Health White Paper - MIND Jersey - Submission - 2 July 2012

Health and Social Services White Paper Caring for each other, caring for ourselves'

1.0  Introduction

This brief paper has been prepared as the written response of Mind Jersey to the White Paper and is to be submitted to the Health and Social Services Minister and the Health, Social Security and Housing Scrutiny Panel as part of the consultation process. It has been prepared following a presentation made by Mrs Julie Garbutt and Ms Rachel Williams to the full Mind Jersey Committee when there was opportunity for questions and discussion which has assisted in the preparation of this response.

2.0 Background

Mind Jersey, formerly known as Jersey Focus on Mental Health, is a local charity that seeks to provide information and support for those people and their families and friends whom are experiencing mental illness. We do this so that as many of them as possible can lead full and active lives and play their full part in society.

We  sponsor  the  activities of  an  Independent  Mental  Health  Advocate,  whom  provides invaluable support and advice, ensuring that those in need are heard and listened to. We employ a carer's support manager whom works closely with the families and friends of people experiencing mental health illness in looking after their loved ones. We also maintain a number of properties that provide accommodation for those requiring support and this includes Camelot, a residential home for eight individuals requiring more intensive support.

Mind  Jersey is  affiliated  to  Mind  UK  and  has,  very  recently,  successfully  completed  a thorough  and  exacting  quality  management  in  Mind  assurance  process  as  part  of  this affiliation. We campaign locally for a greater public understanding of mental illness and to address issues of stigma and misunderstanding.

We aim to work closely with the statutory services, have co-sponsored a Partnership Project with them and seek to influence decisions and policy that might lead to improvements in the range and quality of mental health services provided locally.

We have a Nearly New shop, run entirely by volunteers, that provides invaluable income and we are also reliant upon donations and bequests to augment the grant that we receive from Health and Social Services to maintain our range of activities. All monies raised in Jersey remain on Island.

3.0 Context

For Mind Jersey one of the most encouraging outcomes of the consultation, generated in response to a detailed questionnaire that accompanied the Green Paper, is confirmation that a very significant number of islanders believe that mental health is just as important as physical health.

Mind Jersey accepts and endorses the outline premise of the White Paper that services will need to be redesigned and modernised in order to continue to provide high quality, cost effect services as the island's population ages. We are pleased to see that services for adults with mental health issues are included amongst the first four areas that require attention and reform and hope that the necessary investment that will be required will be forthcoming.

There remains a very strong feeling that the lack of investment made in health and social care services overall, during the last decade, has been most acute within Mental Health – often and quite rightly described as the Cinderella' service. Under-investment in comparable services nationally has also been highlighted in a significant report, How Mental illness loses out in the NHS' which has just been published and is receiving widespread attention.

Chaired by Professor Lord Layard, Director, Well-being programme for Economic Performance at the LSE, the key findings of this report are that mental health is generally more debilitating than most chronic physical conditions – yet many are failing to receive treatment – and that increased expenditure in these areas would almost certainly be cost neutral overall. There is every reason to believe that many of the key findings will also apply to Jersey.

0. Key issues

Mind Jersey welcomes the emphasis on more care being provided in the community and additional investment being committed to early interventions in accordance with a preventative agenda.

1. Additional support and recognition for carers

The laudable desire of putting in place appropriate care packages to promote continuing care in the community should mean that greater recognition, and resources – to include a Carers support budget – will also be forthcoming. Whilst our Carer's support manager has significant experience in supporting families of those with mental health illness, currently he has no additional capacity. Mind Jersey is ideally placed, with the input of additional resources to help deliver this agenda.

We also believe that greater attention should be given to these families at times of crisis. Currently individuals are required to have a mental health assessment prior to either a hospital admission or appropriate treatment and this can be difficult and expensive to secure – especially out of hours (see section 4.4 below).

