Benefits of the proposals
Benefits of the proposed developments are:
- An increase in mental health beds which will reduce the need to place people outside of Dorset
- The provision of the new services will enable people to access support and treatment in the least restrictive
- More choice about how to access services
- Improved access to services at weekends and evening that include safe spaces in towns and rural areas so that people get support earlier
- Self-referral to the safe spaces
- Help people to avoid crisis and support people if they are experiencing a crisis
- The location of beds will be where the demand it
- More support from people who have lived experience of mental illness and personal understanding of serious mental illness
- Enable people who have been supported by community mental health teams to refer themselves back to the team if they feel they need support
What is the Mental Health Acute Care Pathway?
Mental health acute care is that type of care needed when a person is experiencing any type of crisis in their mental health. The Mental Health Acute Care pathway consists of all the mental health services that work with people who have a serious mental illness and who sometimes need support, care and treatment when things are starting to go wrong or when they are experiencing mental health crisis.
What services are included in the Acute Care Pathway?
The services included are:
- Community Mental Health Teams for Adults (18 +) and Older People (65+)
- Crisis Resolution Home Treatment Teams
- Street Triage Service
- Psychiatric Liaison Service
- Inpatient Services
- Local Authority Out of Hours Service
- Weymouth Recovery House (Recovery beds)
For information about these services please visit the Dorset HeatlhCare website.
Why was the review undertaken?
The review was undertaken because people who use MH services were telling us that existing services were not meeting their needs. People who work in MH services also told us that services were not working as well as they could to meet service users’ needs partly because the demand on services had risen which made them less able to respond when people were experiencing a mental health crisis.
Who are the ACP Project Team?
The project team has changed and developed to meet the requirements of the review.
Stage one the project team consisted of people who have access to business information and data, who were able to identify and analyse current services, where there is need for services and how they are resourced.
Stage two was the view seeking stage and the team consisted of people who use services, carers, mental health and other professionals and
Stage three was the modelling stage and the project team grew to about 72 people in all, there was a mix of people who use services, carers, staff, service managers, commissioners and people from the voluntary sector, the police and the ambulance service.
Is the review about saving money or cutting services?
The review is not about saving money or cutting services it is about making sure that existing money is used to the best effect. The review is about improving services and making sure that they are in the right place to meet the need. The changes aim to help people in mental health crisis to access support and treatment as quickly as possible and as near to home as possible and to improve equity of access to services. The review highlighted the need for a range of new services and the consultation document describes the proposed additions to the community and inpatient services.
How was the review carried out?
The review was carried out in three stages which included:
- Stage one: needs and data analysis which looked at current and future demand for mental health acute care services
- Stage two: seeking the views of people who use and provide the services
- Stage three: ‘model development’ where the options for how services might be improved were discussed and developed
- Stage 4: Public consultation (1 February 2017-31 March 2017)
What are the bed usage figures in each area?
The current bed numbers are seen in table below (this does not include Psychiatric Intensive Care Units).
|North and West||South and East||Total|
Dorset has under the national average number of beds Dorset has approximately 16.1 beds per 100,000 head of population vs a median position of 19.0 beds per 100,000 head of population nationally.
The bed usage across the county shows that people in the east of the county often occupy beds in the west and vice versa. Around 67% of people with a serious mental illness live in the east of the county and over 40% of the beds in the west are used by people from the east of the county.
What are the Serious Mental Illness (SMI) prevalence rates?
GPs have a register for people with a Serious Mental Illness (SMI). Based on the information on the SMI Register, Dorset has an SMI prevalence rate that is has a higher than national average and some areas of Dorset are significantly higher. The national rate is 0.86 % and Dorset is 0.90%. This is calculated on the number people who are on the SMI register as a percentage of the population size. There are 13 localities in Dorset and the table below shows the localities prevalence:
|Weymouth & Portland||74,255||804||1.08|
How was the view seeking carried out?
