Leeds Mental Health Framework Update jenny.thornton@nhs.net Mental Health Partnership Board 1. Focus on keeping people well – to build resilience and self-management 2. Mental health and physical health services will be better integrated 3. Mental health services will be transformed to be recovery and outcome focussed 4. We will ensure access to high quality services informed by need 5. We will challenge Stigma and Discrimin-ation Our local Framework preceded the national plan – but covers all of the key themes. Our Framework has driven our local transformation plan for the last 18 months through four overarching themes, and it is the update against those four priority themes that I am focussing on today. 4 Priority overarching Projects Development of Information Portal “MindWell” Community Based Mental Health – Service Redesign Children and Families - Perinatal, Children & YP, Transitions Crisis and Urgent Care Data & Intelligence

Key features of the new model Community Based Mental Health Key features of the new model Accessible to all Simple points of access, accessible in primary care, navigated to the right service using common language to understand need & complexity Assessment and records Common triage, brief assessment & holistic assessment will be supported & shared, with consent, across planned pathways supporting the person to tell their story once & build where required. Care & Recovery Planning Person centred, personalised with recovery & goal focused outcomes Includes clear recovery & contingency interventions with personalised early warning signs Includes previously understood & agreed relapse prevention & intervention steps & where these are accessed. Joined-up support Partnership working enhances the system to focus on prevention, earlier intervention & supportive transitions with shared recovery outcomes Where further referral or navigation is planned the person’s transition will be supported.

Principles of the Community Based Mental Health New model Empowering people to seek earlier solutions -principles of self management Ensuring easy access to information & early intervention A strengths & asset based approaches to increase resilience Ensuring physical health issues carry equal importance Enable people to get to the right service first time by providing clarity of the best route to take – by them or as a professional Ensuring early recognition of those with an emerging crisis & fast track to the most appropriate crisis support Improve the outcomes for those with long term needs & conditions by the development of more bespoke packages of support Recognise & value wider determinants impacting on wellbeing & provide appropriate advice, guidance & navigation –non mental health included Interventions are responsive, targeted, build self-reliance & prevent anyone entering the mental health system unnecessarily The whole system is supported to offer coherent, connected, targeted skills & resources

Elements of Primary Care approach to Common Mental Health interventions. MindWelll General Public access to Information Prevention Self management Direct referral to IAPT Professionals access to Advice Clinical tools “I need help now” information and advice at times of crisis Telephone support or face to face within 1 hour of contacting crisis service GP/ Practice team IAPT Screening assessment Step 2 : Common MH CCBT 121 Group Step 3 & 4 Complex Common MH Group & 1:1 IAPT SPA Psychological Stepped care Primary Care MH Liaison and Early Intervention Common triage and brief assessment and intervention Consultation and Decision support Pharmacy support Review of care Development of recovery and resilience plans Transfers of care from specialist MH Annual MH/Physical health review Formulation of a safety plan by primary care liaison Access to crisis response within 2 - 4 hours Denotes MH crisis network response

The new pathway elements – First Steps Building on the principles within 5 Year Forward for mental health - we propose to move to a more integrated whole person approach that recognises the social impact & wider determinants of health. So what will be different in primary care? New “first step” offer in primary care that draws down more integrated specialist expertise targeted at common triage, brief assessment & intervention & purposeful navigation that: Offers choice, accountability & greater focus on preventative primary care interventions. Acknowledges & uses the strengths of the service users & carers, supporting transitions At each stage empowers people to source information & support needed to retain independence & avoid or shorten the use of higher intensity resource.

Pilot sites for new community services LYPFT Primary Care Liaison workers North CCG Chapeltown South & East CCG Beeston & Crossgates West CCG Student Medical Practice

New Pathway Elements Second and Third Steps What will be different in secondary care? Improved second step to navigate to the right place by using a common triage, navigation & brief assessment process – reducing unnecessary rejections, repeat referrals & assessments for all- by drawing on specialist advice or navigating directly to Psychological Treatment or Combined Multidisciplinary Treatment with high intensity intervention which focusses on both clinical & social recovery interventions. Alternative third step for longer term support to be provided in an integrated, co-productive and focused way to improve the service user outcomes – whilst retaining the continuity of support to ensure sustained “recovery” and fast track access when required. The proposed model is one of a tiered approach, with a triage process & itinerate assessment using shared vocabulary and an agreed set of screening tools rather than have one all-encompassing single point of access.

