Newsletter - December 2014

London Mental Health Strategic Clinical Network

From Dr Matthew PatrickLondon Mental Health Clinical Director

Dear Colleagues, friends and other interested parties,I am very pleased to welcome you to the first edition of the Mental Health Strategic Clinical Network Newsletter.

Let me start by introducing myself. My name is Dr Matthew Patrick. I am the Clinical Lead for the London Mental Health Strategic Clinical Network (SCN) on behalf of NHS England London Region. I am also Chief Executive for South London and Maudsley NHS Foundation Trust. The Mental Health SCN has been established for just over a year now. This newsletter aims to provide an overview of the Mental Health SCN work streams and the resources we are developing to support commissioners.

Our vision is to create a system of clinical leadership linking health and social care for consistent, high quality, efficient and evidence based care for mental health across London. In order to make this contribution, over the last year we have been working with healthcare professionals, commissioners, social care, voluntary sector and other third sector organisations to develop commissioning standards and other resources to improve the quality of care and outcomes for the people we serve.

Our aim is simple; to build on the momentum that is visibly growing around mental health to ensure that the citizens of London enjoy better health and wellbeing.

“An invasion of armies can be resisted, but not an idea whose time has

come.”

Victor Hugo‘Histoire d’un crime’ (1852)

French dramatist, novelist and poet

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London Mental Health Strategic Clinical NetworkNewsletter - December 2014

The concordat is a shared, agreed statement signed by senior representatives from all the organisations involved in the care and support of people in crisis, including NHS, police, social services, housing, third sector organisations and so on.

In signing the declaration, the organisations make a commitment to work together to continue to improve crisis care for people with mental health needs.

Crisis and urgent care work stream

Dr Nick Broughton (right) leads the crisis and urgent care work stream and is the Medical Director of West London Mental Health NHS Trust.

In February, the Department of Health published the Mental Health Crisis Concordat, aimed at improving outcomes for people experiencing a mental health crisis. The urgent care work stream is aligning its work in response to the concordat and has 12 lessons attached to the numerous standards developed by the work-stream. Each lesson has an example case study attached to provide commissioners with realistic solutions in supporting a crisis pathway.

The London Concordat declaration event on 27 October was attended by 150 delegates to launch the London mental health crisis commissioning standards and London declaration. The next steps will be to continue to raise awareness of crisis care and support the implementation of the standards.

Please see links below to the London mental health commissioning guide, standards and case studies:

http://bit.ly/mh-stds | Summary version of standardshttp://bit.ly/mh-urgent-cs | Case studieshttp://bit.ly/mh-urgent-doc | Standards and recommendationshttp://bit.ly/mhmanual | Interactive manual with evidence and SCN findings

Quotes from Mind service user consultation event

111 should have the local crisis line number.

I should be assessed within two hours (not more) by a competent mental health profes-sional staff member.

A safe space, not crowded area (dedicated room) to sit in. This area is essential to keep me safe in a crisis.

I was sent down to Brighton when I was not well because there were no beds in my bor-ough, which put a big strain on my family.

Not having to repeat yourself to every indi-vidual you meet.

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London Mental Health Strategic Clinical NetworkNewsletter - December 2014

Primary care work stream

Dr Phil Moore (right) leads the primary care work stream and is a GP and Deputy Chair for Kingston CCG.

The recently published guide developed by the primary care work stream, Strengthening Mental Health Commissioning in Primary Care - practical solutions and learning from experience is intended to provoke and support clinical commissioners to champion effective primary care mental health services. The guide is written specifically for mental health commissioners and practitioners, and would be a useful resource for other commissioners and providers, too.

The ten lessons included in the guide have been derived from more than 100 international, national and regional case studies, the lessons cover community based care, proactive wellbeing, accessible services and coordinated mental healthcare. Included in the guide is a directory showcasing the relevant case studies, summarising the learning from the experience.

The guide was launched at the SCN primary care event in July 2014 to raise awareness, encourage feedback and spread learning. The future aim is to make this a live resource to update case studies and refresh online content. The next steps will be to support implementation by influencing commissioning outcomes and building capacity to strengthen the primary care workforce.

Further publications include Ten tips for mental health services from primary care by Dr Moore and Stefanie Radford, Senior Project Manager, London Mental Health SCN. To view HSJ article, click here.

Quotes from SCN event in July

Thought provoking … hopefully stimulate innovation across London

Workforce development - needs to be invested in

Need to take risks - support teams to take risks and positively share lessons learnt if things go wrong

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London Mental Health Strategic Clinical NetworkNewsletter - December 2014

“This is a really useful guide full of practical examples, clear and focused recommendations, and a useful framework upon which to measure the severity of psychological issues suffered by people with diabetes. It is all about looking after the individual, patient-centered care, rather than the condition.”

