1. North Tyneside - Improving outcomes for people experiencing mental health crisis Jacqui Old Director of Adult Social Services November 2014

2. Life expectancy & disability-free life expectancy & premature mortality rates
Issues of the north east are well understood and rehearsed.
All understand the landscape of rising demand decreasing resources.
Hold up the mirror of where we are
And the issue of the scale of the problem we face
Hard for many people to know and understand their inequalities for they live with them day in day out.
Don`t underestimate the impact of debt on health/wellbeing
Crisis care is perhaps the gap between physical health and mental health is most stark.”
We know the average age of death for someone who is homeless is 42yrs
We know that homeless people behaviour is more likely to change if they are supported by other people who have been homeless Don’t underestmate the importance of peers.
Instead of asking what is the matter with you : what matters to you.
Need to build on the assets of the north and build on resilience

3. Context Children / Adult cover 65% of council budget
N. East - By 17/ % reduction resources
North East highest level of decrease in spending power
Worrying signs that gap could widen - impact of recession
Flaw in public spending is shown - NHS as an island
Local government & Benefits seen as easy for cuts
Consequences for NHS.
Trusts finances/ operational sustainability over next 5 yrs
Need for more granular information on the impact of austerity
Increasing divergence on health inequlaities
Opportunity to put prevention at the heart
Make people a partner in wellbeing
Tremendous sense of ambition and a case of doing it now.
promoting living wage
joint spending power to promote good employment
improving quality and affordability of housing
trusts are concerned about finances and operational sustainability over next 5 years.
. if funding continues what will implications for nhs. cant ignore questions. the flaw in public spending is shown as nhs as island separate sees local gov and benefits as easy for cuts. dangerous consequences for nhs.

4. Challenges in North Tyneside
Availability and access to
Place of safety beds
Joint training front line police and mental health practitioners
Supported Housing Offer
Parallel Tracks
Separateness of each imitative
Excess use of police cells
for people with mental health problems
Cliff-edge of lost support as children and young people with mental health needs reach the age of 18
Out of hour access to crisis beds for young people (17+)
Transportation of people with mental health problems in Crisis
ltc need for care is rising. reaching end of capacity to deliver further. any saving outstripped by growing numbers of those needing care.
intentions good but complex
it pays to be up front of where we are and honest.
made al ist of things that cannot be changed and those that can and surprisingly the cannot was a short list.
prevention and integration are key.

5. Emergent Thinking Urgent and Emergency Access to Crisis Care
Quality of Treatment & Care
Service data to track and assure
Beds readily available
Single commissioning budget
Access to support before crisis
Universal single point of access
- Thresholds, Gateways
Universal Services
Information and advice
Primary care
Recovery and staying well
- Early Intervention/Prevention
- Information and Advice
- Care and Connect
Urgent and Emergency Access to Crisis Care
136 Pathway /Crisis team/ MEAM
- Improved services for those with co-existing mental health and substance misuse issues
Chronically excluded from services
AMPHS -
4 Themes
Access to support before crisis point
Urgent and emergency access to crisis care
The right quality of treatment and care when in crisis
Recovery and staying well and preventing future crises

6. Access to support before crisis point
Matching local need with a suitable range of services
Improving mental health crisis services
Ensuring the right numbers of high quality staff
Improved partnership working in X locality
Improve access to support via primary care
Barker report landed without much of ripple debate changer. extensoin of nhs move from means testing no political agreement on it but can aspire to this.

7. Access to support before crisis point
Help this person to recover, become more independent and reduce care needs
Maximise ways to promote prime interventions to support recovery
Develop a clear political model of care which has promoting independence for citizens and find some of the care solutions from communities families and individuals
get off the treadmill and re-engage your best friend is your community listen to what people are asking for and listen again use common sense and lived experience step away from control

8. Access to support before crisis point
Phone for help- divert you to menu of options
Improve access to support via primary care
Awareness of local mental health and substance misuse services and how to engage them
Focus on outcomes from our interventions
New compact with community
Work with ph to make every contact count
PCP
move from medical model of support to social model of support.
big challenge of today is challenge of ageing, mental health and obesity, lifestyle.
Wont find the solution by running medical model.
Link health to housing, environment etc. marmott report.

