Councillors and committees
Adult Mental Health Services and progress with the Suicide Prevention and Self Harm plans
To note the report, scrutinise and make any recommendations
The Panel had agreed to consider progress with the Suicide Prevention and Self-Harm plans in response to a letter dated 4 April 2017 from Dr Sarah Wollaston, Chair of the Parliamentary Health Committee, to Chairs of Health Overview and Scrutiny Committees. The Committee’s third progress report “Preventing suicide in England” was published in January 2017. One of the recommendations was that “health overview and scrutiny committees should also be involved in ensuring effective implementation of local authorities’ plans. This should be established as a key role of these committees”.
The officer report provided detailed information about two recent Kingston Strategies, firstly the Kingston Suicide Prevention strategy (launched in 2016) and secondly, the Thrive Kingston mental health strategy for adults and prevention for all ages (launched in 2017). The report also provided the context of these local strategies which include the NHS Five Year Forward View for mental health (2014) (FYFVMH), plus two Concordats for better mental health programme and for crisis care (Appendix 5).
Thrive Kingston is the local strategy for local mental health services for the whole of the Kingston community and provides the local approach to the wider Thrive London strategy. It was co-produced with over 200 people in the Kingston community including people with mental health conditions, their friends, carers and parents as well as health and social care professionals, commissioners and representatives of voluntary organisations (see Appendix 1). An update on the progress with implementation of the strategy was presented in Appendix 2.
In relation to suicide there are approximately ten cases each year in Kingston and this can fluctuate slightly. Due to the time taken for Coroners’ verdicts there is a time lag in the availability of confirmed data. The suicide rate per 100k population in Kingston broadly follows the national average. (Across London there are 4 - 5 suicides per week). Details of key performance indicators for suicide and related risk factors were presented in Appendix 3.
Dr Phil Moore, Deputy Chair of KCCG and Mental Health Clinical Lead, gave a presentation to the Panel explaining the Thrive Kingston strategy. He confirmed that this was in line with the national policy (FYFVMH) and provides a vision for mental health and wellbeing and a guide to shape the future provision setting out the policy for prevention, early intervention, self-care, treatment and recovery.
The Thrive concept is international and developed in New York. Thrive London has six key aspirations:
· A city where individuals and communities take the lead
· A city free from mental health stigma and discrimination
· A city that maximises the potential of children and young people
· A city with a happy healthy and productive workforce
· A city with services that are there when and where needed
· A zero suicide city
Thrive Kingston has five key themes and Appendix 2 to the report expanded on these themes (pages A18 to A25):
· Wellbeing and prevention
· Early intervention
· Community connection
· Access to Services
· Joined up Care
Priorities being progressed in 2017-18 are:
· Early years, children and family, schools prevention
· Workplace mental health
· Directory of services
· Development of primary care
· Peer support networks
· Triaging and single point of access
· Roadmap of services and establishment of mental health and wellbeing hub
There are 200,000 people registered with Kingston GPs. Approximately 10% have common mental health problems (depression and/or anxiety) and 1% have a serious mental illness such as bipolar or schizophrenia. Almost 10% of children and young people experience some form of mental health problem.
Employment rates for people with mental health problems are less compared with people with other health conditions and are 31% below the general population. Only 25% of people with mental health problems receive the treatment recommended by the evidence. Dr Moore drew attention to the fact that periods of poor mental health are normal for most of us and only a small proportion are longer term.
Dr Helen Raison spoke about suicide prevention in Kingston. This is led by Public Health but involves working jointly with health partners.
Dr Raison referred to the recent audit of coroners’ records which covered a four year period and looked at 38 deaths. This has enabled Public Health to develop plans very specific to the population. She explained that in Kingston the key age group for suicide is different from the national picture and there are more people in the 45 - 54 age group than elsewhere. Other factors are a higher numbers of men compared to women, being single, separated or widowed and having a long term physical condition or mental health problem. Economic difficulty is a factor in many Kingston cases and losing a job can lead to a range of issues. The main methods used were hanging and poisoning. Half of the people who take their life have recently seen a GP or mental health professional and the plan focuses on this element.
The suicide prevention strategy aims to minimise the number of suicides in Kingston and to better support those who are bereaved or affected by suicide. Key areas are to:
· Reduce risk of suicide in key high risk groups
· Tailor approaches to improve mental health in specific groups
· Support frontline staff
· Promote suicide awareness and help seeking in the community
· Provide effective local response to the aftermath of suicide
· Reduce access to the means of suicide
· Support research, data collection and monitoring
A multiagency suicide prevention group has been formed and 30 representatives (listed on page A12) are involved. The suicide action plan for high risk groups was presented at Appendix 4 – Key Area 1 and has been cascaded to health and social care colleagues. There is also a pathway to manage people in mental health crisis and information for relatives and carers who support people in distress.
A range of questions were asked by members of the Panel:
In response to a question about actions being taken with employers to support workers experiencing mental health problems and alleviate crisis, Dr Moore responded that the NHS was working with large employers in London and there was also work with local employers in Kingston. He added that there is a strong economic case to help support people in work and avoid absence. There is also an approach to provide individual work placements to support return to work in the longer term. The Trust helps employers with devising plans for supporting and returning to work and a primary care project funded by the lottery provides individual placement support. NHS E is developing further plans to increase support.
