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No Health Without Mental Health’ Event Monday 23 June 2014 The Vassall Centre Jill Shepherd, Chief Officer, Bristol Clinical Commissioning Group


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No Health Without Mental Health’ Event


Monday 23 June 2014
The Vassall Centre

Jill Shepherd, Chief Officer, Bristol Clinical Commissioning Group
Jill welcomed everyone to the meeting. She said that ‘No Health Without Mental Health’ is a priority for the Bristol Clinical Commissioning Group. It is the first national mental health strategy which covers all ages and especially maternal mental health. There is a well evidenced link between mental health and physical health and there should be parity of esteem.
Jill went on to say that the meeting today is about bringing together voluntary and statutory organisations to renew their pledges as well as to work more informally together. Statutory organisations cannot manage it on their own and all organisations need to work together to make a difference. Mental health is everyone’s business.

Amy Shortridge, Almighty You and Marvin Rees, Bristol City Council
Context and process so far for the development of the ‘No Health Without Mental Health’ activities for Bristol
Marvin began by saying that Christina Gray of Public Health had been the champion for this initiative for mental health in Bristol. She left Bristol City Council earlier in the year. He then talked through the power point presentation ‘Mental health in Bristol’ which outlined the evidence and analyses of risks by electoral ward, risk factors and co morbidity.
Amy said that Christina had resourced a stakeholder event last May which held a mirror up to senior representatives of organisations to ask them how and what they were going to do about this. There will be another stakeholder event in October for further discussions. It is really important to create an environment where organisations can meet and discuss and there is also a need to build resilience for the future.
Hannah Russell and Tim Wye, Bristol City Council
No Health Without Mental Health’: Bristol City Council’s Progress on Pledges
Tim talked through the power the power point presentation. View the presentation at: www.thecareforum.org/pagebristol-adults-events-archive.html
Mel Cornish, Bristol Clinical Commissioning Group
New Mental Health Services for Bristol
Mel talked through her power point presentation. View the presentation at www.thecareforum.org/pagebristol-adults-events-archive.html

She said that the process had involved a huge number of people which had led to key features of the new system e.g.:



  • The assessment recovery system – the quicker people are seen the less critical they will become

  • A 24/7 crisis service – with a single point of access telephone number

  • An 8am to 8pm seven days per week appointment service.



Morgan Daly, Healthwatch Bristol
Involving service users to have a say in mental health services
Morgan said that Healthwatch is now just over a year old and is the link between what people are saying and service provision. It is currently:

  • Carrying out enter and view visits to care homes which cater for people with dementia

  • Talking to young people about obesity and body image which will be followed up by an event for children and young people across the four Healthwatches in October half term.

  • Collecting issues and concerns about discharge from hospital or services.



Workshops – working towards a voluntary and community sector ‘No Health Without Mental Health’ pledge:
Marvin said that the new interim Director of Public Health is redesigning the Public Health Service, which is moving into the Local Authority, because it needs to feed into education etc. but this requires the building of a structure and a common operating language. Help is being sought to help with this and currently over 120 staff are feeding into the organisation.
Part of the integrity and authority of this initiative is that partners and the public have been asked what should be done.
Caroline then asked the delegates to divide into their designated groups and consider the following question under six headings:

What would lead to: -
Group 1: More people in Bristol with mental health problems recovering?
What we currently do:

  • Second Step breadth of offering

  • More focus on young people and domestic abuse

  • St. Mungo’s recovery college

  • DEF enabled involvement for political impact

  • Listened to by Bristol Independent Network

  • Free wellbeing activities

  • Active peer support – provided by people who are all volunteers

  • City farm volunteer programme

  • Service user involvement in casual work

  • Encourage

  • Service users having a voice and impact i.e. AWP.

Gaps:


  • A needs to be more open to change, there are not always instant results

  • The politics of an organisation has a major impact

  • We need more people to be involved

  • Lack of signposting

  • More focus on prevention is needed

  • Using experience to access funding

  • Continue to be service user led

  • Access to IT – lack of it can lead to exclusion

  • Lack of overall to resilience.

