demand, cost and quality. In addition to this, all systems are spending increasing amounts year on year, on health and social care.

Health and social care services are continually developing in order to improve quality and maintain safety. However, changes will not be able to keep pace with increases in demand, due to a combination of significant ongoing funding pressures and the scale of challenges which Jersey faces in the next 10 years. A system-wide view is required, with significant strategic service investment.

P.82/2012 describes the vision of a health and social care system for Jersey which is safe, sustainable and affordable. This followed the publication of R.63/2011: Health and Social Services Review May 2011: Caring for each other, Caring for ourselves – Consultation Paper, presented to the States on 31st May 2011; and R.82/2012: Health and Social Services White Paper: Caring for each other, Caring for ourselves – Public consultation, presented to the States on 26th June 2012.

Those  2 documents  outlined  the agreed strategic  principles  and the  proposed  key investments in service and system redesign required to meet the existing and future known service gaps and challenges.

In particular, P.82/2012 made the case for delivering more health and social care services in community and primary care settings. It also advocated for multi-disciplinary services where teams are comprised of a range of professionals, with a focus on a more holistic approach to assessment, and interventions and services that are evidence-based, efficient, effective, productive, integrated and provided in the right setting by the right people.

P.82/2012 has already brought about investment directly into mental health services with the establishment of Jersey Talking Therapies and a service redesign of Alcohol Services.

An implementation plan has also been agreed for the development of community mental health services for older people, including those with dementia.

There has also been investment in children's early intervention services delivered by Health Visitors during the first few years of childhood.

Jersey Talking Therapies is a new service offering psychological therapies for people over the age of 18 years who feel anxious, worried, low or sad. This can include people who have issues such as depression, anxiety, obsessive compulsive disorder, phobias, panic and post-traumatic stress disorder or are drinking up to 15 units of alcohol daily.

The  redesigned  alcohol  service  is  now  able  to  offer  increased  opportunities  for detoxification and relapse services in non-hospital settings, and has extended the choice and  increased  the  efficacy  of  relapse  prevention  programmes  available  to  people recovering from alcohol dependence.

Maternal Early Childhood Sustained Home Visiting' improves child and maternal health  and  wellbeing  by  providing  a  structured,  evidenced-based  programme  of sustained support in the home for families at risk of poorer maternal and child health and development outcomes.

The full document can be found at: http://www.statesassembly.gov.je/AssemblyPropositions/2012/P.082-2012.pdf Sustainable Primary Care

In the adoption of P.82/2012 the States Assembly agreed –

"to request the Council of Ministers to co-ordinate the necessary steps by all relevant Ministers to bring forward for approval –

2. proposals to develop a new model of Primary Care (including General Medical  Practitioners,  Dentists,  high  street  Optometrists  and Pharmacists) ".

The demands on health and social services are changing. The growing number of older people, the rising demand for Children's Adolescent Mental Health Services and mental health services are recognised as requiring a new approach to the provision of primary (as well as secondary) care services. In particular, a new approach must deliver care,

treatment and support closer to home, enable people to be independent and exercise choice and control over that care.

The development of a Primary Care Strategy and a new model of primary care that are to be safe, sustainable and affordable, offering value for money, is a central element of reform.

The Sustainable Primary Care Programme will set out a vision for the future that includes –

• An inclusive registration system
• Funding mechanisms that have long-term viability, support and incentivise the provision of care out-of-hospital, optimise access and equality, and give value for money for the States and for Islanders
• A flexible workforce model designed to deliver high-quality care across integrated care pathways, with the right staff and teams providing modern, accessible care in the right locations
• Information Technology that facilities an Integrated Care Record and provides data to support clinical decision-making and assessment of quality, including patient- reported quality outcome measures.

By January 2015 a set of principles' for sustainable Primary Care had been produced through a series of workshops that took place in the latter part of 2014. Work is now ongoing to develop the strategy, by identifying the elements of a new model for Primary Care.

The next steps of the programme include modelling different scenarios based on the agreed principles. The results of this work will generate insights as to the strengths and weaknesses of particular scenarios and inform future service models. The Strategy will be completed by the end of August, with a public consultation following in the autumn of 2015.

The "Out of Hospital" System (OOH)

The concept of the "Out of Hospital" system is a direct result of P.82/2012. The overarching aim is deliver a person-centred approach which –

• enables people to stay in their own homes
• increases people's quality of life and independence
• reduces demand on hospital and long-term care beds
• improves clinical outcomes
• delivers value for money.

Services are promoted through partnerships, including primary care, community voluntary sector and statutory services. The benefits of such an approach are twofold, in that it builds greater community resilience and reduces individual dependence on services. In time, services will be able to focus on those who need them most; this reduces demand for building-based services, including institutional forms of care and support, such as hospital, residential and nursing home services.

The next steps for this service development will be to include elements of mental health services which will integrate into the service model. In the first instance, this will include the Older Adult Mental Health Liaison Service, followed by integrated pathway development in long-term conditions which will address people with co-morbidities including depression, anxiety and dementia.

The Future Hospital Project

The States of Jersey has considered the options for change and consulted with Islanders about the way forward. The Future Hospital Project is taking forward a series of plans for redevelopment of the Hospital.

As part of the development of the Future Hospital, mental health issues are being carefully considered. For example, the project is committed to dementia-friendly wards; the Emergency Department will have facilities to provide a place of safety for vulnerable children and adults to be assessed and helped to access appropriate services.

Community Social Services Estates Planning

The provision of safe, suitable accommodation from which services operate has been acknowledged as an area that requires development in Jersey. A series of proposals and plans are in train to address particular service needs, most of which require some degree of capital investment in order to be realised.