The view seeking was undertaken across Dorset and aimed to involve as many people who use or work in mental health services as possible with the following results:
906 responses for
- 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
The results were analysed and a report was written by Bournemouth University. The results alongside the needs analysis were the basis for the development of the proposals. Over 300 people from the respondents remain on our distribution list as they wanted to stay involved/ up to date on the project.
How did you involve people who use mental health services in the review?
The review was coproduced, which is a way of working together that involves as many interested parties as possible. Throughout the review people have worked together to consider and create options and collectively make decisions. This way of working means that power and decision making is shared between all the participants. It assumes that everyone involved has a contribution to make.
The MH ACP’s coproduction teams included managers, staff and people who use services and carers. Thirty percent of the groups’ representatives had lived experience of mental illness.
The coproduction team also worked with two independent expert organisations to facilitate the process and introduce best practice and innovation from around the world, these were: Implementing Recovery through Organisational Change (ImROC) and the National Development Team for inclusion (NDTi)
How did you involve carers in the review?
The MH ACP’s coproduction team included people who use services and carers. There were also two workshops specifically for service users and carers to scrutinise and challenge all the proposals as they were being developed and input further ideas for the coproduction team to consider.
Have the decisions already been made?
No final decisions have been made and all the options in the consultation are possible. The views provided through the public consultation will be used to help the CCG make the final decision.
How will the proposals improve acute mental health care?
The proposals will improve acute mental health care by:
- Increasing the range of choice for people who experience crisis in their mental health
- Ensuring that people are able to refer themselves to services when they feel that they are heading towards a crisis
- Ensuring that as many people as possible are able to access safe spaces within 25 minutes off peak by car
- Increasing the number of mental health beds to meet current and future demand
Will the proposals improve access to inpatient services?
As part of the ACP review the intention is to make sure that the number of beds meets the level and location of demand. It was identified that Dorset requires an additional 16 beds to meet demand and this is reflected in the proposals. There is also the need to ensure that all services are sustainable and safe. The proposals also aim to ensure that people are able to be in a bed as near to home as possible. To make this happen there are several stages:
Stage 1: The proposal is to increase the number of acute inpatient beds, Forston by 4 beds to 29 and add a further 12 to St Ann’s.
Stage 2: The proposal includes closing the Linden unit and transferring the 15 Linden beds to St Ann’s. The relocation of the beds ensures that there is the right number of beds to meet the demand.
The consultation proposals will make sure that people are able to have support earlier to prevent crisis and reduce the need for hospital admissions. The Linden Unit will not close immediately because it will be important to make sure that the other proposed changes are made and are working first.
What services will be added to the Acute Care Pathway?
The proposals aim to enhance existing MH Acute Care with additional services. These are described briefly below:
- Retreats which are places that people will be able to visit or refer themselves to when things are starting to go wrong or to help prevent things from going wrong. The will be located with a Community Mental Health Team and people will be able to see a MH professional and /or a peer support worker so that they get the right type of help when it is needed. The Retreats will be open 4pm-12am Monday to Thursday and 6pm -2am Friday to Sunday.
- Community Front Rooms are also safe places to go when things start to go wrong or to help prevent things from going wrong. People will be able to refer themselves and visit and have support from a MH professional and or a peer support worker. These will not be located with a Community mental health team but developed in local areas in community settings. Community Front Rooms will be open 3pm-11pm Thursday to Sunday
- The Connection will enhance the current Crisis Line at peak times. People will be able to call the telephone line or use Skype for face to face conversation or email and have protected time with a MH professional and/or peer support worker to help them through periods of crisis. The service will be staffed to provide crisis assessment in the community within a 4 hour timeframe.
- Additional inpatient beds to meet the needs of Dorset patients who require a hospital admission.
How soon will changes be made after the consultation?
Once the consultation is closed the views will be analysed and final decisions made. Final agreement will be given by the CCG’s Governing Body scheduled for 21 July 2017. Once final agreement has been given, the implementation process will commence.
