Ian Wake, Director of Public Health, presented the report that set out the work undertaken to date to address problems in the local mental health and care system in Thurrock. It also set out plans with NHS Thurrock Clinical Commissioning Group, NHS and third sector provider partners to transform mental health services moving forward. The report also highlighted the issue of suicide prevention and how best to integrate commissioning of services between the Council and NHS. Ian Wake stated that the report sought HOSC support for the new programme of transformation and for proposals to reform the section 75 agreement between the Council and EPUT.
At the request of the Chair, Ian Wake presented a comprehensive and detailed PowerPoint presentation to members that covered:
• Epidemiological Overview of Mental Health
• Projected number of older people in Thurrock with depression – up to 2030
• Key Themes
• How to address under-diagnosis
• How to get into the system
• Emergency Response Pathway
• New treatment offer for Common Mental Health Disorders
• New enhanced treatment model
• Integrated Commissioning
• Next steps
This presentation can be found on-line at the following link.
The Chair thanked Ian Wake for the very comprehensive presentation.
Councillor Redsell thanked Ian Wake for the presentation and stated that more should be done at an earlier age for those older children being diagnosed now with mental health issues.
Ian Wake stated there was no simple answer as there were multiple causes such as bullying at schools and plans were in place to address this. Councillor Redsell stated that bullying also needed to be addressed as this was a contributory factor with schools not picking this up early enough and schools would be expected to action this but in cases would not have sufficient time and resources to do this. Ian Wake continued by stating that excessive social media usage caused depression and anxiety in people. With neglect and sexual assault being key contributing factors for depression. That Mental Health school based teams were in schools addressing these issues and plans were in place to expand the mental health treatment provision.
The Council should encourage more physical activity. Ian Wake stated there was no simple answer to the physical activity question but there was a range of activities, sport provisions and infrastructures in place and this would be the opportunity to promote these.
Councillor Redsell continued to state that she did not know who the Local Area Coordinator was for her ward. Roger Harris agreed to organise an introductory meeting between Councillor Redsell and the Local Area Coordinator covering her ward.
Councillor Redsell questioned the 8628 residents being undiagnosed. Ian Wake stated these were primarily people who were unable to seek and ask for help. A high risk of depression was getting older and this may be stigma amongst elderly residents who may be too proud to ask for help. Councillor Redsell questioned whether the 8628 number was correct. Ian Wake stated that figures were produced by Public Health England following modelling undertaken by Imperial College in London based on demographics and was the best evidence base available.
Councillor Redsell stated that more could be done between the elderly and the young and referred Members to the popular TV programme that demonstrated the bond that brought the elderly and young together. Ian Wake agreed that the programme had some very valid points and demonstrated some opportunities.
Councillor Allen thanked Ian Wake for the presentation and questioned whether the waiting times for Thurrock Mind could get worse. Ian Wake stated he did not have the figures for Thurrock Mind but the patients for IAPT NHS counselling service were being seen within 6 weeks. Ian Wake agreed that a long term solution would need to be addressed. Councillor Allen welcomed the change in waiting times and agreed that early intervention was vital.
Ian Evans had a concern on the individual placement scheme to which those people that received back-to-work support who had mental health conditions but did not fit in the parameters of IPS and questioned what plans were in place. Mark Tebbs stated there was evidence base around employment support with people with serious mental health illnesses. An employment specialist would be embedded in the mental health teams as part of active treatment programme and this had produced the best results. Ian Evans further questioned whether as part of the model would the third sector specialist employment be involved as well as having employment specialists embedded into the CMHT teams. Mark Tebbs stated that would go back to working holistically with local authority colleagues and working closely to ensure that those offers were joined up.
The Chair stated that this needed to be handled delicately when built into the model being designed.
Councillor Kent thanked Ian Wake for the presentation and questioned how the scheme would be monitored. Ian Wake stated there were plans to move to an outcome framework that would measure if people were getting better.
Councillor Kent stated that more awareness had to be undertaken inside and outside schools with schools having to take some responsibility. Councillor Kent questioned that with insufficient general practitioners in Thurrock how patients could be reassured that when they ring for appointments their calls would be answered. Ian Wake stated that it was a competitive market for general practitioners and that with the introduction of the Integrated Medical Centres would make Thurrock a more attractive place for new general practitioners to work. For those patients accessing mental health services would follow the crisis pathway which would enable people to access specialist crisis care via 111.
Councillor Kent asked whether there was sufficient staff to cope with the expected number of calls and how the 111 service would be publicised. Mark Tebbs stated that the business case had been finalised with the secured funding being built into the contract with a 6 to 9 month mobilisation plan. That it would take up to 9 months to recruit staff and was ambitious that the model would be up and running by next winter. That engagement would be made with members of the public and publicised.