The need to re-provide the existing adult acute inpatient service in more suitable accommodation has been identified as a priority. The option of co-location with older adult  inpatient  service  provision  is  being  explored.  Alongside  this  there  are  also proposals for the relocation of day services for people with dementia, and through vacation  and  refurbishment,  the  provision  of  updated  accommodation  for  some community teams.

A detailed mental health estates strategy will be developed that will identify the longer- term  mental  health  inpatient  and  community  services  requirements  in  relation  to buildings and office accommodation.

Regulation of Care Law: proposals

In 2006 the States of Jersey acknowledged that the current legislation regulating health and social care was outdated and no longer fit for purpose.

It is proposed that the existing legislative framework for the regulation of health and social care in Jersey should be replaced with a single enabling Law, supported by specific Regulations and codes of practice.

This will provide clear, modern definitions of regulated activities and provide for the comprehensive regulation of nursing agencies, domiciliary and primary care, including care provided by the States, within the same framework. It will require those managing services or working with people in need of health and social care to have appropriate qualities, skills and expertise to be safe and competent practitioners. It will also enable clear, comprehensive and enforceable standards to be set for the provision of different types of care to be set.

The Law will establish a new independent Commission that will command public confidence  to  regulate  the  provision  of  health  and  social  care  and  promote improvements in standards of care. The Commission will be established in 2016 and will lead a phased implementation of regulatory reform.10

Long-Term Care Benefit

Jersey faces a substantial increase in both the number and proportion of older residents over the next 30 years, with care costs predicted to more than double by 2044. The introduction of a Long-Term Care Scheme was designed to share long-term care costs more fairly across the community; and the scheme established a clear and simple process to help individuals and their families understand the choices available and plan for the cost of long-term care.

The scheme provides financial support to Jersey residents who have significant long- term care needs and who are being cared for either in their own home or in a care home.11

A considerable number of claimants for this new benefit will have mental health needs and will qualify for the benefit. It is important that support is in place for people to realise the opportunity of constructing a package of care that is personalised to them. This represents a significant shift in service provision and learning for claimants and service providers remains ongoing.

Mental Health Law review and capacity law

Jersey's Mental Health Law is currently being reviewed. During the next 2½ years HSSD will be working with the Law Officers' Department (LOD) to deliver both a new Mental Health Law and a Mental Capacity Law.

There is a recognised need for fit-for-purpose legislation which can address the deficits of the existing Mental Health (Jersey) Law 1969 and the Criminal Justice (Insane Persons) (Jersey) Law 1964 (the "1964 Law"), alongside an urgent need for Jersey to comply with the European Convention on Human Rights (Right to liberty). There is also a  need  for  appropriate  powers  for  courts  to  deal  with  cases  involving  Mentally Disordered Offenders ("MDOs") and to replace the 1964 Law.

The proposed new Mental Health Law has a number of key guiding principles –

• The establishment of new definitions and roles to ensure higher standards of care and better decision-making.
• Nominated Representatives and Nearest Relatives to give greater choice, but ensure efficacy of the Law.
• Compulsory detention for treatment revised to provide new, shorter time periods before each review of detention giving better protection for those detained.
• Changes to leave of absence to encourage recovery and increased treatment in the community, subject to appropriate safeguards.

10 Regulation of Care Law: proposals, States of Jersey, May 2013. 11 Long-Term Care (States Contribution) (Jersey) Regulations 2013.

• Express  provision  about  consent  to  treatment  and  safeguards  on  compulsory treatment to provide greater clarity for professionals and better protection for vulnerable patients.
• Provision for mental disordered offenders and replacement of the Criminal Justice (Insane Persons) (Jersey) Law 1964 to provide appropriate powers for the Courts to divert people from the criminal justice system where appropriate.
• Continuing the role of the Mental Health Review Tribunal and maintaining and enhancing existing safeguards.

There has been no legislative framework to assess and support people who lose capacity in accordance with their human rights, and the development of a Mental Capacity Law will address this gap.

The Capacity Law has a number of guiding principles –

• Test for assessing capacity and best interests to ensure better and more consistent decision-making.
• Lasting Powers of Attorney (LPA) to enable people to plan for their future.
• Powers for the Royal Court to make decisions and appoint delegates, thus enabling decisions to be made in contentious cases and where there is an absence of an LPA.
• Advanced decision to refuse treatment to provide better protection for patients and guidance for staff, and respecting people's wishes and dignity.
• Clarifying when restraint can be used, thus ensuring human rights compliance and providing greater safeguards for patients and staff.
• Capacity and Liberty (CAL) assessments and authorisations, thus ensuring human rights compliance and safeguards for patients and staff.
• Wilful neglect and ill-treatment, introducing a new offence that will provide more comprehensive protection for vulnerable people.

The developing and drafting of the legislation is ongoing and a significant body of work remains to be undertaken. At present, it is anticipated that both pieces of legislation will be enacted by spring 2018.

The Independent Jersey Care Inquiry

The Independent Jersey Care Inquiry has been set up to establish what went wrong in the Island's care system over many years and to find answers for people who suffered abuse as children.

The hearings will be held in public, although at times the Panel may hear evidence in private session. The hearings will start in due course, once all necessary arrangements are  in  place.  At  present  the  Inquiry  Team  is  collecting  evidence  from  potential witnesses. These include people who were in care, those who worked in Jersey care services or came into contact with them, whatever their perspective.

The Inquiry Panel wants to build up as full a picture as possible so that it can then be in a position to make recommendations, ensuring that the Island's care system is fit for its purpose of caring for vulnerable children and young people.

One of the key tasks for the Independent Care Inquiry that is set out in its terms of reference is to set out what lessons can be learned for the current system of residential and foster care services in Jersey, and for third-party providers of services for children and young people in the Island.

