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Comments by Lucy Nicolaou, Service Lead at the Listening Lounge
- Please could you provide the Panel with details about whether, in your experience, the Covid- 19 pandemic has changed the need, or the requirements, for Mental Health Services in Jersey. Please provide any further data, or details, where possible.
The Listening Lounge opened in November 2019, only a few months before the pandemic began, as such we have limited pre-Covid 19 data from which to draw comparisons. However, utilisation data and trends observed during this time provide a useful snapshot of islanders' experience of the pandemic in relation to their wellbeing. It is not possible to ascertain the number of people who may have accessed support at the Listening Lounge had we have not experienced the pandemic, but certainly demand has been far greater than originally anticipated, with 3,500 islanders accessing 11,500 appointments since the service launched.
Depression, anxiety, and stress have consistency been the most common presenting issues throughout. For many people visiting us, it has been the first time they have experienced a difficulty relating to their mental health. In terms of other key issues, the leading reported concerns month- to-month have been loneliness & isolation and the impact of covid, followed by relationship difficulties, concerns around employment and financial worries.
Whilst some islanders have shared that restrictions and working from home requirements have been beneficial for managing their wellbeing, there has also been a consistent narrative relating to the difficulties of working from home, with blurred boundaries, reduced social contact and isolation.
- Please could you provide the Panel with details about whether, in your experience, the Covid- 19 pandemic has impacted the provision of Mental Health Services in Jersey? Please provide any further data, or details, where possible.
The provision of Mental Health Services has been greatly affected by Covid-19, particularly during periods of lockdown when the delivery of some services was disrupted, and others closed entirely. At these times we saw not only an increase in demand, but a change in the types of difficulties experienced by those contacting us, with a greater number of people seeking support for thoughts of suicide, self-harm, eating disorders, historic trauma, and psychosis.
One of the key issues we have heard from islanders throughout the pandemic relates to poor communication from services, which at times has had a detrimental impact on care. This relates to a lack of clarity regarding appointments, care plans, transition between services and points of contact. We are still now being contacted by people who were engaged with Mental Health Services prior to Covid-19, or were due to be, but have since been discharged having received no contact at all.
Mental Health Services have been required to work flexibly and adopt other ways of engaging with clients, at times switching from in-person support to online or phone-based modalities. This has been useful in providing some continuity and ensuring essential services remain available, however oftentimes has not been either a client or practitioners preference. For our clients at the Listening Lounge, it has also posed additional considerations such as clients needing to have a safe and confidential space at home from which to contact us.
A further impact of Covid-19 relates to opening hours and capacity at different times throughout the day and week. For many, working from home meant greater flexibility during the day and for a period we saw an increase in daytime availability and demand for support during the traditional working week. As restrictions have eased and many have returned to usual working environments it has been necessary to shift some resource to ensure there is appropriate capacity during evenings and at weekends.
- 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? If you are unable to comment on change specifically, but have positive experiences to relate, the Panel would be grateful to receive this information.
A greater focus on early intervention and accessibility has been a positive change, along with self- referral options and more choice to help prevent problems escalating, and empower islanders to be leaders in their own wellbeing and/or recovery.
There has been a greater endeavour to enhance collaborative working between agencies with the introduction of the Mental Health Network, leading to more front doors' and improved system navigation. There have been many examples of excellent joint working between different services across the public, private and voluntary sector. This has also led to joint mental health campaigns to raise awareness, bolstered by increased conversations around mental health generated by Covid-19.
It is essential that community facing services are plugged into the wider system and able to facilitate access to appropriate support, and there has been some consideration and work in terms of pathways. At the Listening Lounge we have experienced positive changes in this regard when seeking support for islanders experiencing crisis, via the Crisis and Home Treatment teams. Similarly, the development of the Complex Trauma Network and the addition of Community Navigators within the Psychological Assessment and Therapy Service has been beneficial.
There has been some momentum towards a greater emphasis on the value of lived experience, with Equals by Experience having more involvement in the design and delivery of a growing number of services. Our Peer team at the Listening Lounge occupy integral roles within the service, working alongside qualified counsellors in a client facing capacity. This has proved incredibly successful and has been well utilised, with over 40% of those visiting us choosing to access this type of support. There is huge scope and opportunity to adopt a genuine co-production approach and ensure that meaningful engagement with those who have lived experience of poor mental health or mental illness exists across all services. The introduction of a Lived Experience Engagement Framework would support this movement.
- 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? If you are unable to comment on change specifically, but have positive experiences to relate, the Panel would be grateful to receive this information.
The Mental Health Improvement Board has not met consistently, and this has impeded progress relating to improvements and key priorities. The Adult Mental Health Network has come together regularly and provided a useful space for collaborative thinking and operational updates, however this serves a very different function to that of the Mental Health Improvement Board. We are also lacking a current Mental Health Strategy for Jersey which is essential to bring together overarching objectives.
- What, if anything, could improve the patient experience of Mental Health Services?
At times there is rigidity in terms of applying thresholds and criteria as a priority over client care, rather than a whole systems approach which considers the whole person. Services should be organised in a way that prioritises dialogue and relationships.
Some waiting times continue to be problematic which can lead to further deterioration or islanders' engaging with multiple different services while waiting for appropriate support. It would be beneficial to introduce additional community spaces which are easily accessible and offer a range of support options, including the option of longer term counselling. Social prescribing opportunities could be enhanced to help address psychosocial problems and, in doing so, make best use of specialist mental health resources.
Improved communication between services and clients is essential, along with improved communication between individual services. There are multiple electronic patient systems being used and a lack of coherent information sharing processes in place, which can hinder the quality of client care. There needs to be a sustained focus on partnership working to bolster improvements made to date.