9. 2. Recovery and staying well
Divert people away from formal care  through good info and advice services
Develop the right level of preventative interventions in order to help people at the right time
Service model of the future will be radically different
Changing the model of care from one of paternalism and protective interventions to one which promotes independence and manage risk with customers
Instead of asking what is the matter with you - what matters to you.
Carers
Joint planning for prevention of crises

10. 2.Recovery and Staying Well
We will not assess person in crisis until we have given them the opportunity to recover/rehab
Never make long term decision in middle of crisis
Develop the right set of interventions that prevent long term placement
What is the practice and interventions that work
Is Reablement /recovery delivering cost effective outcomes ?

11. 3.Urgent & emergency access in crisis
136 Pathway
Process mapping workshops held with key partners across all areas
Issues raised in the mapping workshops brought together in partnership meetings to agree actions required.
MEAM
Improved services for co-existing mental health substance misuse issues
Getting costs down before - not building costs up
Meam
The pilot was established as it was recognised that in every local area people with multiple needs and exclusions are living chaotic lives and facing premature death because as a society we fail to understand and coordinate the support they need.
Evidence shows that by working together local services can develop coordinated interventions that can transform lives.
In North Tyneside there is an operational panel that meets every two weeks. It includes representation from Adult Social Care, Probation, Housing, North Tyneside Recovery Partnership Stonham Depaul and Thirteen. Others agencies are invited if the needs of the individual indicate they would be able to support the individual. The panel identify support that can be provided using existing resources in North Tyneside. This is often achieved by services working in a more flexible way to meet individual needs.
So far there have been twenty cases discussed at the panel.
Most of the cases have had a housing need. This can be particularly significant if someone is homeless or sofa surfing when trying to arrange other support such as mental health support or drug and alcohol treatment. It is difficult to complete or even prioritise treatment or support if you do not know where you are going to sleep that night.
In North Tyneside we are working slightly differently to some other areas. The MEAM co-ordinator has a predominately co-ordination role and the case responsibility remains with the professional agency who has submitted the referral. If this is not appropriate, another agency is identified to be the keyworker. This allows an ongoing MEAM service.
The MEAM strategic board guides the operational work. It will analysis the evidence from the pilot and identify necessary changes to systems to embed the learning from the pilot across all the partners. The operational panel highlights gaps and issues in services to the board to inform this.
136 Pathway
Address improvements in early intervention and mental health crisis services Undertaken mapping led by CCG to review the existing Sec 136 pathway, currently analysing findings Multi agency involvement Inform model going forward – taking into consideration and working with partners within NTW who are piloting closer working with police based on a street triage model Make the model a local one
Concordat progress so far
Process mapping workshops held with key partners across all areas: Social Care, Police, Ambulance / Transport, A&E providers, Crisis Teams.
Issues raised in the mapping workshops will be brought together in partnership meetings to agree actions required.
On track to sign up to declaration by the end of December 2014 and action plan by the end of March.

12. 4. Quality of Treatment and Care
Commissioning team with eye on the ball and team who are much more forensic
Commissioning that allows for beds to be readily and locally available in response to urgent need
Commissioning provision for under 18 year olds that ensures local provision for young people in urgent need
Single budget- commissioning for adults.
Proper sense of partnership.
Review police use of places of safety under the Mental Health Act 1983 and results of local monitoring
Service User/Patient safety and safeguarding
Staff safety
Primary care response
Team that develops a subtlety to ensure money is well spent with right intervention
start to commission for whole child and adult.
why does it not happen . no public body has whole responsibility. still tendency not to invest saying not responsibility. activity tariff in nhs
Need to create year of care tariff to have combination of health and socail care staff. no one has responsibility for whole person. bring physical mental and socaial into one system.
strengthen peoples rights to the system for single point of contact across system, right to carers respite, right to be a home, right to sign off support plan. stornger rights in nhs constitution. what is people entitlement to care. local job is the how. go with the grainas oppose against it.

13. 4. Quality of Treatment and Care
Effective joint performance framework – Create system that gives clarity and purpose
Sufficient amounts of service data info that we can track and provide assurance that services are working
Build intelligence so we have an informed approach to strategic and operational decision making
Response Timescales/Esculation/Bed avaiability/ AMHPs
Focused on managing demand and cost- Know weekly if they are meeting need
Timescales for health and social care services to respond to police
Police officer training
Timeliness of assessments
Understanding of roles and responsibilities and arrangements for escalation
changing cultures and transforming as important on money
easy to say workforce and fall into trap of not thinking of component parts.

14. So where we have got to ?
A shared perspective - joint statement about how public services will work together
Agreed set of principles and good practice
Switched into different gear. Not the solution but good focus and start.
Recognition that we can`t do this in isolation – interdependency
Systems leadership
Thank-you