The proposals show that more people should be supported by in primary care, for example low level depression. How will primary care be supported to do this?
When a person is supported by the community mental health teams they remain registered with their GP. There are currently approximately 300 people who have mild to moderate depressive illness who are treated and supported by a CMHT who could be supported appropriately by primary care with access to the Steps to Well Being Service.
The number of people GPs have on their registers will not increase because of the proposed changes.
To enable primary care to support these people, Dorset HealthCare will be putting several things in place to support the GPs in their role.
- Regular support and advice from psychiatrists to GPs as necessary
- In reach from psychiatric nursing staff into GP surgeries for easy access to mental health expertise
- Advice and guidance and shared care protocols will be developed
- Where a patient has been open to a CMHT they will be able to re-refer themselves when they need additional support from the MH teams.
Why close the Linden Unit / why is there no option to keep it open?
The proposal to close the Linden unit is based on several key issues.
- It is an isolated unit and is not the best environment for this service as it is on two floors. It does not have the same access to additional staff and support as the other wards at Forston or St Ann’s, which also means that not all people requiring an admission can be admitted to the unit. We need to make sure that all of our in-patient sites are able to admit anyone who requires admission.
- Access to the Linden unit only enables 49.9% of Dorset’s prevalent population to access it within 33 miles of home where as Forston is accessible to 89.3% and St Ann’s 87.8% of the prevalent population.
- As an isolated unit there are challenges in staff recruitment and retention. To ensure a sustainable skilled workforce into the future having two strategic in-patient sites provides the best opportunities.
Where will the community front rooms be located?
The coproduction groups discussed access for people in the rural areas and through discussions we found out that people feel most isolated in the evenings and weekends. The location of the retreats will aim to provide the best access possible for people in rural areas, within the available budget. We have modelled this on the prevalent population being able to access either a retreat or a community front room by car within 25 minutes during off peak times.
If a Retreat is situated in Dorchester, the potential Community Front Room locations are Bridport, Sturminster Newton and Wareham. If the Retreat is in Weymouth the potential locations of the Community Front Rooms are Bridport, Sturminster Newton and Swanage. The Retreat in Bournemouth would enable people from Bournemouth and Poole to access it within the 25 minute timeframe.
How will people be able to access crisis assessment overnight?
The crisis response will continue to operate 24/7. The Connection would be the contact point after 10pm and if someone needs an urgent assessment, they would be assessed within the mandated 4 hour window.
The Retreats will be open 4pm-12am Monday to Thursday and 6pm-2am Friday to Sunday for support and assessment.
There is also a 24 hour psychiatric liaison service operating in the three main acute hospitals in Dorset.
Why is the Mental Health Acute Care Pathway consultation shorter than the Clinical Services Review consultation?
NHS Dorset CCG follows best practice and national guidance on public consultation.
The national guidance was revised in January 2016. It does not set prescriptive timescales but makes it clear that the period set for public consultation should be proportionate to the matter under consideration. It states:
Consultations should last for a proportionate amount of time and should be based on the level of legal advice required, and take into account the nature and impact of the proposal. Consulting for too long will unnecessarily delay policy development. Consulting too quickly will not give enough time for consideration and will reduce the quality of responses. You can read more here: bit.ly/2l7Brnp
The Mental Health Acute Care Pathway (MHACP) consultation focusses on one part of the whole mental health system – people with a serious mental illness – not the whole system (unlike Clinical Services Review which covers both acute and community services across Dorset). The number of people in Dorset with a serious mental illness is currently around 7,000.
The consultation is shorter in time but a detailed plan for engagement has been designed to ensure quality interaction and communication with the public. This includes 17 events we’re hosting around Dorset, which is proportionate with the number of people currently and potentially affected.
Our consultation plan was reviewed by NHS England who scrutinised the plan and approved the two month period.