-- The Commissioning Elf website

Long term conditions work stream

Dr Steven Reid (right)leads the long term conditions work stream and is a Consultant Liaison Psychiatrist and Clinical Director, Psychological Medicine at Central and North West London NHS Foundation Trust.

The guide, Commissioning recommendations for psychological support – Focussing on London’s diabetes care pathway, was published in August to provide recommendations for commissioners in providing emotional and psychological support on the diabetes care pathway. The report has been shaped from information gathered from discussions with professionals and people with lived experience and surveys identifying local provision in London.

The 10 recommendations are supported by more than 20 national and regional case studies, which are included. The case studies cover a variety of models providing evidence and outcomes for people with diabetes who need psychological or emotional support can improve. The recommendations are designed to help commissioners and others to develop improvements to psychological and emotional care provision in London and should also be a useful resource for providers and practitioners. The next steps will be to raise the profile of the report and support its implementation within CCG commissioning. Our next phase of work will also look to extend to other conditions to test the principles and approach with a different long term condition.

Quotes from co-production event

Medical services seem to be better integrated and helpful in contrast to psychological services.

No space to discuss ‘well-being’ beyond diet/exercise.

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London Mental Health Strategic Clinical NetworkNewsletter - December 2014CAMHS

The Children and Young People’s SCN and the Mental Health SCN have jointly appointed a chair of the newly established Children and Young People’s Mental Health Strategic Leadership Group, Isobel Heyman (right).

Isobel is a Consultant Child and Adolescent Psychiatrist at Great Ormond Street Hospital where she leads the psychological medicine team, who have a particular commitment to integrating physical and mental health care.

There has been a great response to the application process which is clearly indicative of the high level of clinical engagement and strong commitment to improving future children’s services in the capital. The group, which has representatives from a range of children’s services including health, social care, education and the voluntary sector will first meet on the 12 January 2015 where they will agree priorities and develop an action plan.

The group sits between, and under the auspices of, the Children and Young People’s SCN (Clinical Director: Prof Russell Viner) and the Mental Health SCN (Clinical Director: Dr Matthew Patrick). Amy Stebbings and Vanessa Brunning will provide project management support for the group.

London Perinatal Mental Health Net-workSince the launch of the London Perinatal Mental Health Networks in October 2013, more than 160 members have joined from a variety of organisations including representatives from perinatal and parent infant mental health services, midwifery, obstetrics, health visiting, social care, third sector, service users and commissioners.

The three clinical networks cover north east, north west and south London plus the Pan London Network (below left). They have met on a quarterly basis since the launch, promoting open communication, knowledge sharing and peer support in terms of service delivery and service development. Several areas in London have plans under way to increase existing resources or develop new services.

The networks are making good progress on the five 2013/14 priorities as follows:

» Perinatal mental health training programme pilot in Barnet, Enfield and Haringey with plans to roll it out London-wide in 2015/16 (funding awarded by Health Education England)

» Pan London MBU admission protocol (developed and circulated to all 10 London mental health trusts)

» London perinatal mental health care pathways (in progress)

» Database of all London perinatal and parent infant services (developed)

» Perinatal information openly accessible via the Royal College of Psychiatry website (available soon)

This work continues to be supported by the Mental Health and Maternity SCNs.

In addition a Perinatal Mental Health Conference has been arranged for 15 January 2015, aimed at commissioners and policy and decision makers in London to further support service development (see below for details).

For more information please contact Jo Luckie, London Perinatal Mental Health Network Coordinator (Jo.Luckie@nelft.nhs.uk). North west London

North east LondonSouth London

London perinatal mental health clinical networks

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London Mental Health Strategic Clinical NetworkNewsletter - December 2014More Than MentorsPeer mentoring programme

There is reasonable evidence that peer mentoring improves emotional resilience and secondary outcomes in adolescents. Many existing programmes exist but they are varied in quality and in particular, the level of training and support for mentors.

UCLPartners, together with Newham CCG and the London Borough of Newham, won a small grant to collaboratively develop and test a best practice model. This pilot has been generously championed by the London Mental Health SCN and Public Health England.

Collaborative development of the best practice model between May to September of this year involved adolescent peer research, interviews with local and regional expert mentoring providers and a review of the mentoring and positive psychology literature. Two workshops brought together these findings, and a best practice model is currently being developed which will be openly available. The best practice model consists of four elements: mentor and mentee recruitment and matching; mentor training and support; mentoring activities and routine outcome monitoring.