Important:



  • Creative approach to employment

  • Constant evaluation and learning

  • More events and consultation

  • Experts at the right point

  • First response

  • More in younger peoples services at earlier more ‘normal’ stages

  • Co-productivity services

  • More locally based including primary care

  • Real service user involvement

  • Using work placements as recovery

  • The service user decides their own goals

  • Accessible services

  • A recovery navigator

  • Effective partnership for fast referrals

  • Fall out at implementation

  • Respect and dignity

  • Change handled well

  • Value old and new services

  • GPs need to be more society responsive

  • Encouraging new ideas.


Group 2: More people in Bristol with mental health problems having good physical health?
What we currently do:

  • Some organisations do see people in their own homes

  • Churches/lunch clubs collect people from their own homes

  • Walking groups

  • Football/badminton/cycling

  • Advocacy

  • Work with smoke free Bristol

  • Peer support groups

  • Matthew Trust/Easton Community Centre → providing healthy food

  • Food banks

  • Growing food projects e.g. the Trinity project.

Gaps:


  • Awareness of how physical health problems impact on mental health (and physical access)

  • People not meeting the criteria for secondary services

  • Not knowing what the services are and how to contact/contribute

  • Not enough activities/therapy/creativity (used to be more, reduced by cuts)

  • Advocacy is under resourced

  • Funding cuts/gaps e.g. smoke free Bristol

Peer support

Bristol Active Life Project

Trinity growing food project


  • Funding sustainability – resources, people

  • Funding is too short term

  • Housing problems – poor housing, long waits

  • Courses for the voluntary sector e.g. food, mood and nutrition

  • Brookland Hall Gardens – what can be done to save it?

Important:



  • Council ring fenced money spent on mental health an physical health

  • Building community resilience

  • Involvement of public health commissioners with service user commissioning group

  • Service user groups/representation

  • Healthwatch

  • A young people focus and including the needs of children with parents with poor mental and//or physical health

  • Smoother transition to adult services

  • A wellbeing approach rather than ‘diagnosis’, reaching out to easy to ignore communities

  • Better involvement of service users in planning/care

  • Treatment near home

  • There is no mental health network for Bristol and it needs one.


Group 3: More People in Bristol having positive care and support?
What we currently do:

  • Unfunded, low level support needs to be recognised

  • Good improvement in acknowledging low level preventative work (WECIL)

  • Working with employers to support (Princes Trust)

  • The VCS already meets needs but perhaps needs to better map the work. Preventative work is already ongoing! (Morgan: asked to refer to and discuss with Healthwatch)

  • Referrals via care direct to support.

Gaps:


Key issues: Funding problems: Referrals- but who funds the work?

How can they continue without funding?



  • Dhek Bhal supports carers of and clients/service users with mental health issues

  • Ask SARI and others how they will signpost. All organisations: How are culturally specific services going to be funded?

  • Princes Trust – there is an issue with funding for young people who a re not in school

  • Big Society...’Use the voluntary sector’ – but how is the VCS funded?! (Dance Voice/WECIL). There is a risk of losing people most at risk

  • ‘Low level’ preventative work.

Important:

Key themes: Prevention – services before crisis, not waiting for crisis


  • Better work between the CCG etc and VCS around priorities (safeguarding versus need)

  • Less fire fighting

  • Collaborative co-working, co-buying

  • What can VCS organisations do to improve their services?

  • Less stigma

  • There has been lots of VCS mapping – how is this linked in? (Marvin Rees’ event: AWP?) Better qualifying and captured data etc.

  • Get businesses onside with money and staff time!

  • The VCS already works together and in some instances are overstretched – don’t take advantage or too much of the resources

  • CCG/MMH have heard views during planning and do have a pot of money to spend. We need to hold to hold them to account, including via Healthwatch

  • Help and referral before crisis point!

  • MMH – looking to combine CCG and LA approach – important.


Group 4: Fewer people in Bristol suffering avoidable harm?
What we currently do:

  • Needs linking up/mapping

  • Too big a question – needs to be a commissioned map linked to the commissioning of community hubs under Modernising Mental Health.