In addition, the Independent Care Inquiry is also required to report on any other issues arising during the Inquiry considered to be relevant to the past safety of children in residential or foster-care and other establishments run by the States, and whether these issues affect the safety of children in the future.

Recent reports that link to this Strategy

Suicide Prevention – A Strategic Framework for Action

As a cause of early death, suicide represents a real public health problem for our community. Many more years of life are lost by suicide than other more common causes of death that tend to occur later in life.

The framework acknowledges that suicide is not an inevitable outcome and that it can be prevented. This document scopes the nature and size of the issue of suicide in Jersey and proposes ways of reducing it. It recognises that the prevention of suicide is a shared responsibility, requiring a breadth of sustained approaches and actions across services, agencies and the community.

It identifies 4 high-level objectives on which to base future actions: Objective 1: Improve mental health and wellbeing in vulnerable groups. Objective 2: Reduce stigma about suicidal feelings.

Objective 3: Reduce the risk of suicide in high-risk individuals.

Objective 4: Improve information and support to those bereaved or affected by suicide.

Further to Ministerial approval for the endorsement of the framework, an action plan will be developed and integrated into the implementation plan for the Mental Health Strategy.

Child and Adolescent Mental Health Services (CAMHS) – Scrutiny Report

In June 2014 the Health, Social Security and Housing Scrutiny Panel published the report of their review of CAMHS in Jersey. The Scrutiny Report built upon work undertaken by a specialist adviser who was commissioned to advise on improvements to services provided to children, young people and their families who need to access specialist CAMHS in Jersey. This followed on from a review conducted by the charity Young Minds' in 2006.

The Scrutiny Report required that a range of changes and improvements be taken forward, in particular these related to –

• Early intervention
• Emergency access and in-patient services
• Governance and information management.

The Scrutiny Panel also made 10 specific recommendations in the Report that directly addressed areas of concern in relation to gaps in service.

The full report can be found at –

http://www.statesassembly.gov.je/ScrutinyReports/2014/Report%20- %20CAMHS%20-%2016%20June%202014.pdf  

In response to the Scrutiny Report, the CAMHS team spent a week working with experts in LEAN methodologies, with a view to redesigning the service. Partner agencies were involved in this process. The redesigned service model is now established and has led to significant improvements, including reducing waiting time for a first appointment, which has dropped from 14 weeks to under 3 weeks, and more efficient processing of referrals.

A range of clinical pathways have been developed to ensure that treatment is evidence- based and benchmarked to monitor the effectiveness and efficiency of the provision. Work has been completed to standardise questionnaires to monitor outcomes and satisfaction with the service. Planning is in place to benchmark the service against national outcome data through the CAMHS Outcomes Research Consortium (CORC).

Also being developed is a fully implemented Systemic Family Therapy service for children and young people with significant mental problems, and their families, so that therapeutic intervention can be targeted to all family members when required. The recommendations made by Young Minds' have now been implemented or superseded.

The Ministerial Response to the Scrutiny Report was published in July 2014 and can be found at –

http://www.statesassembly.gov.je/ScrutinyReports/2014/Ministerial%20Respo nse%20-%20CAMHS%20-%2031%20July%202014.pdf

Disability in Jersey

A commitment to the development of a disability strategy was made by the States of Jersey in early 2014. Prior to that, a range of work is being conducted to establish the prevalence, profile and perceptions relating to disability through a focused research project. It has 3 main aims –

• To achieve an accurate set of data about the number and types of disability in Jersey.
• To understand more about the lives of Islanders with a disability.
• To identify the needs and aspirations of Islanders living with a disability.

This work is expected to be completed by October 2015, with a view to informing the Strategy, which is expected to be complete by early 2016.

Acute Services Strategy

This Strategy is part of "Caring for each other, caring for ourselves" and has been developed in the context of the changes described in the Future Hospital plans. It sets out proposals for the development of service models that will enable the delivery of acute care services to Islanders, drawing upon best practice examples, and has 3 core objectives –

• Avoiding  patients  being  admitted  to  hospital  when  safe  and  effective alternatives can be provided.
• Treating  patients  as  effectively  and  efficiently  as  possible  when  they  are admitted.
• Discharging or transferring them in a timely way when they are ready to go home or to an out of hospital' service.

It is important that all parts of the community have equitable access to acute health care at time of need. Research evidence shows that people with enduring mental health problems have poorer health outcomes than comparative groups in the population. In addition, people with co-morbidities presented challenges to acute health care services where the focus remains on one particular area of health or illness.

3. Overview of the Current Mental Health System

In planning for the future and considering the priorities for change in relation to mental health services, it is important to consider a range of other associated information and data.  In  particular  an  understanding  of  the  composition  of  the  population,  the demography and the current or predicted levels of prevalence for particular conditions is helpful when considering service development that can respond to those changes.

Population – demography

A census of the population of Jersey was held on 27th March 2011: the total resident population of the Island on this date was 97,857.

Table One – Population from 2011 Census

Source: http://www.gov.je/Government/Census/Census2011/Pages/index.aspx

Table  One  shows  that the  largest  population age-group  is  currently  between  40– 49 years. There are a greater proportion of females in the older age-groups (65+), which reflects the increased life expectancy of women over men at these ages, with particular pressure on mental health services for younger people and older adults.

Approximately 27% of the population of Jersey are under 25, and 16% of the population are aged 65 and over.[10]

The States of Jersey Statistics Unit estimate that the proportion aged 65 and over in the population will increase over the coming years, which will consequently increase demand on local health services.

Population density

Jersey has an area of 119.5 km2 at high tide. This translates to a population density of 828 people per square kilometre in 2012. A third of the Island's population lived in St. Helier at the time of the Census.

Dependency ratio

The  Jersey  dependency  ratio  for  year-end  2012  was  48%,  meaning  there  are 48 dependent children and adults for every 100 of working age. Essentially, for every one child or person of pensionable age, there are 2 people of working age.

