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28 February 2022
Dementia Jersey response to the Health and Social Security Scrutiny Panel follow up review of Mental Health Services
Iamwritingwithregardstothe follow up review of Mental Health Services in Jersey. We understand that The Health and Social Security Scrutiny Panel would value hearing from Dementia Jersey about whethertherehasbeenanyprogressagainsttherecommendations from the initial review, in
addition to collecting information about how the COVID19 pandemic has impacted Mental Health Services provided by the Government of Jersey.
Current Government services for people with dementia focus on the Memory Assessment Service, the Dementia Assessment Unit at Beech Ward and support provided by the various teams supporting Older Adults.
Please see below our responses below the recommendations we feel in a position to comment on.
RECOMMENDATION 1: A part of its refresh of the Mental Health Strategy, the Government should develop some clear objectives from which progress can be measured. These should be published on the Government's website.
At the moment there are no objectives relating to dementia and no specific measures to report on. Webelievetherecommendationshouldhaveincludedtheneedfor a separate dementia strategy forJerseyandaskTheHealthand Social Security Scrutiny Panel to note that Government have now committed to the development of a separate Dementia strategy and are working in partnership with Dementia Jersey to develop it. Dementia Jersey requests that objectives and measures for this strategyareincorporated intowider high level reporting for mentalhealth.
RECOMMENDATION 2: The Government should publish a list of the outcomebased measures and indicators it will use to monitor its performance in relation to mental health by the end of 2019. The information it collects in relation to these measures and indicators should be published on a yearly basis thereafter.
Dementia Jersey requests that outcomebased measures and indicators are also developed for services for people with dementia and that these are incorporated into overall measures for mental health which are published and publicly available.
RECOMMENDATION 3: The Government should regularly ask service users for their views and opinions on the quality of the mental health services it provides. In light of our survey, the Government should start this regular engagement in Q1 2020. Regardless of the tools that the Government uses to collect user feedback, the results should always be published.
We wholeheartedly support using feedback from service users and are keen to support the governmentinaccessingpeoplewithlivedexperienceofdementia. We are not aware of any user feedback with people with dementia which has been published by the Government to date. Dementia Jersey has a Lived Experience Advisory Panel (LEAP) which meets monthly and is able to incorporate questions on the quality of services they experience.
RECOMMENDATION 4: The Government should consider the merits of having a designated Minister for Mental Health to provide sufficient leadership for mental health in Jersey. Alternatively, the Government should transfer official responsibilityformentalhealth toa designated person. The Government should demonstrate that it has considered this matter and set out its decision in response to this report
We support having a Minister for Mental health which a clear appreciation that dementia is within the scope of this remit too.
RECOMMENDATION 5: The terms of reference, membership and reporting linesoftheMental Health Improvement Board should also be made public. The Board should be chaired by a senior officer in Health and Community Services. Membership of the Board should include operational representatives from all frontline services that interact with mental health as well as appropriate third sector organisations. Its membership should also include at least two people with lived experience of mental health problems.
Dementia Jersey has been invited to the initial group of stakeholders for the Mental Health Improvement Board.
RECOMMENDATION11:Anappropriate place of safety should be created within the existing hospital until an alternative arrangement can be found. Children and adults in mental health crisis should be separated.
There is nothing to suggest this recommendation has been put in place with regards with people with dementia. We believe that it would be good not only for people with dementia, but also for other people with other mental health problems in inpatient facilities, if people with dementia had separate dedicated care facilities – with specialist, dedicated, experienced and dementia trained staff to care for them until an appropriate placement in a care home, or appropriate package of care at home can be provided.
RECOMMENDATION 13: The Government should adopt the parity of esteem concept and develop a plan for how it will be integrated into health and social care services. This concept should be reflected in the Mental Health Improvement Board's terms of reference.
We completely agree and this is particularly of relevance for people with dementia too.
RECOMMENDATON 14: The Government should adopt a genuine coproduction approach to the design and ongoing delivery of Jersey's mental health services. People with lived experience should be empowered and involved in all aspects of mental health strategic andoperation development including having a voice at corporate management level.Thesepeopleshouldalso be remunerated for their contribution.
This needs to consider people with dementia too and Dementia Jersey is very happy to facilitate this involvement.