The Fulham Football Foundation has developed a project for people with serious and enduring mental health problems to get involved in exercise, help in writing CVs and getting back into employment. The Healthy Work Place charter focuses on wellness issues and stress.
The Chair suggested that linking with the local Chamber of Commerce on wellbeing at work may help with educating local businesses and the Vice Chair drew attention to work in progress as the Chamber of Commerce has recognised that people working from home can experience social isolation and is looking at ways to support people. One initiative is the Canbury Coffee morning for lone workers.
It was pointed out that social isolation can be both a cause and an effect of mental health issues and Kate Dudley spoke about feedback KCN had received from carers. There seemed to be a lack of consistency in primary care about when to refer for secondary care support and she questioned the threshold for referrals. She also pointed out that there was evidence to suggest that carers were not listened to and outlined a case where the GP did not visit promptly which led to the patient being treated at Kingston Hospital for self-harming.
It was noted that people who seriously self harm are generally admitted to hospital and a joint protocol includes follow up care. However, Dr Helen Raison did point out that there were some gaps in the pathway. This will be taken forward in the New Year and Dr Raison invited Kate Dudley to participate in this.
Self harm in children and young people in London is also being looked and early evidence suggest that there is an improvement where there is follow up by texts and other messages to check that people are OK. However the levels of self harming is high in young people aged 16 to 24 years and locally there is work in schools is being progressed. Training initiatives are being developed to improve GPs skills.
Gillian Moore, Head of Service Delivery (SWLSTG), confirmed that there was a South West London project with psychiatric liaison service in A&Es to provide follow up. This is about enabling people to access help and support rather than expecting them to initiate this themselves.
A member commented that the report made hard reading and she asked whether enough was being done for people who don’t recognise they have a problem and are not accessing services. Dr Moore pointed out that there is substantial evidence that friends and families of people who take their own life are at greater risk of suicide and that this area needs more discussion.
Dr Helen Raison drew attention to the need also to change the culture and enable openness and discussion about mental health as stigma of it is part of the issue. Also in about half of cases where people take their own life they will have seen their GP or another health professional in the previous week.
It was noted that Camden and Islington Mental Health NHS Foundation Trust C&I attended the Panel in January this year and spoke about the primary care mental health services. It was also noted that work is progressing with the student population and also around stigma progress.
A member commented on the wider implications for family and employers of people who take their own life.
Dr Phil Moore provided details of GP training. 19 local GPs had been trained to advanced diploma level in Mental Health. There is also a mental health learning set which continues the training and enables access to supervision and support. People generally respond well if they receive both medication and talking treatment and he confirmed that there was a good service in Kingston. GPs are encouraged to refer to the local service which is also open to people who self-refer. Reference was made to www.good-thinking.ukwhich provides an online service to Londoners on a range of mental health-related topics including sleeping.
A request was made for information be provided to members and it was agreed that the new Counselling in Kingston directory would be circulated.
member enquired about the relevant contact centre training and it
was confirmed that there was an awareness of this need and steps
would be taken in the near future. (Weblink: https://www.kingston.g
In response to a question from Dr D’Souza about the implementation of the mental health strategy Dr Moore confirmed that work was progressing across the country but it is hampered by budget problems. Claire Murdoch, National Mental Health Director at NHS England is leading the Five Year Forward View for Mental Health and she is pushing for investment. He added that he was working with her and there is CCG oversight to measure mental health investment per weighted population to target investment. There is evidence that by investing in mental health savings can be made in other areas. He confirmed that progress was being made in Kingston and achievements made.
Councillor Mary Clark’s two written questions were asked on her behalf. In response to a question about Police custody arrangements Dr Phil Moore confirmed that people detained under Section 136 are not detained in police cells but are transferred to the S 136 Suite at Springfield Hospital or an alternative place of safety, of which there are several across London. Police cells are used only in very exception circumstances.
In response to Councillor Mary Clark’s question about whether there are any plans for further Crisis cafes in addition to those in Tooting and Wimbledon, Dr Phil Moore replied that these two cafes had been set up as pilots and it is possible that Kingston may have one in the future operated by the voluntary sector. Gillian Moore confirmed that there was good attendance at the two cafes by people from Kingston.
Mr Robb made a request for carers to be enabled to contribute in client consultations and suggested that patient confidentiality prevents this. Dr Phil Moore advised that the recent mental health act review had highlighted awareness of the issues for carers and the Data Protection Act should not act as a barrier to involving carers.
Recommendations were made to strengthen the health-in-all policies approach by ensuring that all reports to committees include a new section on health implications and also by for example introducing health impact assessments (which include mental health) on all major new strategies and developments.
1. The Counselling Services in Kingston booklet is circulated to all members;
2. The Panel recommends to the Health and Wellbeing Board that the council takes a health-in-all policies approach by introducing health impact assessments on all new policies and strategies; and
3. Committee reports include a new section on health implications.