Currently a psychologist from Newham CAMHS and a local school inclusion worker are writing a set of best practice mentor training materials. The mentoring programme will be piloted with two schools in Newham. Twelve peer mentors (16-18 years old) will be recruited from a local school and will test the training in January; 10 mentees (12-14 years old) will be recruited. The pilot will run for 10 weeks with the mentors supervised by an inclusion worker and psychologist in collaboration with the school. The pilot will include online outcome monitoring. The aim is to demonstrate that the mentoring programme can be feasibly delivered by an inclusion lead in a school with support from the local CAMHs service.

If you are interested in finding out more please contact Dr Simon Munk (above), Young People Mental Health Lead, UCLPartners (simon.munk@uclpartners.com).

Mental Health, Dementia and Neurology Intelligence Network

The National Mental Health, Dementia, and Neurology Intelligence Network (NMHDNIN) launched on 18 June. For the first time, the Network has collated a range of publicly reported mental health data and made it openly available in support of greater transparency and local improvement.

The MHDNIN consists of an intelligence hub (www.yhpho.org.uk/mhdnin) and profiling tools (http://fingertips.phe.org.uk/profile-group/mental-health/), which bring together the range of publicly reported indicators about risk factors, prevalence, access to services, outcomes and finance covering:

» Common mental health disorders » Severe mental illness (including psychosis) » Community mental health profiles (updated

from last year’s publication) » Children and young people’s (CYP) mental

health » Neurology (emergency admissions and

epilepsy)

The CYP mental health profiling tool went live on 7 October (http://fingertips.phe.org.uk/profile-group/mental-health/profile/cypmh). For more information about the tool, please contact Sue Foster (sue.foster@phe.gov.uk)

A prototype Co-existing mental health and addictions issues profile is due to launch in December.

A national psychosis care pathway data review, exploring variation at CCG level by commissioning region and deprivation quartile across this key mental health care pathway, is available in draft form and will be published early next year.

The network will be working with regional SCN leads to offer stakeholders access to a training event on using the Intelligence Network tools to better understand local data completeness and quality and to support JSNAs.

For further information, please contact James Seward (james.seward@phe.gov.uk).

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London Mental Health Strategic Clinical NetworkNewsletter - December 2014Third sector interviews

Naomi James, NSUNTell me about your role within NSUN. My name is Naomi James and I am the Regional Development and Research Manager for NSUN, the National Survivor User Network. Like many of the independent charities’ staff and board members, I have had many years experience of mental health services. My main role is to strengthen and support the direct service user/survivor political voice, review mental health policy and influence the development of mental health services. Recently NSUN worked in partnership with Mind to produce a valuable resource for involvement. In my role as a consultant to the SCN at NHS England, I have focused on ensuring Clinical Commissioning Groups (CCGs) understand the importance of meaningfully involving service users, not just in the design and delivery, but also in the research and auditing of services.

How do you see the SCN’s role in driving forward quality improvement?The SCN’s role to drive forward quality improvement can be achieved by supporting people accessing services to get involved in all stages of commissioning, service design and determining their own care plan. We are delighted that the MH SCN refers to the principles of our 4PI National Involvement Standards. The next step is for us to ensure the purpose, process, presence and impact of involvement is carefully worked through and modelled at this strategic level to ensure it is implemented in practice at CCG level and throughout the system. This will help to determine the amount of real influence people can have to bring about changes as a result of involvement.

Sophie Corlett, MindTell me about your role within Mind.My name is Sophie Corlett and I am the Director of External Relations at the mental health charity, Mind. I head a team of around 60 people and oversee all of Mind’s national policy and campaigns, media, communications, information and legal work. Some of our key projects include our Elefriends service, which provides free peer-to-peer online support for over 14,500 people and our newly launched Election Manifesto, which seeks to put mental health

at the top of politicians’ agenda in the lead up to next year’s general election. In addition to this, I’m regularly called on as a media spokesperson for Mind, particularly with regards to commenting on the changing landscape of mental health policy and service provision.

How do you see the SCN’s role in driving improvement?Part of my role in the group is ensuring the different work streams include a patient and public involvement focus. Mind has also particularly been involved in the Crisis and urgent care work stream. The SCNs provide drive, expertise, practical guidance and ideas for how commissioners and providers can organise services more effectively. One of their key roles is about providing momentum around local and national issues and supporting CCGs across London to understand that their locality is not the only one dealing with those particular issues. Another role of the SCN is to help support commissioners to be more ambitious and innovative when designing or commissioning services.

Victoria Bleazard, Rethink Mental IllnessTell me about your role within Rethink Mental Illness.My name is Victoria Bleazard and I am the Acting Director of Communications and Campaigns at Rethink Mental Illness. We directly support almost 60,000 people every year across England to get through crises and live independently. We work to change attitudes and policy at a national level, including through the Time to Change programme which challenges mental health stigma and discrimination, in partnership with Mind.