RECOMMENDATION15:IftheGovernment wants the community and voluntary sector to provide whatareessentiallyfrontlinemental health services then it needs to provide realistic support to these organisations. The Government should provide adequate funding to, at the very least, cover the cost of delivering services, as well as longer term contracts to these organisations (which could still be reviewed intermittently) in order to ensure that these services can provide the services required.
Dementia Jersey is the only charity in Jersey supporting the estimated 1,600 islanders with dementia and their families. We provide a range of support groups for carers and therapeutic activities for peoplewithdementiafacilitated by an expert team of inhouse dementia specialists, often with the help of occupational therapists and expert subject tutors. Activities range from music, art classes, swimming,walking,gardening,tai chi, and coffee mornings, to compliment the day care which government offers. We also offer expert support and counselling from 3 Dementia Advisors which between them saw over 1,400 people in 2021 (up from 336 in 2019). The charity costs over £420,000 to run and we currently receive £35,000 from Government towards one of our services for people with a recent diagnosis of dementia.
RECOMMENDATION16:TheGovernment should offer to all Jersey's General Practitioner (GP) practises, training on mental health and information about Jersey's mental health services.
Wewouldliketoseededicatedmodulesonthediagnosisofdementia included. This should ideally cover training beyond diagnosis of dementia, to also include the management of people with dementia, (inc. specialist training in communication skills, social prescribing, knowledge of other services available, and understandingofthe LongTermCarescheme and other Income Support benefits to help refer their patients appropriately.
RECOMMENDATION 20: The Government should review the model of care that is used in Jersey's mentalhealthservices. Aspartof this, the Government should define the model of care that it uses. This definition should include elements used in Open Dialogue including collaborative and joined up approaches to care. ThisshouldbepublishedinQ22020.
This review should also include best practice as it relates to dementia. Dementia Jersey was also requested to answer the following questions:
- Please could you provide the Panel with details about whether, in your experience, the Covid19 pandemic has changed the need, or the requirements, for Mental Health Services in Jersey. Please provide any further data, or details, where possible.
We believe the Covid19 pandemic has severely impacted the provision of Mental Health Services in Jersey as it relates to people with dementia.
We understand that the Memory Assessment Service (MAS) was suspended at the height of the pandemic and staff were reassigned. For over a year now there have been significant backlogs as a result and the waiting time for an appointment at the Memory Assessment Service (MAS) now is nowataround9monthsaccordingto our clients. As at midFebruary MAS estimated that they have 135 patients waiting to be seen. 36 of those will be seen within the six weeks (referral to diagnosis) establishedbytheRoyalCollegeof Psychiatrists. The other 99 are outside the 6 weeks and they are working on triaging those 99 individuals and allocating cases accordingly to level of impairment, risks, etc. to other medical colleagues within the Older Adults Mental Health team.
Dementia Jersey has seen an increase in the numbers of people requesting specialist advice from our Dementia Advisors and they went from having 320 appointments in 2019 to over 1,400 in 2021. We believe this is because people are experiencing confusing or distressing symptoms of dementia are haven't been able to access any help due to lockdown and isolation, and this is having a huge impact on partners and families. The number of our referrals to SPOR have also increased significantly.
MAS agree that some interim support for people on their waiting lists would be helpful. Dementia Jersey is now providing a temporary monthly group session just for these patients which would be set in a hotel with tea and coffee available and it would be about making social connections, sharing experiences and speaking with a dementia Advisor to answer questions.
- Do you consider that there have been any good, or positive, changes in the delivery of Mental Health Services in Jersey in the period since 2018?
No
- Do you consider that there have been any bad, or negative, changes in the delivery of Mental Health Services in Jersey in the period since 2018?
A negative change has been the impact of the suspension of Sandybrook's day care services for people with dementia due to the refurbishment of the premises. They closed on Monday 18thOct2021andanticipatetherefurbishment taking 15 weeks and reopening in early
2022. Some provision has been made to provide 121 support for people with dementia, however this has meant limited opportunities for clients to socialise in a group and been verydisruptivewhichisfarfrom ideal with people with dementia who rely on routine and familiarsurroundings
- What, if anything, could improve the patient experience of Mental Health Services?
Having an islandwide strategy for dementia would greatly improve the patient experience. More specifically, having defined care pathways for people with dementia and named Care Coordinators' available for everyone from the point of diagnosis would make a significant difference, so long as these were extremely knowledgeable and accessible.
Thank you for this opportunity to input into your review. Your Sincerely,
Claudine Snape CEO
Dementia Jersey