1. Doing Things Differently ….. Our Journey to Person Centred Mental Health Services in Dorset Becky Aldridge, Chief Executive, Dorset Mental Health Forum Phil Morgan, Lead for Recovery and Social Inclusion, Dorset HealthCare Kath Florey-Saunders, Head of Mental Health and Learning Disabilities, NHS Dorset CCG

2. Dorset Population (all ages): 783,543 Welcome to Dorset

3. SMI prevalence in Dorset CCG locality Population size 2013/14 Population of SMI Register 2013/14 SMI prevalence for locality % SMI prevalence rank 2013/14 East Bournemouth596869091.521 Poole Bay722018031.112 Weymouth & Portland742558041.083 West Dorset409594040.994 Central Bournemouth963268900.925 Poole Central302792740.906 North Bournemouth655905800.887 Mid Dorset426433550.838 Purbeck334052470.749 Poole North520543780.7310 North Dorset860376190.7211 Christchurch542393830.7112 East Dorset702613610.5113 South of England prevalence 0.78 National prevalence 0.86 Source: Wessex Strategic Clinical Networks and Clinical Senate

4. Dorset SMI Register : Total CMHT caseload excluding dementia WD 404 380 WD 404 380 W&P 804 795 W&P 804 795 MD 355 340 MD 355 340 ND 619 809 ND 619 809 ED 361 283 ED 361 283 PB 247 192 PB 247 192 BP&C 4,217 3114 BP&C 4,217 3114

5. The Wellbeing and Recovery Partnership Partnership of lived experience expertise alongside professional expertise. WaRP established May 2009, putting people with lived experience of mental health problems at the heart of service design, training and delivery. Dorset Mental Health Forum – peer run recovery orientated organisation, local employer, strategic partner, advocacy, consultation, representation. Development of local lived experience infrastructure.

6. Our Journey Together …… Establishing buy-in to Wellbeing and Personal Recovery principles as concepts. Building the Recovery contagion. Scale and nature of the task for the organisation. Demonstrating the value and inspiration of lived experience expertise and the successful development of partnership working. Dominance of clinical recovery. Power struggles. The introduction of Peer Specialists and Recovery Education Centre. Change at the periphery but not at the core? Parallel process of recovery journeys of individuals, teams and organisations. Engaging commissioners. CQC and Governance.

7. Poor experiences being reported Lack of clinical work force and misallocation Current provision/service configuration not meeting needs Inequity of provision across the county Services set up to work in isolation We need a financially viable and sustainable services fit for the future All services not focussed on recovery We need to ensure services are provided as close to home as possible where clinically viable Why did we start this review?

8. Urban Areas of Dorset Generally higher levels of Serious Mental Illness e.g. psychotic illness Higher caseload numbers Generally higher referral rates to Crisis Resolution Home Treatment Higher admission rates and readmission rates Generally higher levels of deprivation than in more rural areas

9. Rural areas of Dorset Generally lower levels Psychotic illness Lower caseload numbers Generally fewer referrals to Crisis Resolution Home Treatment Lower admission rates Generally higher levels of depressive illness in CMHT caseloads Generally lower levels of deprivation than in more urban areas

10. Coproduced commissioning We need a commissioning system that: Is dynamic and iterative Recognises assets & builds on local resources Applies local insight and data Builds collaboration Opens opportunities for innovation Takes a longer term view We need a commissioning system that: Is dynamic and iterative Recognises assets & builds on local resources Applies local insight and data Builds collaboration Opens opportunities for innovation Takes a longer term view Source: New Economics Foundation

11. How? View Seeking Options Development NHS Assurance Consultation Implementation Coproduction Coproduction Specialist advice: ImRoc and NDTi and Benchmarking

12. 906 responses from… 22 Public events 17 groups or existing meetings Inpatient views gathered by Peer Specialists 2 Staff events and 17 staff meetings Online survey and postcards Which has given us 3,355 comments 545 comments about what works well 1,572 comments about what works less well 1,238 comments about ways to improve View Seeking: Co-produced plan

13. Clear parameters at the start The new options must be achievable in the current budget 2 strategic in-patient sites would remain Outcomes as defined by people who access services Reflect the views of people who use services and their carers Services working to the principle of recovery Clinical services staffed in a safe, sustainable way NHS Mandate NICE concordant services (not all services) NHS quality standards to be reflected in all proposed models of care Statutory responsibilities

14. People’s knowledge and experience first; roles second Innovation days: helping people to understand the bigger picture Larger co-production groups set up to address local issues: urban and rural Service user cross- checks days Co-production group No ‘silly’ questions and ‘real’ environment Dedication and commitment were/are key Co-produced models

15. Objectives Consistency There are significant differences in the level, scope and style of services across the county Accessibility Across Dorset, people are finding it hard to access services that can help them Community Facing There is a disengagement of local communities from mental health issues Style and Culture The style of service provision (in both health and social care) does always not lend itself to person centred recovery-focused approach Objectives

16. Easier access to MH services Earlier access to MH services Better services when in crisis Only telling the story once A place of safety Support from Peers What we’ve heard

17. From ‘what’s the matter with you’, to ‘what matters to you’…… Paul Siebenthal, Senior Peer, Dorset Mental Health Forum

18. We’re thinking…. Urban Larger teams to provide a more responsive workforce Crisis resource provided as part of large urban area Living room – providing access and support to MH services for the whole community Link with GP practices Rural Tailor making resources to the local area CPN and Peer workers in local GP Practices West Crisis team will continue to support people needing enhanced support. Build capacity in local 3rd Sector and Community Groups to support living room and wellbeing centre style functions

19. We’re thinking…. Wellbeing, advice and support Centre Outward facing service Recovery and Education Centre (REC) Library of resources Therapeutic sessions Supported by CPN, Psychologists, Occupational Therapists, Peers and third Sector services. Community Navigators Housing, employment, and benefits support Support for carers

20. Peer Support and Community Navigation Supporting people with self-management plans including ‘my crisis plan’ and empowering people to have input into their own care planning Help people navigate mental health services and their local community resources. Peers may see people for 4-10 weeks to complete this work and promote uptake in community participation, self management and participation in CPA reviews and care planning Community navigation also helps support people to access their right to care under the care act 2014 We’re thinking….

21. Personalised Health Budgets to allow choice o PHBs have a role for people with complex needs o Could support around transport in rural areas. Innovative use of Technology within CMHTs and HTT o Telehealth o Skype/Facetime o on-line library for mental health resources for service users, GPs and mental health staff Shared responsibility of accessing services o My safety plan We're Thinking……

22. What we have learned Messy but brave Great sense of accountability Shared humanity Consistency of attendees Timing – it takes a lot longer Expectations Resourcing Business process helps Dr. Paul French: reflections

23. Thank You …..