How do you see the SCN’s role in driving improvement?When the new NHS England infrastructure was being created we met with SCN leads countrywide to discuss their plans for improving mental health care. Rethink Mental Illness was then invited onto the mental health strategic clinical leadership group (SCLG). What has been great is that each of the charities represented on the SCLG have been involved in different ways within the work streams, and have been part of discussions around the entirety of the SCLG’s work. I think the role of the SCN is to support commissioners to make evidence-based decisions around commissioning, and to encourage innovation and co-production.

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London Mental Health Strategic Clinical NetworkNewsletter - December 2014Primary Care Mental Health CCG Net-work leadership programme and mas-ter classes

CCG Mental Health NetworkThe London CCG Mental Health Network emerged out of the first primary care mental health leadership development programme in 2013/14. Network participants include GP commissioner alumni from the 2013/14 leadership programme, current GP commissioner participants from the 2015 Leadership programme and CCG staff working in mental health across London.

Bi-monthly network meetings aim to: » Provide an informal networking opportunity,

ongoing peer support and strengthened collaboration in commissioning

» Showcase existing pieces of work or innovative developments to the group

» Support discussion and debate around the commissioning of adult and children and young people’s mental health services

The success of the first leadership development programme was highlighted in a recent HSJ article.

Q&A with the Rt Hon Norman Lamb MPAt the November meeting, network participants were joined by the Minister for Care and Support, the Rt. Honourable Norman Lamb MP. After hearing about several of the commissioning successes from the 2013 cohort of GP leads, the Minister held a Q&A session with attendees. Key issues discussed:

» Ensuring money from specialist commissioning reaches communities / populations in need

» Communicating and persuading politicians of the benefits of investment in children and young people’s mental health services

» Overcoming the limitations of specialist commissioning pathways

» Integrating substance misuse and mental health commissioning

» Tackling work-related stress

2015 leadership programme and master classesUCLPartners, in collaboration with the London Strategic Clinical Network, is pleased to announce the dates and curriculum for the 2015 programme for leadership training in commissioning mental health services. This course has been specially commissioned and will be delivered by NHS Staff College and Professor Richard Bohmer. This January 2015 course will help participants to better acknowledge, accept and understand their role as a senior leader, to establish networks and develop relationships in order to produce improvements in commissioning services.

A series of master classes in commissioning mental health services will complement the leadership training from December 2014 through April 2015. Developed for clinical and non clinical CCG staff working in mental health, classes on mental health topic areas and technical commissioning will be delivered by expert academics and clinicians, ensuring participants are up to date with current and developing evidence and research.

For more details, contact the CCG Academic Network Manager, Lottie Cantle (lottie.cantle@uclpartners.com or 020 3108 2344).

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London Mental Health Strategic Clinical NetworkNewsletter - December 2014EventsThe 11 November event, Sugar and spice: Type 1 diabetes and eating disorders (T1ED) - Meeting the challenges, hosted by three London Strategic Clinical Networks (Diabetes, Mental Health and Children and Young People) recognised the importance of the issue with 100 delegates attending from across paediatric diabetes, adult diabetes, dietetics, psychological services and eating disorders teams.

People with type 1 diabetes were also present, plus charity organisations DWED (Diabetics with Eating Disorders), Diabetes UK, Young Minds and MIND. A panel session was chaired by Nicola Kingston, Patient Voice representative with the London Clinical Senate and mother to a son with type 1 diabetes.

The meeting heard evidence that people with type 1 diabetes double their risk of developing an eating disorder such as anorexia or bulimia, and 40 per cent of 15 to 30 year old women with diabetes regularly omit insulin (“diabulimia”) over concerns about eating and weight.

People who experience these issues are associated with worse glucose control and a two- to four-fold increase in the risk of devastating complications, such as kidney disease, eye disease and even death. They frequently surface as recurrent emergency admissions and very poor glycaemic control.

However, these issues are frequently unrecognised and individuals can suffer with these problems for many years before the problems surface.

Links:Event summary | http://bit.ly/t1ed-summary Slides | http://bitly/t1ed-slidesBios | http://bit.ly/t1ed-bios

Forthcoming events

London Perinatal Mental Health Networks conference 15 January 2015Royal College of Psychiatrists, London

Further infoIf you would like to give us any feedback or if you have an idea for a future edition, please email us on england.london-scn@nhs.net.

“I have to say that it was one of the most amazing, reassuring and inspiring meetings I’ve attended on T1ED as it’s a topic that has been ignored for decades. I’m thrilled that it’s now reached the consciousness of healthcare professionals at long last! As I said at the meeting, it took over 40 years for me to get appropriate help via the NHS and I’m only fairly recently able to be at peace with food. I hope that other young people won’t have to go through this life-long struggle for recognition of their difficulties with diabetes and food.”

-- Lis Warren, delegate and service user