Gaps:


Answered by the effort to clarify what we mean by avoidable harm

  • Physical harm because people are locked out of physical health services

  • Softer aspects of harm – from constant rejection → compounded stress

  • Harm caused by the discharge process, putting people out of services into limbo

  • People falling through the safety net because the service is harder to get

  • Safeguarding – bullying, hate crime, exploitation

  • Suicide, self harm/injury.

Important:

CPN:


  • GPs are critical – provider approach id the problem

  • Plan/strategy needed to address the areas missed by the gaps

  • Healthwatch to look at asset mapping


Group 5: Fewer people in Bristol experiencing stigma and discrimination?
What we currently do:

  • Alzheimer’s Society – dementia friends.

  • Awareness and challenges – reducing the stigma of dementia. Bristol is a dementia friendly city

  • Off The Record – schools and mentality work

  • 1625 – schools work around homelessness

  • The treatment of the perpetrators of domestic violence – proposal of the Wellbeing Partnership

  • ‘Circles’ – UK wide anti stigma work

  • Nilaari – 2 REC trainers for 3 years

  • 1 – 20 in Bristol

  • -Race equality and any difference, including mental, included in the new framework

  • Time 2 Change – a volunteer champion, very active in Bristol whose funding may end in March 2015 – provision = 6 events in Bristol in 2014

= A St. Paul’s Carnival and Gay Pride presence

= Employer’s event in September



  • How can we work together to continue this work?

Organisations can pledge how to work towards Time 2 Change at the October stakeholder event. George Ferguson, the Bristol Mayor, has not yet signed up

  • Service Level Agreements and targets can make it hard to work on anti-discrimination

  • Advocacy at The Care Forum

  • User led organisations and Mental Health Voice in Gloucestershire

  • Time 2 Change – speaking out training, work with the Richmond Fellowship to ensure the agenda is high

  • Bristol – independent mental health network being set up

  • Second Step peer support training – could peer support volunteers be paid?

Gaps:


  • Data – focus resources based on discrimination data

  • Police/GPs/ambulance drivers – how can we improve the way people are treated?

  • The police have delivered training on mental health crisis – possible extra training on stigma and other issues?

  • The culture of these organisations need support to change

  • Employers to talk about mental health issues

  • Better clinical supervision

  • The police need to know more about local support

  • Officers to learn more about the mental health pathway(s)

  • Working out where some one is on their journey

  • There needs to be greater understanding by staff on the beat and the police should be working towards this

  • Safe spaces for organisations

  • Think about our language - need rather than label

  • Open spectrum in health

  • Start young: teachers can have mental health issues/problems

  • Education in schools so that children take care of their wellbeing, stigma is eradicated and more talking takes place

  • Off the Record can help with this and Nilaari is delivering workshops to young (mostly) Somali people

  • More young people are needed

  • Thinking of other ways to look after health by an empowering approach and conversations about mental health

  • Work more with the community/social rather than the medical, model

  • Honour people’s experience

  • Family support may reduce suicide

  • Autism in the work place – changes in the work place

  • Wellness action plan – listening service,

  • Stigma – association of past history resulting in the police being called at the wrong time – cards for people?

Important:



  • More joined up working around stigma

  • Stigma and discrimination meeting together/partnership on this?

  • Stigma and discrimination – thread to run through all services.


Group 6: More people in Bristol experiencing good mental health
What we currently do:

  • Non medicalisation of mental health → social model, social prescribing

  • Individual/person centred service which is user led

  • We can more creatively respond to a gap or need than the statutory services

  • Client involvement – co-production

  • A flexible/creative approach to engage young people.

Gaps:


  • GPs and the voluntary sector meeting up – or how do we actively engage with GPs? Use VOSCUR as a conduit?*

  • Gaps in primary mental health for adults – see * above

  • Flexibility in services in order to engage young people in statutory services

  • Dual diagnosis? E.g. mental health and addiction, services that understand the co-existence of conditions

  • Young people as carers – think family.

Important:

Statutory:


  • Information sharing protocol across services

  • Assertive engagement to support the engagement of people who are harder to reach/vulnerable with services.

