Mental Health Services - Mind Jersey - Submission - 10 October 2018

Health and Social Security Scrutiny Panel review of Mental Health Services review – Mind Jersey response

0. Summary
1. Mind Jersey is the island's leading mental health charity. Just 13.5% of Mind Jersey's annual budget is funded by the taxpayer. Every year we help hundreds of islanders by providing  family/carer  and  peer  support,  residential  accommodation  and  a  growing number of services for children and young people.
2. One in four of Jersey's population, and one in ten of children and young people, are currently experiencing some form of mental health problem. With additional funding we could use our trained staff and expertise to deliver much needed services to many more islanders.
3. This paper provides recommendations for the scrutiny panel to consider. We hope the panel  will  support  Mind  Jersey's  ambition  to  become  the  Government  of  Jersey's voluntary sector partner of choice in delivering low intensity, prevention and early mental health interventions to include the offer of training. We believe this will be critical if we are to achieve an improvement in the island's collective mental health in a cost effective and sympathetic manner.

0. Context
1. Mind Jersey welcomes the opportunity to contribute to the 2018 Scrutiny review and submits these written comments in addition to forthcoming opportunities to brief the panel orally. The charity was very actively involved in the development of the Mental Health Strategy and continues to work constructively – albeit at times as a critical friend – with Health and Social Services.
2. We welcome the increased attention that mental health is receiving, both nationally and in Jersey. We lead campaigns that encourage more people to talk openly about their mental health.  This  raises  awareness  and  increases  understanding  which  is  crucial  in  tackling stigma. Our current focus is to support these campaigns in workplaces, schools and colleges.

0. Prevention and early interventions
   1. There is overwhelming evidence that prevention and early interventions can make all the difference, whether in adult (18-65), older people (65+) and most obviously in children and young peoples' services. Nipping things in the bud' before they escalate can reduce suffering, save resources and take some of the escalating pressure off secondary services.
   2. Both the Mental health strategy and the CAMHS scrutiny report in 2014 highlighted the importance that should be attached to early interventions and the provision of low intensity input, to include mental health awareness training and strategies to tackle stigma.

Mind Jersey believes that the voluntary and community sector, rather than government, can be more effective in realising this objective.

3. We have developed new services for children and young people and were the first to introduce  peer  support  in  mental  health.  Unfortunately  there  has  been  no  financial investment from Health and Social Services in these important areas, where we have a good reputation and a solid evidence base for what we provide.

3.3  We  strongly  supported  the  introduction  of  an  Improved  Access  to  Psychological Therapies (IAPT) service, known locally as Jersey Talking Therapies (JTT). This is an excellent example of how working differently can improve access to services. The recent push to tackle unacceptable waiting times for JTT is most welcome and it is to be hoped that this progress is maintained.

Recommendation

The Government of Jersey should make sustained investment in prevention and early interventions delivered through strategic partnership with the voluntary and community sector where there is often latent talent, experience and capacity.

0. Getting things right so Carers thrive not just survive.
   1. Mind Jersey is proud of the Family and Carers service it currently offers. Carers are given practical and emotional support, including representation in multi-disciplinary meetings, and have access to our educational programmes. We operate an active carers' forum that represents the voice of mental health carers and are an active member of the Carers' Partnership  group;  we  helped  drive  the  development  of  the  Carers'  strategy  and  we continue to campaign strongly for the introduction of a Carers' Law.
   2. Our service has led on the introduction of the Triangle of Care model. This is a practical and evidenced based tool used to underpin successful partnership working between the health and social care professional, the service user and the carer. We strongly encourage increased  engagement  from  health  and  social  care  providers  and  believe  that,  if  fully embraced by all local mental health services, there would be very positive dividends for individuals, their families and the service provider.

Recommendation

The Government of Jersey should introduce a Carer's law which would bring recognition and protection to all carers, including those supporting loved ones with mental ill health.

The Triangle of Care model should be progressively rolled out by health and social services to all mental health areas as it has equal application and potential to support children and young people as well as older adults.

