1. What is working well What needs to work well Set up in West Cheshire examples

2. What we Have Primary Care Primary Care Mental Health Team now single referral point for mental health. Secondary Care Mental Health Drug and Alcohol Service

3. Primary Care Team-GP Practice Nurse, HealthVisitor, Community Matron Mild to moderate mental health problems/primary care mental health team Severe and enduring mental illness/secondary psychiatric care Alcohol dependence, high risk and increasing risk

4. Problems Getting a meaningful assesment in some who is drinking Being able to deliver treatment to someone who is drinking Mechanical/practical Psycholgical/pharmacological

5. Extras in West Cheshire Homeless Practice-has a PCMHT CPN and a counsellor who is also healthcare assistant. Hospital Alcohol Liaison and Engagement Team-able to work closely with Liaison Psychiatry PCMHT and GPs D+A workers attend PCMHT team meetings Training 2 IAPT high intensity workers- opened up liaison with PCMHT better and will be a resource for delivering psycholigical therapy to D+A service and treatment for dependence in PCMHT. Dual Diagnosis Team in Drug and Alcohol service who have always worked with CMHTs but are now doing so more closely

6. Example 1 50 year old lady. ED presentation-suicidal after long Hx of alcohol leading to social losses Joint assessment with Liaison Able to help to sobriety Has appt with Liaison consultant for assesment of mental state.

7. Example 2 48 year old Identified as one of top 50 attenders at ED with alcohol issues. Joint appointments with PCMHT and GP Helped to reduce alcohol Now assesment more possible re possible dementia

8. Example 3 48 year old dramatic gesture Seen in ED and alcohol an issue Joint assessment with PCMHT Alcohol reduced and counselling and medication started Making progress

9. Example 4 42 year old Diagnosis of schozoaffective disorder Difficulty working with him Long process of dual diagnosis working with him has reduced his alcohol leading to better compliance with medication and CMHT

10. Example 5 49 year old Long history of alcohol issues Presenting at GPs drunk and threatening suicide. Police involved several times. Many attempts to engage with alcohol and mental health Eventual admission section 2. diagnosis bipolar Reduction in alcohol and better compliance with CMHT and medication Improving health, no more crisis presentations. Still some way to go.

11. Example 6 45 year old lady with long drug and alcohol dependence. Domestic abuse. Physical health. Admitted medical wards reduced and stopped alcohol Now reducing methadone and wanting to address sequelae to her domestic abuse. Also anxiety reducing and considering a change to antipsychotic started in prison but never formally assessed due to her dependence issues

12. Improvement in services But Time is needed for them to work at right time and right place.