Under  a  population  projection  scenario,  which  maintains  the  current  registered population, this ratio will increase to 66% in the medium term (2035). So, in future, Jersey is likely to have a higher proportion of dependent children and adults in its population (66 for every 100 of working age by 2035).[11]

Population growth

Table Two sets out the predicted growth in the population of Jersey up to 2030. It shows that by 2030 the number of people aged 85 or over will have more than doubled. Looking more broadly, the number of people aged 65 or over will have grown by over 10,000, and will comprise just over 23% of the total population of the Island. Those aged 15–64 will comprise just under 62% of the total population of the Island by 2030.

The total population of Jersey will increase by just over 8% by 2030 to 106,200, a growth of just over 8,000 people. This growth in population, and its pattern, highlights the challenges that public service reform in Jersey is designed to address.

Table Two

Population projected to 2030 – States of Jersey

Table Two – 2011 population data taken from the Census. All projections taken from States of Jersey Population Projections 2013 release

Estimates of future prevalence of mental illness

The figure below shows the estimated percentages and numbers of people who may experience mental illness in the population of Jersey over a 12-month period. This number is broken down by severity, based on diagnosis, disability and chronicity. The estimates of prevalence demonstrate the need to have a range of mental health services that can respond effectively to different levels of mental health need. It also shows the importance for integrated services to ensure that people have a smooth transition between different levels of service.

Figure One

Source: Contact Consulting (Oxford) Ltd. 2015 based on modelling used in COAG National Action Plan on Mental Health 2006–2011

Figure One shows that the majority of the Jersey population is not currently diagnosed with a definable mental illness. However, from that group statistically around a quarter may develop some form of mental illness at some stage in their life. This has been a factor in the development of preventative forms of care and the raising of awareness so that emerging mental illness can be identified. This enables early interventions to be provided to reduce longer-term reliance on statutory services. It also demonstrates that general practice is key in identifying emerging mental illness in the vast majority of the population.

Mild forms of mental ill-health may be present in around 12% of the population, and many of these cases will be supported by primary care. Where appropriate liaison with secondary care and other services is in place, this segment of the population should not require the sustained input of specialist services.

Mental ill-health at the moderate and severe tip of the diagram shows that a relatively small  percentage  of  the  population  should  experience  mental  illness  that requires specialist intervention from secondary care services.

Overall, the figure shows that approximately 21,000 people may experience some form of mental ill-health at some point, highlighting the need for the right range of services to meet those needs.

Table Three

People aged 15 – 64 predicted to have a mental health problem, by age, projected to 2030, States of Jersey

In 2011 there were 10,982 people predicted to have a common mental health disorder, this figure is set to reduce by 3.5% in 2030 to 10,594. Whilst the predicted number of people to have a common mental health disorder reduces, the percentage of the total population within the same age range remains at a constant level at around 21%.

The trend illustrated by the figures within those people with a common mental health disorder is mirrored within the figures for those people predicted to have a borderline personality disorder. The reduction through the period 2011 to 2030 is slightly higher at 4% from 307 down to 296, but again given the reduction in the total population aged 15 – 64 in the same time period, the proportion of those predicted to have a borderline personality disorder remains constant and in line with this.

The pattern is repeated through the rest of the table, with reduced numbers of the population predicted to have a mental health problem through the period to 2030. This is counter-intuitive to the current demand for access to services if taken in isolation, but as has been shown, the reduction is in line with the projected reduction in the total population and therefore the demand as a percentage of that population remains the same.

Table Four

People aged 65 and over predicted to have depression, by age, projected to 2030, States of Jersey

The numbers is this table relate to predicted prevalence of mild to moderate depression.  An overall increase of 73% can be seen in those aged 65 and over predicted to have depression, rising from 1,224 people in 2011 to 2,119 in 2030.

The greatest increase in those predicted to have depression can be seen in the age cohort 85 years and over, showing an increase of 110% from 154 in 2011 to 324 in 2030.

The total number of those people aged 65 and over predicted to have depression stands at around 8% of the total population in the year 2011. Whilst there is an increase of those predicted to have depression in 2030, this figure stands at a little over 8% of the total population aged 65 and over in 2030, and is therefore a real terms constant level of demand between 2011 and 2030.

Table Five

People aged 65 and over predicted to have severe depression, by age, projected to 2030, States of Jersey

There is predicted to be a steady increase in those aged 65 and over to have severe depression between 2011 and 2030. The number of people over 65 years predicted to have  severe  depression  was  389,  with  this  number  rising  by  just  above  76%  to 686 people in 2030.

The greatest overall rise can be found in those aged 85 and over, which shows a predicted rise of around 111% through the period 2011 to 2030.

A 26% rise is predicted for those aged over 85 in the period between 2015 and 2020. This is the single greatest increase that can be seen anywhere on the table of predictions.

The predicted increases shown in Tables Four and Five should also be seen in the wider context of the possible current or future usage of other forms of health and social care and  the  potential  presence  of  co-morbidity  (other  health  conditions  experienced alongside mental ill-health). The parity of mental health in relation to physical health therefore comes into sharper focus when considering the likely rise in prevalence, and practitioners will need to be equipped to identify and meet these needs.

Table Six

People aged 65 and over predicted to have dementia, by age, projected to 2030

See footnote14

Rates for men and women with dementia are as follows:

See footnote15

Table Six highlights a 104% increase between 2010 and 2030 in the population over 65 predicted to have dementia from 1,147 to 2,347. The increase in predicted numbers of those with dementia is also a real-term increase when measured against the total population for those aged 65 and over.

The age cohort that illustrates the most significant increase is within those aged 85 and over, where an increase of 141% can be seen from 489 to 1,181 between 2010 and 2030.