The Chair questioned whether a similar service would be presented to young people and young children. Ian Wake stated the two plans would be undertaken under the Joint Strategic Need Assessment and through the School Mental Health Summit. Roger Harris stated that the Health and Wellbeing Board was the oversight group to ensure that the plans came together.
Malcolm McCann praised Ian Wake on the quality of the presentation and work undertaken into the analysis on the direction of travel. Malcolm McCann applauded the priority of addressing mental health in Thurrock and complimented the health and social care commissioners. That EPUT had been working hard to transform services and were on a better journey of recognising the need to work within localities such as Thurrock. With EPUT having a strong desire that mental health services should go into the Integrated Medical Centres and commitment to offering services locally.
Councillor Rigby questioned how schools were educating children on social media. Ian Wake stated that social media was a risk factor in schools and that there was mental health teams based in schools who would discuss and address such issues.
Councillor Kelly questioned whether Thurrock had a high rate of mental ill health compare to the national average. Ian Wake stated that he did not have the figures to hand and would provide this information for Members.
Councillor Kelly questioned the comparison of mental health cases in urban areas compared to the number of cases in rural areas. Ian Wake stated that this would depend on the type of urban and what type of rural areas and that age was a key drive into depression so was hard to separate. That there was strong evidence that living near green areas and trees the less likely people would suffer from depression. That there were dedicated members from the Public Health Team who worked alongside the Planning and Regeneration teams and conversations were taking place. This would be a key opportunity to get it right in the local plan. Mark Tebbs referred Members to the Mental Health Needs Index with the University of Manchester analysed all the numbers nationally where a score was given per area on their mental health needs. Further to Councillor Kelly’s earlier question on the rate of mental health compared to the national average, Thurrock was broadly in the middle with significantly higher needs compared to Southend.
The Chair stated that it was evident that surrounding areas affected mental health and this should be addressed.
Councillor Kelly referred Members to Thurrock’s population increase by 0.6% and that it was disappointing that new housing planning applications were being brought to committee but there appeared to be little prioritisation on health provisions. Roger Harris stated over the last 12 months there had been a housing and planning sub group alongside the Health and Wellbeing Board to try and shape and influence the local plan. That when planning applications were submitted it would be the intention to have early dialogue with developments to discuss the needs required.
The Chair stated that having recently sat on the Planning Committee it was evident of the constraints in the law in what the Council can do.
Members questioned where they should direct their constituents if asked about a referral for mental health. Roger Harris stated that the starting point would be either through their general practitioner or to ring 111. That the recommended route would be to contact Thurrock First who were open 7 days a week, 7am to 7pm and were able to make referrals to Grays Hall.
The Chair stated it was vital that local general practitioners received the appropriate training to ensure the right person was being seen and as quickly as possible.
The Chair stated it was good to hear that finally we were addressing the disparity in money with regards to mental and physical health and that once we start to treat mental health the same as we treat and cure cancer we had the system that would work for people.
The Chair also stated that the 8-12 week waiting times was still very concerning but recognised the work being put in to reduce these times. Ian Wake referred Members to the PowerPoint that displayed the work already done and that treatment times were down.
That Chair referenced that crisis care was a big issue and previously mentioned adjustments in beds and questioned at what point would we not need crisis care as money had been put into prevention. Mark Tebbs stated that more money was being invested into IAPT this financial year with more high intensity training being undertaken to keep up with the ongoing demand. Those specific pathways would be available for specialist services. Mark Tebbs stated that important point to make was the people can refer themselves and not have to wait for general practitioner appointments. The crisis care had been successfully implemented into Basildon Hospital and had been a good winter from a mental health prospective with some good response times. That regular winter plan meetings took place to look at all the indicators.
The Chair questioned when the plans would be put into place. Ian Wake stated he would like to manage expectations on timescales as this was a very complex system. With Thurrock at the start of formal transformation journey with a working case change document be ready by the end of the calendar year.
Councillor Allen requested the contact numbers for Thurrock First. Roger Harris agreed that the numbers would be forwarded to Members following the meeting.
1. That Health and Wellbeing Overview and Scrutiny Committee notes the contents of this report and comments on the direction of travel in terms of adult mental health system transformation
2. That Health and Wellbeing Overview and Scrutiny Committee comments on and supports the proposals as set out in section 7.14 to 7.15 of this report to develop a new Section 75 Agreement with EPUT from 1 April 2019 based on a longer term contract, with a revised performance and budget framework
3. That Health and Wellbeing Overview and Scrutiny Committee comments on and supports and approves the proposals set out in section 10 of this report in relation to suicide prevention.