Elements of Combined MDT approach to complex, severe and very severe mental health interventions. Three phases pathway LYPFT SPA Combined MDT approach 1. High Intensity MDT Interventions: Clinical & Social Recovery 121 & Group Programme Social Recovery intervention Partnership packages CPA Case management Access to relapse intervention Review period: 6 – 12 months 2. Transition Intervention to recovery or continuity Graded transition from clinical case management to care management based on goal and recovery Care management Navigation Personalisation 6 months 3. Continuity Low intensity Group Support package Greater than 12/12 Care management 12 months Primary care Relapse Intervention: “Elastic Approach” Open door and rapid access without a new referral to LYPFT for those people supported by continuity approach Robust follow up when people in difficulty – crisis response Shared care plans across agencies including crisis planning Support to engage with Physical health care needs assessments Formulation of a safety plan by referrer including any safeguarding considerations Crisis response 2- 4 hrs

Expected benefits for Service Users & LYPFT Clinicians will focus on providing high intensity interventions for those with complex & combined needs and support partners in Adult Social Care, hospital avoidance and out of area placements Specialist skills focussed on the right part of a persons journey and earlier intervention in social recovery support Working co-productively in partnership across the mental health system on shared recovery outcomes Overall increase in the number of people offered transition support to reach recovery Overall increase in the number of people offered continuity approach with robust support from primary care Overall reduction in repeat & unnecessary referrals to SPA Overall reduction in re-admissions LYPFT Overall reduction in the number of people held at secondary level, especially in CMHTs, to ensure the delivery of intense, complex, interventions is possible in relation to the caseloads Overall reduction in unnecessary Crisis assessments – more targeted response or acute admissions- hospital avoidance

How Crisis & Urgent Mental Health Care Looks Now Crisis and Urgent Care How Crisis & Urgent Mental Health Care Looks Now Emergency services 999 Helplines and NHS 111 999 - YAS and Police 24/7 Social Services Connect Helpline 7/7 18:00 - 02:00 NHS 111 24/7 ASC emergency duty team 24/7 DIAL House 18 - 02 F,S,S,M ,W Walk in Centres 8:00 –20.00 Minor injuries 8.00 – 23.00 Voluntary and 3rd sector agencies General Hospital ED LYPFT MHCT response 1 hour 24/7 GP services LYPFT PALS 9:00 – 17:00 M - F Specialist Mental Health LYPFT Acute Liaison psychiatry 3 hour 24/7 GP M – F 8:00 – 18:00 Out of Hours doctors 24/7 LYPFT SPA, 24/7 LYPFT Crisis response 4 - 8 hours 24/7 CMHT 9:00 – 17:00 M - F Intensive community support 7/7 8 - 21 LYPFT S136 response 0- 3 hours 24/7 LYPFT DCR 6/7 ext hours

Principles of the new C&UC model Mental health crisis and urgent care will have parity of esteem As few a people as possible should be accessing crisis services and repeat use should be minimal. Whichever service is the ‘front door’ the pathway will be clear and consistent. The community crisis pathway will be accessible 24/7 with an emphasis on early intervention available within the local community. There will be a multi-agency needs led response to MH crisis that meets the specific needs of the individual. Defined response times – aligning the crisis & urgent care pathway. The use of IT and information sharing will be maximised. New referrals requiring an ‘Urgent ‘ response will be (where possible) booked into rapid access assessment clinics. There should never be a “bounce back” on any referral.