14 Figures calculated using Jersey population model 2009 & Alzheimer's Research UK,

Defeating Dementia statistics 2012.

15 The most recent relevant source of UK data is Dementia UK: A report into the prevalence

and cost of dementia, prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King's College London, for the Alzheimer's Society, 2007.

The prevalence rates have been applied to ONS population projections of the 65 and over population to give estimated numbers of people predicted to have dementia to 2030.

To calculate the prevalence rates for the 90+ population, rates from the research for the

90 – 94 and 95+ age-groups have been applied to the 2006 England population to calculate the numbers in each age-group; the sum of these groups is then expressed as a percentage of the total 90+ population to establish the predicted prevalence of the 90+ population as a whole.

Table Seven

People aged 15 – 65 predicted to have a drug or alcohol problem, by age, projected to 2030, States of Jersey

The  table  shows  a  decrease  in  the  number  of  people  predicted  to  have  alcohol dependence from 4,092 in 2011 down to 3,945 in 2030. As a proportion of the total population,  the  number  of  people  predicted  to  have  alcohol  dependence  remains constant at around 3% throughout the same time period.

This pattern of projection is repeated within the table among those predicted to have a dependency on drugs, with the figures reducing through the time period, but remaining at a constant level when set alongside the total population projections.

Alcohol use has been recognised as a particular issue in Jersey, and the annual Alcohol Profile contains more detailed information about rates of drinking among the Island's population. Around 2% of all deaths annually are caused by deaths from alcohol- specific causes, such as alcoholic liver disease and alcohol poisoning, and account for around 300 years of life lost each year.

Deaths caused specifically by alcohol have increased in the past decade in Jersey. In 2012 there were 13 deaths from such causes. Over the past 3 years there has been an average  of  12 alcohol-specific  deaths  each  year,  giving  a  death  rate  of  11.2  per 100,000 head of population (2010 – 2012). The majority of these deaths were due to chronic liver disease, accounting for 9.9 per 100,000 of the overall rate of 11.2 per 100,000.[12]

Co-morbidity

People with long-term physical health conditions who are often the most frequent users of health and social care services often experience mental health problems. This can lead to poorer health outcomes and reduced quality of life.[13]

Depression is 2 to 3 times more common in a range of cardio-vascular diseases. People with diabetes are 2 to 3 times more likely to have depression than the general population, and mental health problems are approximately 3 times more common among people with chronic obstructive pulmonary disease.[14]

In Jersey, 10% of the population has a long-term illness or condition that affects their day-to-day life. The top 3 causes of death in Jersey are ischemic heart disease, stroke and lung cancer.19 This suggests that there is a high likelihood of significant co- morbidity in relation to mental ill-health. Given that mental health services in Jersey, as in many other places, are separate from physical health services, there remains a challenge in responding to mental health and physical health needs with any degree of parity.

Parity of esteem is a principle that is increasingly being adopted, whereby mental health is given the same priority as physical health. By doing this, the range of co-morbidities is more easily identified, and interventions that seek to support the whole person, rather than individual diseases or disorders, can be delivered.

Child sexual abuse, trauma and mental health

It is becoming clear, from the evidence presented by neuroscience, that it is experiences laid down throughout our childhood that provide the blueprint for our future mental and physical wellbeing. Emerging research20 supports the case for the development and provision of mental health services that are trauma-informed. Key principles include, but are not limited to –

• Child sexual abuse (CSA) is linked to many mental health disorders, as well as self-harm  and  other  non-psychiatric  problems  such  as  substance  misuse; making lines of treatment diverse and requiring co-ordination.
• The likelihood of suffering from a mental illness in adulthood is increased 4 times if there is experience of CSA.
• Experience of multiple abuse or complex trauma in childhood can affect child development, with consequential impacts on health, educational achievement, and work and life chances.
• Personality  disorder  is increasingly  associated  with  sexual  abuse:  91%  of patients with borderline personality disorder reported being sexually abused.21
• NICE Guidance on PTSD (2006) reported that 50% of people with simple trauma had co-morbid affective disorders, anxiety and substance misuse.
• Professionals working with children and young people and with adults with a mental  illness  need  to  sensitively  and  routinely  enquire  about  patients' experience of trauma and be confident that, when necessary, they can respond in a ways that are helpful and healing.

19 Jersey Annual Health Profile 2014.

20 National Centre Social Research: 2014: Violence, Abuse and Mental Health in England:

Preliminary Evidence Briefing.

21 (Zannarini Et al, 1997, 2000).

Suicide

Graph One shows the rate of suicide in Jersey from 1998 to 2012, using 3-year rolling averages. This shows a peak in suicides in 2009 (17 per 100,000), which then reduces between 2010 and 2013 (8 per 100,000). Due to Jersey's small population, suicide rates can fluctuate year to year. Three-year rolling averages are an average of the current year and the 2 previous years. Doing this allows trend data to be seen.

Graph One: Rate of suicide in Jersey from 1998 to 2012

The most recent rate for suicide in Jersey is 8 per 100,000. This is lower than the most recent available European rate, which was 12.3 per 100,000 in 2010.[15]

Community Mental Health Services – An overview of services

Throughout the review process, a range of data and information has been provided which  describes  different  aspects  of  the  community  mental  health  services.  This information has included –

• In-patient bed usage and length of stay information
• Community Mental Health Services
• G.P. prescribing for mental health
• Current capacity for Nursing and Residential Homes
• Overview of Mental Health Services Provided by Community Voluntary Sector mental
• System performance data (Making Care Appropriate to Patients' Survey)
• Workforce information
• Financial information.

In this section, the data made available is presented and analysed to provide insight into trends or common themes, and to highlight issues relating to the performance or quality of services that have informed thinking about how to address gaps or build on strengths within the existing system.

