Item 13 - Mental Health Strategy Update
North Lanarkshire Council · 14 February 2023
Back to IJB Performance, Finance and Audit Committee — 14 February 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 13 SUBJECT: Lanarkshire Mental Health and Wellbeing Strategy TO: Performance, Finance & Audit Committee Lead Officer for Report: Maggs Thomson, Head of Health NHSCP Author(s) of Report Ian Nicol, Programme Manager DATE: 14th February 2023 1 PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement To note 2 ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: The Lanarkshire Mental Health and Wellbeing Strategy Board 3 RECOMMENDATIONS The Performance, Finance and Audit Committee is asked to note that: 1) The delivery plans for all workstreams have been reviewed to ensure that they build on Covid-19 recovery plans and focus recovery efforts on the objectives set out in Getting it Right for Every Person. The refreshed Delivery Plan has been mapped onto the National Transition and Recovery Plan. 2) An Achievement Framework has been developed to link the improved capability delivered by projects and workstreams to improvements in key performance indicators and the achievement of short and long term outcomes and benefits. 3) A prototype performance report is currently being collated based on these. Once this has been achieved a process will be established to enable quarterly production of this report. 4) Planning is commencing for the development of a new Strategy to succeed the 2019-24 Strategy.
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2 4 VARIATIONS TO DIRECTIONS? 5 BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Getting it Right for Every Person, a Mental Health and Wellbeing Strategy for Lanarkshire was launched in October 2019 to provide a shared vision and to drive significant shifts in culture (how we see and treat mental health and physical health), focussing on earlier intervention and prevention as well as the redesign and reconfiguration of services and development of new services. 5.2 There are 4 main workstreams within the Programme: Good Mental Health for All Improving Access to Mental Health Support and Services Children and Young People Mental Health & Wellbeing – fully integrated in the North Lanarkshire and South Lanarkshire Children’s Services Plans Specialist Mental Health Services 5.3 The Mental Health and Wellbeing Strategy Board and the majority of project groups were stood down in March 2020 due to the COVID-19 pandemic. Whilst Strategy delivery was restarted in January 2021, there was a further disruption over the summer of 2021 when all non-essential meetings were stood down owing to the pressure on services. 5.4 Since the last update to this committee in November 2021, the delivery of the Strategy has continued to progress. Over the course of 2022, we have been looking forward, endeavouring to take advantage of the opportunities and experiences of working in different ways rather than necessarily, by default, return services to the way were delivered pre-COVID. All workstreams have reviewed their delivery plans to ensure that they: Take account of the impact of Covid-19; Build on our recovery plans and the new ways of working that have developed over the course of the pandemic; whilst Retaining a focus on the vision and objectives set out in the Lanarkshire Mental Health and Wellbeing Strategy; 5.5 The refreshed Implementation Plan for the Lanarkshire Strategy is attached at Appendix 1. This shows the progress that has been made across all Strategy workstreams and sets out plans for the final year of the current Strategy. 5.6 It also maps our plans in Lanarkshire onto the actions contained within the Coronavirus (COVID 19): Mental Health Transition and Recovery Plan, published by Scottish Government in October 2020, to ensure that they are consistent with current government priorities for mental health and wellbeing. Yes No N/A
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3 6 WORKSTREAMS 6.1 Good Mental Health for All 6.1.1 Challenging the stigma around mental health, promoting good mental health and addressing the barriers (social, environmental, financial or cultural) that make it more difficult for some people to take up opportunities to improve their wellbeing, are a priority across Lanarkshire. 6.1.2 The Covid 19 Pandemic was stressful for many and threw a spotlight on the relationship between mental and physical health. The impact was not experienced equitably. Those least able to draw on protective factors (good health; financial wellbeing; affordable housing; employment; being able to work from home; support home schooling) were less equipped to deal with the impact. It exacerbated long-standing inequalities in being able to thrive in the face of adversity. 6.1.3 The longer-term impact of the pandemic is likely to widen these inequalities further unless significant action is taken. This has taken on a new urgency with the emerging cost of living crisis, compounding the threat and further widening the gap. 6.1.4 Our approach to promoting good mental health and wellbeing and the collective actions/programmes of work undertaken by all community planning partners is distilled in our Good Mental Health for All North and South Lanarkshire Delivery Plans. 