How Crisis Mental Health Care Looks in the Future Emergency services 999 999 - YAS and Police 24/7 – MH practitioners integrated within DCR’s. YAS clinical advisory service Helplines and NHS 111 Connect Helpline 7/7 18 - 02 NHS 111 24/7 Social Services LYPFT SPA, 24/7 LYPFT PALS 9 – 17 M - F ASC NHS integrated MH Hub DIAL House 18 - 02 F,S,S,M ,W Safe Haven Walk in Centres 8 –20 Minor injuries 8 - 23 Voluntary and 3rd sector agencies General Hospital ED Crisis café Ability to have a same day /next day response GP services LYPFT MHCT response 1 hour 24/7 LYPFT Acute Liaison psychiatry 1 hour 24/7 16+ Specialist Mental Health GP M – F 8 – 18 Out of Hours doctors 24/7 LYPFT Crisis response 1 hour response 24/7 PC MH Wrap Around Liaison and Decision Support ASC emergency duty team 24/7 Intensive community support realigned with the Acute Care Pathway 7/7 8 - 21 LYPFT S136 response 0- 3 hours 24/7

Key features of the new pathway Accessibility Single Point of Access for same day assessments Responsiveness Targeted response times – monitored & reported, where this can’t be met contingency/safety plans will be in place. Individuals will be informed of expected time of assessment. Alternative venues for support Diversion from presenting at ED or local in-patient unit All Age 16 + MH liaison urgent care pathway and crisis café linking to young people’s services Network approach Developing a network of services that can offer a same day/next day response. Addressing complex & challenging needs Crisis should be seen as an opportunity, needs to take a recovery based approach.

MindWell – ‘I need help now' Current Position Progress to date MindWell – ‘I need help now' Primary Care Wrap Around – impact on existing MH SPA Acute Hospital Liaison Pathway – Core 24 for 16+ LYPFT internal service reviews – Older People & Intensive Community Support Integrating with Urgent Care Strategy for the city Established NHS partnerships group; focus is access and quality of care. Secured funding to pilot a ‘crisis café’ to provide an alternative to Emergency Department. Pilot funding to explore how to best meet the needs of frequent callers/attender of crisis, urgent & emergency services. Crisis Network – appetite to develop this now focus on prevention, recovery, resilience and self management. Children & Young People crisis pathway development has commenced

Leeds Maternity Strategy Priority Children and Families Perinatal MH Leeds Maternity Strategy Priority Local Action Review of current pathway for those with mild to moderate MH issues MH Promotion initiatives and link to MindWell Improved partnership working across MH, Midwifery and Health Visiting Leeds has an established Specialist service with Mother & Baby Unit + Community team Aim: To ensure that we support the emotional and mental wellbeing of women who are pregnant and ensure that those who experience any emotional problems during or after their pregnancy are well supported and offered the best care. First 1001 days has massive impact on the mental health of a child Linked to Best Start initiatives Good Start for every baby with early identification and targeted support for vulnerable families in the life of the child.

Transitions We know that coping with change is challenging Community based mental health Primary Care MH Liaison workers Criteria and definitions for pathways keep changing. GPs are not always clear on how to refer a young person not in CAMHS without a clear Care Pathway. 17 year olds referred into the CAMHS service may not  be seen quickly enough by them before coming close to reaching the threshold for adult services, and that cases who are close to 18 years are not prioritised and assessed within CAMHS because they will need to then be  referred to Adult MH Services.  Children and young people who do not meet the threshold for Adult MH services but are too complex for IAPT, and those with a changing diagnosis may be at risk of falling between services. Need for more specific response to Students. We know that coping with change is challenging Two key transitions we are focusing on Primary to secondary school Moving from young person to young adult health transfer between services is only a small part of that process

Crisis and Urgent Care NHS STANDARD CONTRACT: “Transition arrangements should be framed by the following principles………….. 4. Commissioners will need to ensure that appropriate plans are in place for young people in crisis 5. Services should work together in integrated and coordinated ways in the best interests of young people We know there is a good response in hours for Emergency Department Out of hours is more challenging Looking at how we can make best use of the resource we have got What else can we do to avoid a crisis – plans, happy vault etc Good response from those closest to the young person Core 24 pilot in LTHT – LYPFT MH Liaison services extending their reach to 16+. Posts recruited to and relationships being established with C & YP services. MH Crisis café - WY Vanguard funding for up to 20 months. Launched 12th Nov . 16+ criteria. Understanding the data – working group as part of MH framework programme looking at flow through LTHT A & E by self-poisoning and Psychiatric condition. C & YP crisis pathway development Targeted work focussing on Autistic Spectrum Disorder