Adult Mental Health In-patient services

Orchard House is a 17-bed acute admissions Unit for adults (aged 17 – 65 years) experiencing acute mental illness or disorder. The Unit also provides in-patient support for people experiencing acute episodes of mental ill-health who are in H.M. Prison La Moye. Orchard House received a total of 180 admissions in a 12 month period, of which 59% (101) were male. In the same 12 month period there were 183 discharges. Overall the ward operated at 80% of capacity.

The majority of those admitted (59%) were directly from their usual place of residence, 26% from other wards or departments of H&SS, and 10% were admitted by the Police. The average length of stay was 2 – 3 weeks, but with a range from less than a day to 52 weeks. The majority (74%) were discharged to home.

Maison du Lac provides a daily therapeutic recovery-based programme of activities, tailored to meet the individual needs of people using in-patient facilities. No usage data has been supplied.

The Liaison Service received 583 referrals, of which 340 (58.3%) were from A&E, and only 15% from General Practitioners.

The Clairvale Recovery Unit with 10 beds received 36 admissions within the 12-month period and had 36 discharges, maintaining an average occupancy rate of 87%.

Older Adult Mental Health In-patient beds

Cedar Ward is a 14-bedded acute mental health unit providing an in-patient assessment service primarily for older adults with functional mental health needs. In the course of 12 months there were 58 admissions, of whom around two-thirds (37) were female. In the same 12-month period there were 47 discharges. These figures include 6 return admissions during the data capture period. The average length of stay at discharge was 103 days, representing a range from 3 days to 876 days. Whilst the average stay for female patients was shorter than for male, they made up the majority of those within the longest period.

The majority of patients discharged (51%) had a stay of 56 days or less, but there was a significant cluster (8%) with stays of 197 days or longer. Overall, the ward operated at 95% capacity. The majority of admissions (53%) and of discharges (55%) were from or to the patient's home address.

Beech Ward is a 10-bedded acute mental health unit providing assessment of dementia and cognitive impairment. Traditionally focused on patients 65 years of age or over, it currently focuses on presenting condition rather than age. In the course of 12 months there were 53 admissions, of which 58.5% were female. In the same period there were 41 discharges. These included 2 return assessment admissions. Two admissions were for respite care. Average length of stay (excluding respite stays which averaged 7 days) was 73 days, with a range from 3 to 286 days. The majority of patients had a stay of between 29 and 84 days. Overall, the ward operated at 99% of capacity.

The majority of admissions (56%) came from the patient's home address, with 22% coming from a General Hospital ward and 18% from community residential homes. Only 20% were discharged to home, with the largest number (32%) going to community residential homes, 24% going to Oak Ward and 12% to Maple Ward .

Maple Ward is a 16-bedded continuing care/intermediate care ward for individuals with complex mental health requirements, for whom return home or transfer to other long-term setting is not currently possible, due to the level of mental health support they require. In the course of 12 months there were 23 admissions, of whom around two- thirds (15) were female. In the same 12 months there were 11 discharges. These figures include one patient re-admitted during the period under study.

The average length of stay was 419 days, representing a range from 149 days to 1,427 days. Male patients had a substantially longer average stay at 526 days, compared with 312 for female patients, but this average may be distorted by a small number of male patients with very long stays. The majority of female patients spent between 6 months and a year on the ward. Overall the ward operated at 99% capacity.

The overwhelming majority (86%) of patients were admitted from a mental health assessment ward, with the remainder being admitted from a community nursing home. 22%  of  patients  died  whilst  patients  on  Maple   Ward ,  with  a  further  11%  being discharged to General Hospital wards. 34% continued their care on Oak Ward and 22% in a community nursing home.

Oak Ward is a 26-bedded continuing care ward for individuals with complex mental health requirements, for whom return home or transfer to another long-term setting is not currently possible due to the level of mental health support they require. In the course of 12 months there were 32 admissions, of which around 60% (19) were female. In the same 12 months there were 10 discharges. There were 8 admissions for respite care; all of these were male patients. The average length of stay for those discharged during the year (excluding respite stays which averaged 7 days) was 312 days, with a range from 3 to 1,738 days.

The majority of patients had a stay of between 29 and 84 days. Overall the ward operated at 85% of capacity. The majority of admissions (69%) came from a mental health assessment ward, with 15% from General Hospital wards and 18% from Maple Ward .

Unlike the NHS, Jersey continues to provide continuing nursing care beds which extend stays within In-patient Units. When comparing the older people's assessment beds, Cedar Ward and Beech Ward , with the statistics from the NHS Benchmarking Network, the UK mean length of stay for older adult wards was 72 days, compared to 73 days in Beech Ward and 103 days in Cedar Ward .

The data therefore suggests that the average length of stay is comparable. What it does not indicate is the appropriateness of ongoing provision of continuing nursing care within hospital environments.

Community Older Adult Mental Health service

The main function of the current multi-disciplinary team is to provide an integrated, whole-systems,  person-centred  assessment,  treatment,  care-planning,  and  ongoing management to older adults and their carers; either living in their own home or within a health  service  care  setting.  The  memory  assessment  and  diagnosis  service  is  an integrated part of the team, with a focus on early diagnosis and support to families. The memory  service  is  accredited  by  the  Memory  Service  National  Accreditation Programme (MSNAP).

The  team  works  closely  with  G.P.s  and  other  professionals  to  provide  advice, information and training, to equip them with basic knowledge and skills to work with the service user group.