6.1.5 The GMHFA Delivery Plans cover 6 key areas: Mentally Healthy Infants, Children and Young People; Mentally Healthy Later Life; Mentally Health Environments and Communities; Mentally Healthy Employment; Reducing the Prevalence of Suicide, Self-Harm, Distress and Common Mental Health Problems. 6.1.6 The Key Highlights from 2021/2022 are set out below. Challenging Stigma and Discrimination 12 NHS Stigma Free Champions have been trained by Stigma Free Lanarkshire 14 Understanding Stigma Workshops have been delivered by champions 152 Participants attended The Leaders of North Lanarkshire Community Planning Partnership committed to ensuring their workplaces and communities are free from mental health stigma and discrimination by signing a pledge to action, creating social media videos with key messages and creating a podcast series 4 Leaders’ workshops delivered – attended by 76 Leaders from NHSL, Police Scotland; NLC; VANL; Fire and Rescue Launch of a Justice Services Pilot in South Lanarkshire (November 2022) focusing on workplace culture: delivering targeted workshops; leaders messaging video; champions programme; and a comprehensive evaluation programme to determine the impact of the SFL/SLC partnership Suicide Prevention Between March and August 2022, 650 people were trained in Suicide Alert across North and South Lanarkshire (90-minute awareness raising workshop)
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4 Between March and August 2022, 162 people were trained in the more intensive (2-day) Applied Suicide Intervention Skills Training (ASIST) Breathing Space benches aim to create welcoming spaces to sit and chat. 4 new benches were installed in 2022 A range of activities and awareness raising events took place during suicide prevention week (4th-10th Sept) including: themed walks; zumba; football tournaments; golf tournament; mindfulness sessions; ALERT training sessions; distribution of suicide prevention drinks coasters with key messaging Recovery “Mental Health is a destination, not a process. It’s about how you drive, not where you’re going” On 2nd November 2022,150 people came together to share stories and celebrate recovery. For many it was the first opportunity to connect with others face-to-face since before the pandemic. 100% of people said they enjoyed the event 100% of people said the event met (or exceeded) their expectations 95% said they’d learned something about recovery 89% said the event had helped with their own recovery “Inspiring and humbling to open up and release your feelings “It has sparked inspiration for helping others and making a positive difference in High Schools (Coatbridge High School) “Without a doubt, helped my recovery” Distress Brief Intervention Distress Brief Interventions (DBI) are an innovative way of supporting people in distress. DBI consists of two parts, with Level 1 seeing trained front-line health, police, paramedic and primary care staff help ease any individual. They then ask the person if they would like further support and, if they agree, they are referred to the DBI service with a promise of contact within the next 24 hours to start providing further face-to-face support. Level 2 is provided by commissioned and trained third sector staff who contact the person within 24-hours of referral and provide community- based problem solving support, wellness and distress management planning, supported connections and signposting. To date 9,316 people across Lanarkshire have accessed third sector (Level 2) support. Between Oct 2021 and Sept 2022 this averaged at 189 referrals per month. The most common source of referral were: A&E departments (40%); followed by Primary Care (21%); Psychiatric Liaison Service (18%); Police Scotland (13%); Scottish Ambulance Service (3%) 79% of appropriately concluded cases engaged in DBI support. Of those, 76% engaged in further support beyond the first supportive intervention The most common presenting problems included: Depressed/Low mood (65% of referrals), Stress/Anxiety (56% of referrals). Suicidal thoughts (40% of referrals) Priorities for Action Secure funding for the Stigma Free Lanarkshire Programme Team. Focus on embedding work to challenge mental health stigma and discrimination
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5 Promote a confident, confident and skilled workforce through delivering training and building capacity for delivering training in-line with the NHS Education Scotland Framework for Mental Health Improvement and Suicide Prevention Promote a compassionate response to people presenting in distress by embedding Distress Brief Interventions into mainstream services and supports Reduce the number of suicides across Lanarkshire through driving a programme of work in line with the new national suicide prevention plan, Creating Hope Together Improve access to a range of non-clinical supports to improve mental health and wellbeing via Well Connected and other social prescribing programmes and the Communities Mental Health and Wellbeing Fund Deliver an annual Recovery Event for Lanarkshire enabling people with lived experience to share stories of recovery and explore what recovery means to them Explore robust Health and Equality Impact Assessments by means of strengthening active consideration of mental health and wellbeing to support a ‘mental health in all policies’ approach. 