0. Old buildings and tired people
1. The mental health estate is in need of significant and urgent investment. In many service areas there are recurring and significant staff shortages; high turnover and sometimes poor morale. These difficulties are compounded by the generally poor working environment as the mental health estate has been much neglected during past decades.

2. Service  users  and  their  families  have  reported  upheaval  and  cancellations  to appointments due to staff changes and lack of resources. Patients and carers have often felt that  discharge  from  Orchard  House  has  been  rushed  with  insufficient  support  being scheduled and delivered from the community teams as part of a comprehensive discharge package. This inevitably can cause significant distress and lead to early readmission which is in nobody's interest.

Recommendation

A comprehensive redevelopment plan for the mental health estate is urgently required to bring together disparate services onto a new health campus – co-located with other services – in order to improve patient experiences, increase efficiency, retain staff and reduce stigma.

0. Listening and learning from the voices of experience
1. The success of the mental health strategy, in contrast with the implementation process that  has  followed,  was  that  real  attempts  were  made  to  engage  with  service users to develop ideas and define priorities.
2. Mind Jersey is proud of its Youthful Minds' group which includes upwards of 30 young people, aged between 11 and 25 years, many of whom have lived experience. This group has advised us about how we might reach their contemporaries and created a campaign with age appropriate and accessible messages and designed a range of training packages. They work with CAMHS and Education to develop and review the services they provide. The group also commissioned a drama production that has toured local schools. Together they have pioneered the concept of real youth participation and we believe that this is a model of effective service user involvement that is worthy of replication in adult and older people's services.

Recommendation

Service users and their families should be much more closely involved in the design and delivery of services. The participation model, as developed by Mind Jersey in relation to children  and  young  people,  should  be  extended  to  encompass  adult  mental  health services.

0. We could do so much better if things could be joined up
1. To date there has been little or no support, from a strategic level, to ensure that the statutory services work in partnership with the voluntary and community sector. The many changes in key personnel, taken together with a plethora of different initiatives and the introduction of a complex and time-consuming commissioning process, do not reflect well on  one  of  the  key  priorities  in  the  strategy  –  namely  to  provide  leadership  and accountability. The voluntary and community sector should be treated as equal partners. Until this happens, and communications improve, there will be many missed opportunities and a potential loss of effectiveness and efficiency.

Recommendation

The Government of Jersey should identify and maintain key points of contact within the mental health services so that partners in the voluntary sector know who to talk to

Appendix 1

About Mind Jersey

Mind Jersey is a small and independent local Mental Health charity affiliated to Mind UK. Its vision is of a society that promotes and protects good mental health for all and treats people with experience of mental distress, fairly, positively and with respect. The charity provides support and help so that people can take control of their mental health and live full lives.

Annual expenditure is approximately £573,000 whilst income is £503,000. Of this 13.7% (£79,000) comes from Health and Social Services as part of our service level agreement in partial support of the Family and Carer's support service. Mind Jersey employs 18 full time equivalent staff and over 40 volunteers work in support of the charity on a very regular basis.

Appendix 2

The table overleaf gives further indication of the range of services provided.

Range of Mind Jersey Services and Activities

Children and Young  Education,  Family and Carers  Fundraising,  Peer Support  Residential Services Peoples' Services  Information  Support  and Retail

and Training

Youth Participation and  One to One support  Fundraising  One to One  Camelot – 24 hours coproduction including  Awareness  purposeful support  registered home with

Youthful Minds tackling  Raising  Carers' group  Retail and  respite facility

stigma campaign  Campaigning  therapeutic  User participation

Triangle of Care  services based  Oakville – Independent Interface with CAMHS, Adult  MHFA  in New Street  Co-production  accommodation

(18-25 years) and Education  Interface with Adult

services  Social media  services  Partnership working

content and  with Practice

Education and training  management  Carers' self-advocacy  Education Facilitator

including Youth MHFA  training  College

Family SMILES  Partnership working  Partnership working

with Recovery College  with Recovery Workshops for 7-12 year olds  College

Signposting and support for parents and professionals

1 to 1 support for teenagers Wellness Recovery Action Plan (WRAP)