Graph 2: Referral activity to the Community Mental Health Older Adult services (June 2012 – June 2014)

14%

27% New Referrals managed through

the memory clinic

New Referrals seen via an outpatient appointment

14% Referrals assessed in the community via the CMHT

Referrals closed/NFA'd 3% Referrals from general

hospital/liaison

17% Re-referrals

25%

Mental Health Liaison service

The Mental Health Liaison service offers early and timely assessment and interventions for people who are in crisis and experience mental health problems. The standard response time is within 30 minutes. The person will initially be assessed by a Registered Mental Health Nurse and, if required, supplemented by additional assessments from a Staff  Grade  Doctor,  Consultant  Psychiatrist  and/or a  Social  Worker. The  Liaison Service is accredited by the Royal College of Psychiatrists. In 2013 there were 563 new assessments made by the service, with 270 people attending follow-up appointments. There was an upward trend in referrals during 2014.

Table Eight

Sources and number of referrals for Mental Health Liaison service (2013)

Source of Referrals

Referrer:  Jan  Feb  Mar  Apr  May  Jun  Jul  Aug  Sep  Oct  Nov  Dec  Total A&E Department  32  23  29  27  20  21  25  20  36  30  41  36  340

Community Mental Health team

The Community Adult Mental Health Team is composed of mental health professionals from medical, nursing, social work, occupational therapy and psychology backgrounds. The team is supported by an Operational Manager, Clinical Team Leader, Consultant Nurse and Clinical Lead (Medical).

People referred to the team are experiencing a range of mental health or emotional difficulties, such as anxiety, psychosis, bipolar disorder and depression. Referral is managed  through  the  Single  Point  of  Referral  for  Community  Services.  Routine referrals are managed through a weekly multi-disciplinary referral and allocation forum.

Table Nine

Source and number of referrals to Community Mental Health team (2013) Referrer:  Jan  Feb  Mar  Apr  May  Jun  Jul  Aug  Sep  Oct  Nov  Dec  Total

Peri-natal  5  2  3  4  1  2  1  1  5  2  2  4  32

Children and Adolescent Mental Health Services (CAMHS)

The statistical data available in relation to CAMHS is limited. In the year 2013, 446 referrals were received. Information suggests that the largest numbers of referrals came from adolescents from the age of 14 and 17; this cohort represents around three- quarters of the total referrals, and peaks among those who are 15 at the point of referral. Referrals among those between 6 and 10 years of age run in the low to middle-thirties for each age cohort, rising to mid-forties to 50 per year for those in each year of age from 11 to 13.

There appears to be some seasonal variation in referrals that may have a degree of convergence with the school year, but the data is too imprecise to draw a definite conclusion.

Primary Care Activity – Mental Health

Primary care has an important role to play in delivering mental health services. General Practitioners have been an important key gateway to services. An indicator of mental health activity in primary care has been the extent of prescribing for certain mental health conditions. In the future it is hoped that with better coding and integrated information technology systems, more detailed analysis of primary mental health care will be able to be identified.

Table Ten

Total number of prescription items dispensed for drugs used in mental health (2011 – 2014)

Jersey Talking Therapies (JTT)

This new service was launched in December 2014. The aim of JTT is to offer Islanders a service staffed with professionally trained therapists who will support them through a range of psychological therapies. Common mental health problems which someone might seek treatment for include anxiety, depression, obsessive compulsive disorder, phobias, issues to do with alcohol, and post-traumatic stress disorder. It is for people

aged 18 and over. Referrals to the new service began in September, and 740 referrals have been received so far, mainly from G.P.s, with an average of 54 referrals a week. To date, a total of 154 people have been successfully discharged, while others are receiving ongoing therapy.

Mental Health and a place of safety

In Jersey the Mental Health (Jersey) Law 1969, under Article 47, gives Police Officers the power to remove a person who appears to be suffering from a mental disorder and is in need of immediate care and control, and who is in a public place and is apparently a danger to him/herself or to other people, to a place of safety' where they may be assessed by a doctor. In Jersey there is no designated place of safety other than States Police Headquarters to detain people who are considered at risk of self-harm or harm to the Public.

In Jersey, mental health assessments are requested by Forensic Medical Examiners (FME) for detainees they consider to be in need of hospital treatment for either self- injurious behaviour or concerns regarding serious mental illness. H&SS provides a mental health assessment service 24 hours a day and can be contacted by the FME as required.

Care of the vulnerable in any society is a joint responsibility. The table below shows the rising number of vulnerable people being detained in Police custody as a place of safety.

In Jersey 90 people per 100,000 head of population were removed to a place of safety in 2014, whilst in England during 2014, 42 people per 100,000 were removed to a place of safety.[16]

Return to work initiatives

The Social Security Department helps jobseekers back into work and aims to improve the prospects of finding sustainable work for all people, including those with poor mental health. The Department recognises that being out of work is detrimental to health and wellbeing, and its policies reflect the additional barriers faced by people with a mental illness.

The Work Right' and Occupational Support Unit' support jobseekers with significant employment barriers. The teams work in partnership with other agencies such as Jersey Employment Trust and Jersey Talking Therapies.

A new assessment structure will ensure bespoke support is offered to those with the most challenging circumstances. Those who, initially, are considered to be unable to benefit from an employability provision due to severe barriers such as dependency and violent  offending,  are  provided  support  from  the  Occupational  Support  Unit  in

partnership with other agencies to enable them address and manage their issues. People who have limitations meaning they are potentially employable, but a long way from work (problems such as addiction, a criminal record, long periods of unemployment, long periods of poor health) are assigned an Employment Adviser who will work closely with them. Their Adviser will agree actions and goals, and will identify suitable and realistic employment opportunities and training to address barriers such as motivation, literacy or communication skills. As people progress closer to work, they are given specific skills training and more intensive job-seeking support.