6.2 Improving Access to Mental Health Support and Services (IAMHSS) 6.2.1 IAMHSS has been concentrating on specific areas to ensure the right support is available at the right time within Primary Care, Emergency Departments, Custody Suites and Prisoner Healthcare and through the development of digital solutions. This workstream has also been responsible for developing and implementing proposals for the use of funding for mental health posts made available through Action 15 of the Scottish Government’s Mental Health Strategy. 6.2.2 Primary Care Mental Health & Wellbeing Teams Primary Care Mental Health and Wellbeing Service (PCMHW) model for Lanarkshire developed with Mental Health Liaison Nurses now covering 91 GP practices supported by LAMH Mental Health and Wellbeing Workers providing a non-clinical role. The Service provides clinical triage and assessment, and both clinical and non-clinical brief interventions and/or support(s) to people experiencing mild to moderate mental health problems of a short-term nature accessed via their GP practice. The Assessment Plus Project is now providing guided self-help intervention in 3 localities. Assessment Plus is a Cognitive Behavioural Therapy (CBT) based guided self-help intervention. It is facilitated by assessment and formulation of individual patient needs by clinical psychologists to create a person centred plan of care based on guided self-help. Assistant Psychologists then work with the patient to deliver the agreed care plan over a time limited number of sessions. Between January and November 2022, a total of 11,155 referrals were received: 10,810 for the Mental Health Liaison Nurses & 345 for the Mental Wellbeing Workers. 6.6% of patients seen required onward referral to secondary care mental health or addiction services. Feedback from key stakeholders thus far has been very positive. There are risks attached to this expansion of the service particularly with regards to lack of accommodation for a staff base. This creates significant difficulties in staff ability to complete clinical administration tasks, provision
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6 of clinical supervision; development reviews; case management, and the delivery of in-house training. 6.2.3 Emergency Departments Staff recruitment process has been successful with a few posts again outstanding due to natural movement of staff. The Flow Navigation Centre (FNC) went live in December 2020 and is fully established in-hours providing an alternative to ED triage for a mental health assessment. Unscheduled care sub-group established to look at the professional interface and strengthen pathways between PLNS and Mental Health specialities. This will ensure more defined and robust processes linked to the patient journey and experience of accessing services within localities. Direct links with Psychiatric Liaison Nurse Service (PLNS) for Community Police Triage (CPT) and Scottish Ambulance Service (SAS) triage is fully established for both in hours via FNC and Out-of-Hours (OOH) at Douglas Street. Expanded in November 2021 to include British Transport Police. (OOH) service at Douglas Street has expanded and is now fully embedded with Standard Operating Procedure (SOP) in place for patients to be triaged and assessed via telephone, virtual platform, or face-to-face appointment. Mental Health Advanced Nurse Practitioners (ANPs) now form part of unscheduled care and liaison services and have developed good links with primary care services to support overall senior decision making. An additional ANP pilot commenced in February to support a triaged liaison approach across the 3 Acute sites. Feedback that it’s going well. Measures are being collated for evaluation. Systematic regular communication between senior staff in EDs, police and SAS established and progressing well. Links established with NHS24 and work ongoing to map pathways and systems. A robust governance framework has been established that spans across mental health unscheduled care service. Consistent weekly data is being reported across all work streams regarding FNC, OOH and source of referrals as well as ED assessments and missed opportunities where assessment could have taken place outwith ED. Annual reports compiled for 2020 and 2021 to identify benefits and challenges in the delivery of unscheduled care and to provide data to determine further areas for service improvement. Patient stories obtained to reflect experience of accessing unscheduled care services. Annual CPT data reviewed with positive progress evident, to date there has been an overall reduction of 68% in police attendance at ED. Work ongoing linking to National Redesign of Urgent Care (RUC) group. Pathway benchmarking against National roadmap completed for our service with no major gaps identified. Lanarkshire has been recognised through RUC as having made good progress and on track with implementation of National requirements. 6.2.4 Custody Suites 2 Advanced Nurse Practitioners ANPs recruited through Action 15 funding in place and providing a valuable mental health assessment resource to