VCS:

  • We can give feedback – we are working directly with the most vulnerable

  • Help other organisations to demystify what we are doing – understandable terminology

  • Advocate, support and maintain engagement in services

  • More therapists in schools

  • Early intervention.

Caroline pointed out that the availability of a ‘post it’ flip chart sheet for participants to post any further thoughts. She then thanked Amy for her hard work towards the event, all the speakers and facilitators, as well as the participants for attending and contributing.


Post it flip chart comments


  • Cross organisation work

  • Appreciation of the importance of early years for future wellbeing, therefore support for families/parenting etc

  • Public Health needs to link into the local community – GPs, voluntary and statutory organisations, local people etc

  • Public Health: Use Healthwatch effectively as a people’s champion to help evidence your work

  • Community cohesion, diversity and respect for difference

  • How can BCC/BCCG connect with and support the VCS with flexible funding? Are there finding pots we can apply for e.g. for pilot provision

  • Understanding the role of service users and input e.g. peer led mutual support groups

  • Joined up work

  • Assessment tool that is simple and transferable

  • More support for homeless people

  • Public Health: use Well Aware to refer within the VCS as one single point of access to simplify, and make equitable, this process

  • Service user engagement at every level and initiative (strategy partnerships etc)

  • Give the public the chance to have their say. Not all of the public are service users

  • Mental Health awareness in schools – remove the taboo

  • Preventative and resilience wellbeing initiative for the general Bristol population, especially young people.


Appendix One – Attendees and Apologies
Present

Colette Bourn Second Step Housing Association

Hazel Britten Bristol Black Carers

Mel Corish Bristol Clinical Commissioning Group

Tina Cossham Knightstone Housing Association

Paul Daley Employment Support Solutions

James De Carvalho The Carers Support Society

Derek Dominey Independent

Denise Donovan Independent

David Dravie-John PAX Productions Limited

Chris Dymond Freeways Trust

Pam Fisher Dance Voice

Lisa Foote Self Injury Help Group

Tina Ford Freeways Trust

Mike Frost Changes Bristol

Rami Ghali Brigstowe Project

Peter Hale Healthwatch

Keith Hall Bristol Disability Equality Forum

Zehra Haq Dhek Bhal

Jane Harris Princes Trust

Frances Hathorn Support Empower Advocate Promote

Beth Hendry Milestones Trust

Paul Hudson St. Mungo’s

Karen James Knightstone Housing Association

Hilary Lindsay Bristol Crisis Service for Women

Geoff Loydon Bristol Mental Health Network

Mhemooda Malek

Pauline Markovits Bristol Survivors Network

David Martin Wellspring Healthy Living Centre

Gerry Monaghan Southmead Project

Claire Murphy Friend North Somerset Limited

Marguerite Paffard Kids Company

Viran Patel The Wellbeing Partnership

Sophie Pickering 1625 Independent People

Marvin Rees Bristol City Council

Jukes Risk Riverside ECHG

Pat Rose Nilaari

Kevin Rowlands Avon and Somerset Police

Hannah Russell Bristol City Council

Sheriden Russell Stand Against Racism and Inequality

Leonie Seaborne County Community Projects

Gillian Seward Bristol Older People’s Forum

Paula Shears Alzheimer’s Society

Jill Shepherd Bristol Clinical Commissioning Group

Amy Shortridge Almighty You

Jonathan Simmons Maple Community Care

Liz Sorapure Bristol Mind

Leah Stone Mental Health Matters

Anna Temple West of England Centre for Inclusive Living

Lucinda Thelwell Knowle West Media Centre

Pamela Trevithick Independent

Susan Walton Rethink

Hannah Weaver Mental Health Matters

Naomi Westbury Alzheimer’s Society

Erica Wildgoose Bristol Survivors Group

Heather Williams Hartcliffe and Withywood CP

Tim Wye Bristol City Council

Caroline McAleese The Care Forum

Morgan Daly The Care Forum

June Aland The Care Forum


Apologies

Ailsa Holmes Creativity Works





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