Jersey Employment Trust (JET)

The primary role of JET is to assist people with a disability or long-term health condition (including mental health) to find and sustain open employment. JET is made up of a number of specialised support services which enable people to access a flexible range of options that can be tailored to their specific needs. Recent figures show a significant increase of referrals for individuals with a mental health condition (from 35 referrals in 2012, to 93 in 2014, going onto 100 referrals for the first 6 months of 2015), mental health now make up approximately 25% of JET's total caseload.

JET recognizes the need for mental health support, recovery and employability for the overall health of an individual. As such, within JET's services is a Wellbeing Support Unit, which is made up of 2 health professionals, implementing evidenced-based practice in mental health intervention and support. This includes, primarily, up-skilling JET staff with education, training and mentoring in mental health, to manage identified barriers or issues with referred clients. Other areas of support include education, training, advice and one-to-one support for clients in developing essential skills to either maintain employment or meet prospective employment needs. This intervention has laid the foundation for effective support and is evident in the increase in sourcing and supporting paid job placements across all sectors (from 80 in 2013 to 152 in 2014, and in 2015 JET is on target for 200 paid job placements), with 28% of those placements being with a client with a defined mental health condition.

As an adjunct to the increased prevalence of referrals for clients with a mental health condition, JET recognises co-morbidity of mental health with other long-term health conditions, and therefore refer to the Wellbeing Support Unit for guidance. The Wellbeing Unit will then assess and support accordingly, to either provide clients and support staff with support measures or to liaise with H&SS for other support.

Overview of the Community and Voluntary Sector – Mental Health Services MIND (Jersey)

MIND Jersey is an independent local charity that provides support to people living with mental illness. It sponsors the activities of an Independent Mental Health Advocate who provides invaluable support and advice, ensuring that those in need are heard and listened to. During October 2013 and October 2014, the charity received 268 referrals to its Mental Health Advocacy service and supported 154 people under 65 and 114 people over 65 with choices about treatment, understanding their rights, and accessing information about their care and treatment. The charity also delivered 500 hours of training during the same period, playing an active role in the delivery of professional training ahead of changes to mental health law and capacity law.

The charity employs a family and carers' support worker who works closely with the families and friends of people experiencing mental health illness. MIND Jersey has recently introduced a Peer Support scheme, run by volunteers who have lived through the experience of mental health problems.

MIND Jersey also campaigns for a greater public understanding of mental illness and works closely with the statutory services, seeking to influence decisions and policy that might lead to improvements in the range of mental health services provided. An area for early attention and investment is in relation to mental health services that should be provided to young people, as it is recognised that early and low-intensity interventions can be very effective.

Jersey Alzheimer's Association

Jersey Alzheimer's Association provides help and support to local people with dementia and their families. The charity has a drop-in' office in St. Helier and employs a full- time Educator to teach about dementia in a wide variety of settings. One of the services offered is the Saturday Club, which is held every week from 9 a.m. until 3.30 p.m. at the Poplars Day Centre, and is open to anyone who has dementia. This facility enables up to 25 families and carers to have a break whilst the person with dementia is cared for in a safe and stimulating environment by our Person-Centred Dementia Care trained staff. The charity also operates an answerphone Helpline, and provides weekly art as therapy' and music therapy classes. JAA works alongside H&SS staff to provide a monthly dementia café and weekly swimming class too. The total cost of providing the charity's services is £200,000 per annum, 90% of which comes from public donation.

Youth Enquiry Services

The Youth Enquiry Service (YES) helps young people access information and advice so that they can make informed choices on a range of issues in their lives. YES is a One-Stop Shop' for young people to access free, independent and confidential support and counselling via the drop-in centre, by phone, text, e-mail and through its website.

Open to all young people aged 14 – 25 years, YES offers a universal access point to targeted and specialist services, supporting young people on a diverse range of issues that are frequently inter-related, such as –

• social welfare issues, e.g. benefits, housing, debt, employment
• mental and emotional health issues, e.g. depression, low self-esteem
• self-harm, family problems and stress
• wider personal and health issues, e.g. relationships, sexual health, drugs and alcohol, healthy eating
• practical issues, e.g. careers, money management, independent living skills.

The following table shows the increase in referrals and appointments made by the service between 2008 and 2014.

Shelter Trust

Aztec House provides walk in' emergency accommodation with provision of 35 units of accommodation. This includes the Drunk and Incapable Unit' accommodation consisting of 4 secure single-occupancy rooms situated at Aztec House.

Strathmore provides emergency single-occupancy accommodation with provision of 16 accommodation units for homeless young adults aged between 16 – 25 years.

Evans House provides single-occupancy accommodation for a maximum of 22 people. It offers medium-term settled accommodation and resettlement support for previously homeless  people  now  aged  over  25 years.  During  2014,  the  bed  occupancy  was approximately 50%.

Midvale Road provides 17 self-contained single-occupancy studio flats for medium- term accommodation and resettlement support for previously homeless people now living independently. During 2014, the bed occupancy was approximately 65%.

Residential and Nursing Home provision

There are a range of nursing and residential homes. The table below shows that there is a total capacity of around 950 residential and nursing beds available in the private sector. There are 4 nursing homes that offer placements for people with a diagnosis of dementia, and one nursing home that has 4 beds for people with dementia. There are 2 residential homes that offer respite care.

Table Eleven

Estimate of Private Nursing and Residential Beds

Residential respite for people diagnosed with Dementia – Pilot Project

Having access to regular respite for carers supporting family members with dementia is extremely important. As part of the investment in the first phase of P.82, a pilot scheme was set up to increase carers' access to respite services.

Respite involves providing a care service in the individual's home, allowing the carer to go out and attend social activities and reduce social isolation, or to remain at home but not be responsible for the care needs of their loved one. These types of packages can include weekly sitting services, 24 hour home care, and weekly overnight care.

For those people who received residential care, wherever possible the carer was given the residential care home of their choice for the period of respite.