What is being done about mental health services?

Your questions, answered.

Many of you have sent questions in after hearing about our report that looked at how people feel as you wanted to know more about what is being done. Here are the answers:

• Before I moved here I understood there were plans to build a mental health facility in Harrogate. Is this completely off the table? Mental health patients who are often vulnerable currently have to be admitted to York or even Scarborough and this is very difficult for them, and it does prevent regular visiting from relatives.

We understand it can be really difficult for people, as well as their families and carers, when they are admitted to hospital. There was a consultation in 2018 which involved patients, families and carers, the voluntary and community services sector and colleagues and staff across health and social care. This was to identify what a future model of sustainable mental health care should look like.

Options for an inpatient unit in Harrogate were explored. However, it was decided that further investment in community based, mental health care, with inpatient provision in a new, modern facility in York, was the option that allowed for maximum patient safety and provided the best possible patient experience.

The plans invested £500,000 a year into community services, to give people the right care, at the right place and the right time. The aim was to support people in the local community and reduce the need for hospital admission.

This remains the premise of our community mental health transformation work. Where possible we want to keep people out of hospital and support them to live well in their local communities.

• What is meant by 'person-centred passports'?

The passports might explain how they like to be communicated with, what works for them and what doesn’t.

It’s about understanding the person and supporting them in the way they want to be supported, no matter who they deal with.

They can also prevent people from having to repeat their stories, which, in turn supports safety and people’s experience.

• What new provision is coming about as a result of this report? The majority of these have been discussed and implemented over the past two years.

The current transformation is a three-year programme to improve access to mental health services and developments have been planned in local communities to meet their specific needs. Over the next year we will recruit more specialist practitioners to work in GP practices to increase and speed up access to services. The biggest change over the next year and coming years will be the development of the new community mental health hubs that will bring partners together to work closer and support people in the local community. These will be shaped by the outcome of this report.

• I am hearing a great deal of NHS-speak of provider-centric aspirations and rhetoric.  I am hearing very little if anything of what patients and the public think of current services.  Are patients happy or unhappy?

Reponses were a mix of happy and unhappy.

The aim of the report was to gather people’s views and opinions of current support and services. You can read the findings of the report and the views shared here  https://www.healthwatchnorthyorkshire.co.uk/report/2023-07-25/publics-experience-mental-health-services . In addition, the report has also outlined a series of recommendations as well as responses from the local mental health alliance, as to how improvements will be made.

• Will users of services and/ or their carers be able to use the anonymous whistle blowing system?

People using services and their carers will need to follow the official concerns process for the relevant organisations.

• Sharing of information to reduce the trauma of repeating the story is vital, but if note taking is poor it can pass on iterated/skewed opinions. Do we need to ensure there is training on this to ensure there is no unintentional worsening of inequalities?

All Tees Esk and Wear Valleys NHS Foundation Trust staff are trained to understand the expected standards of information recording and the regulations around information recording and sharing. Any staff outside of the trust using shared systems will receive appropriate training from the information system provider.

• Being a member of the Armed Forces is now a protected characteristic under the Equalities Act - will staff be made aware of this, and will training be offered to staff to understand the unique environment these people operate in?

Tees Esk and Wear Valleys NHS Foundation Trust offer services for armed forces personnel and veterans through the OpCourage provider collaborative. Access to the services is signposted through the trust website: https://www.tewv.nhs.uk/services/op-courage/

Tees Esk and Wear Valleys NHS Foundation Trust has also signed the Armed Forces Covenant and holds silver status for the Veterans Aware employer recognition (Veterans Covenant Healthcare Alliance).

The Trust has an active armed forces staff network that provides support to staff members who are veterans, reservists, or members of the armed forces community. They also contribute to the vision and planning for how the trust develops support to the armed forces community.

Through their staff armed forces network the Trust has started encouraging and promoting the role of armed forces champions, who will help promote the needs of armed forces communities within their teams.

The Trust is also working to embed recognition of the needs of armed forces staff service users, families and veterans within their induction processes.

• What efforts of projects are available to help people with mental health issues get into work or support them whilst working?

The Individual Placement and Support (IPS) service supports adults who have severe mental health difficulties, are receiving care from our community teams, and who want to work, to move into paid employment.

IPS provides people with the right support to develop employability skills including looking at how to apply for jobs, how to create a CV, interview techniques and with work-related area including benefit calculations and budgeting.

The service also involves intensive, individual support, and rapid job search support followed by placement into paid employment followed up by unlimited in-work support for both the individual and their employer. The team has a wealth of experience of liaising with employers to help people experiencing mental health conditions or with other needs find suitable work opportunities.