The current guidance from Adult Mental Health services is, in sequence, to telephone the G.P for an appointment if the person can attend the surgery. If this is not possible to then request a home visit which can cost up to £100. Alternatively the person should be taken to A&E, if they are willing to go – which a lot of the time they are not – or the police should be called and requested to take that the person to a place of safety to have their

mental health assessed. This is sometimes undertaken in a police cell and recourse to this option brings added distress to both the person experiencing mental illness and to their family.

All three actions can be very difficult to pursue when an individual may be experiencing paranoia or delusions and feeling intense anxiety and can come with a high cost, both financially and emotionally. In the U.K early intervention and crisis intervention teams have been established and Mind Jersey would see this as being a high priority for early implementation, even though this development does not feature in the White Paper.

Providing appropriate support for Young Carers of someone with mental health problems has also been overlooked in the current White Paper. Significant funding in the U.K has been found to support such investment and we believe this approach should be followed here in Jersey. Mind Jersey's Carers support Manager would be well placed to oversee this development as a logical extension to his current remit.

We would welcome the opportunity to contribute to discussions about the role of carers in general and to expand our existing services in this important area on the basis of partnership working with the statutory services.

2. Access to psychological therapies

We endorse the early priority that is attached to improving access to psychological therapies (IAPT) with the aim of granting quick and easy access to support adults with common mental health problems. This is also highlighted in the Layard report (see section 3.0 above) and could be delivered locally in the community, for instance at GP surgeries or in the Well- being centre.

Mind Jersey will need to consider whether this is an area of provision it wishes to enter into or whether it intends to concentrate on improving and expanding existing core services' with the possible addition of an educational / awareness raising role as our first priority.

3. Dementia strategy

In recognising the significant demographic shifts that are to occur within the local population the White Paper highlights the priority that needs to be attached to developing a Dementia strategy. Whilst the Jersey Alzheimer's Association are best placed to lead in these areas Mind Jersey has secured their informal agreement that, given additional resources, it would be most logical for us to extend the invaluable work of our Independent Mental Health Advocate to encompass older and increasingly vulnerable clients.

There is already evidence that our single-handed Independent Advocate is receiving more and more referrals and requests for assistance for mental capacity advocacy or non- instructed advocacy from those aged 65 years and over. Some of these potential clients are very vulnerable and Mind Jersey believes that, with investment, it could provide an important service to this group.

4. Access to Primary care, especially in the improved management ofLong Term Conditions (LTCs)

An area that deserves considerable attention is how it is envisaged that Primary Care services may be delivered and accessed in the future. Whilst it might be assumed that the majority of the population has reasonable and timely access to their GPs, and accepted that there is some merit in maintaining aspects of the existing system of co-payments, it is often quite a different picture for those with Long Term Conditions such as Diabetes, Asthma and Mental illness.

The very people that should be in regular contact with their GPs, so as to be appropriately managed in the community – rather than in a hospital setting – are often deterred due to the current costs that will be incurred in doing so. This shortcoming is serious and impacts adversely on the health and wellbeing of some of the most vulnerable members of our community.

This dilemma can, and should be tackled in a number of ways. Practices could be encouraged to manage LTC patients for a fixed' annual sum, presumably to be largely funded by Social Security; they could employ a range of (cheaper) health and social care professionals (nurses, therapists etc.) and some care could be delivered from the Community Wellbeing Centre by a similar group of individuals working out of that base – rather as currently occurs for a different range of services out of The Bridge.

This last proposal is worthy of detailed examination as this might provide a real opportunity for Third sector organisations to come together as a consortium, secure a visible presence in the community, and deliver a range of services that – in the case of Mind Jersey - could include Independent Advocacy, access for carers requiring support as well as shared facilities from which tailored training and educational sessions could be delivered. Depending upon the design this could enable Mind Jersey to deliver important services in a more accessible and integrated manner, all the while working to reduce stigma and promote inclusion.

5.0 Conclusions

Overall Mind Jersey welcomes the White Paper and in particular the recognition that improving the way in which adult mental health services are delivered is a high priority. It waits to be seen if the public, and more especially the States Assembly, will be prepared to identify and secure the additional resources that will be required if these plans are to be a implemented in a timely manner.