More information available at - Individual Placement and Support (IPS) service for adults - Tees Esk and Wear Valley NHS Foundation Trust (tewv.nhs.uk)

• The distance people have to travel for inpatient treatment is a problem for many individuals.

We recognise that distance can be a factor for many people and where possible we always try to support people in their own homes in the first instance. We’d encourage people to speak to their care team if they are experiencing any problems so we can discuss in more detail with them.

• My daughter has autism spectrum disorder and mental health problems. There seems to be a lack of support to combine the two (which are common in both children and adults).
• You get the autism spectrum disorder diagnosis then zero help/support where therapeutic support is vital for understanding and growth. Because of this, its causing mental health concerns.
• Child and Adolescent Mental Health Services (CAMHS) change their support workers too quickly or wont travel to rural areas so children and adults with autism cannot 'connect' with the person working with them which is vital to their care.

There are a number of different organisations that provide assessment and diagnosis services for young people with signs of autism spectrum disorder across North Yorkshire and York, depending on where people live.

• York and Selby – Tees Esk and Wear Valleys NHS Foundation Trust
• Scarborough, Whitby, Ryedale – The Tuke Centre
• Hambleton and Richmondshire – Northallerton Child Development Centre
• Harrogate and District NHS Foundation Trust - Children’s Services

Most of the support for young people who have been diagnosed with is provided by the voluntary sector or other primary care level service.

Where a young person presents with a mental health concern in addition to their autism spectrum disorder diagnosis, they will be assessed to determine whether they should be supported in the community, voluntary and social enterprise or school mental health services or whether a referral to secondary child and adolescent mental health services (CAMHS) is required.

It’s recognised that this is quite a fragmented approach and commissioners and partners are currently looking at how services could be linked and improved to provide better support and experience for families and young people.

Young people are generally seen by TEWV CAMHS services in a clinic. We recognise that those living in rural areas may have transport challenges and we would always encourage people to speak with a member of the team or service to see what support is available for attending appointments.

We also understand that changes in a person’s care team, especially that of a young people can be difficult. We always try to minimise disruption best we can.  It’s very important that the people we care for feel able to connect with and comfortable with their care team. We would always encourage anyone with any concerns to raise this with their care team so that we can support them in the best way possible.

• Can you give any examples of people choosing and controlling their support? What are the main barriers to people taking more control of their care and support?

Where possible people are offered as much choice and control in how they receive their services, particularly through co-produced individualised care planning.  Choice and control will increase further as the new community mental health hubs are developed as people will be linked to a range of community-based services to provide or compliment their treatment.

• Is there funding attached to this report to deliver against the outcomes? And to fund local based initiatives?

There is initial NHS England funding attached to the Community Mental Health Transformation for the first five years. This has over the last couple of years enabled us to take the first steps in transforming the way we work together and introducing innovative new approaches to how we support local people.

However, ultimately this is a system-wide programme and will require investment, support and commitment from a wide variety of organisations over the coming years in order to continue to drive forward the change necessary.

• I am a community support worker in the rural Esk Valley villages. We support people with serious mental illness to 'wait well'. The problem we have is data sharing agreements. With the community mental health team - we see these people regularly; they trust us and share more information and also appreciate the less 'clinical' approach.

We recognise the complexities of data sharing. This is a significant challenge within the transformation programme and one that we are working to address. We already have a number of data sharing arrangements between providers of care in North Yorkshire.  We will need to monitor and review these arrangements as new services and relationships are formed as services develop over the next few years.

• Will there be enough staff (particularly trained psychologists) to offer psychological support (cognitive behavioural therapy (CBT) or dialectical behaviour therapy (DBT) to people with severe and enduring mental illness?

The transformation programme is focused on increasing access to a range of psychological interventions that are delivered by a range of practitioners across primary and secondary care.  We have already employed a significant number of new specialist practitioners (psychologists, nurses, occupational therapists etc) in primary and secondary care and we are exploring the potential of new and different roles. 

• Was there any place-based variation in the published results or the data behind the report?

The decision was made to structure the report around the key themes that emerged from all the data as a whole as when we looked through the data there were no huge differences based on district or information type (whether the information came from the survey, focus groups or interviews)- the key themes from the data were consistent across the different Places, hence why we structured the report in the way we did.

• The benchmark distance for maximum travel to treatment is 30 miles. This benchmark is frequently broken in North Yorkshire especially.

The new community mental health hubs over the next few years will increase access to mental health services within the communities where people live.

• How are people supported to travel to and from work?

Access to work may be a funding stream that can be utilised to support people with travel to and from work who have a disability/mental health condition. There is a criteria, for more information look at the direct.gov website.

This may be something considered on an individual basis as part of their care planning.