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7 support people who present with mental health needs when detained for any period of time. Feedback has been positive. 6.2.5 Prisoner Mental Health Staffing model for the mental health within Shotts Prison developed to ensure the level of care for prisoners reflects the services offered to the rest of the population. Psychological Therapies Service posts and the Health Improvement Practitioner post have been recruited to, though there remain challenges around filling some of the other posts: o Unable to recruit to a Band 7 Advanced Nurse Practitioner post due to salary issues; however, agreement was reached to recruit 2 ‘whole-time equivalent’ Band 3 Support Workers instead. o An Administrator was recruited and has since left post. It has been difficult to recruit a replacement. o An Occupational Therapist was recruited and left post shortly after. Again, it has been difficult to recruit a replacement. Notwithstanding recruitment and accommodation challenges, the population of HMP Shotts now has improved access to a wider range of mental health services – in particular psychological therapies and health improvement – through a match-stepped model of care. An Multi-Disciplinary Team approach has been established with weekly MDT meetings incorporating all specialities. Referral pathways have been established, ensuring patient-centred care. Communication between specialties is improved with an increased focus on health improvement. The main risks relate to significant difficulties in recruiting and retaining staff and a lack of fit for purpose accommodation for the new multi- disciplinary team within HMP Shotts. 6.2.6 Digital Solutions Digital solutions are being explored to help provide services in new ways that make them more accessible and enhance patients’ experience. The Digital Safety Plan project was short-listed for the Holyrood Connect Awards. Near Me is being well-used with CAMHS, Psychology, and Psychiatry the top 3 users of the system. MORSE transition completed for all previous Midis users. Work remains underway for remaining services to migrate to MORSE system. Successful collaboration with Connecting Scotland to provide devices and support to service users. Increase in use of digital interventions for service users. Specific digital intervention training completed and MORSE training completed. Digital champions have been identified and regular meetings are in place which are very well attended with good practice being shared. 6.3 Children and Young People’s Mental Health and Wellbeing 6.3.1 CAMHS and Neurodevelopmental Services CAMHS In 2021, the Scottish Government Children and Young Peoples Mental Health and Wellbeing Taskforce published national specifications for Child and
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8 Adolescent Mental Health Services and Neurodevelopmental Services. Both Specifications aim to ensure that children and families receive the supports and access to services that meet their needs at the earliest opportunity, based on the GIRFEC approach. For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. These services are required to be available for all children and young people who are aged 0-18 years, and young adults aged 18-24 (and up to age 26 for care experienced people). The Lanarkshire CAMHS Modernisation Programme 2021-23 has been established to implement the National CAMHS Service Specification – as well as associated Scottish Government directives – by March 2023. The purpose of this programme is to assess, evaluate and, where appropriate, redesign Child & Adolescent Mental Health services, ensuring a whole systems approach based on children and young people’s rights and relationships, to deliver safe, effective and child-centred care across Lanarkshire. In April 2021, North Lanarkshire HSCP received confirmation from Scottish Government of recurring funding specific to CAMHS of £3.3 million via the Recovery and Renewal Fund (RFF). The main areas of focus of the Programme are: Implementation of the Choices and Partnership Approach service transformation model for CAMHS by March 2023. Full implementation of the national CAMHS Specification to include extension of age range, requirements for eating disorder patients and planning for transition of care by March 2023. Numbers of children and young people in CAMHS already nearing the age of 18 requires to be gathered and numbers of patients who wish to remain under the care of CAMHS requires to be quantified in order to inform demand. Timelines for this activity are contained within the project plan. Full implementation of Children and Young People – national neurodevelopmental specification: principle and standards of care. Neurodevelopmental Service Nationally there is an expectation that Neurodevelopmental Service will deliver an assessment and diagnosis of neurodevelopmental disorders including Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD) and Dyspraxia. This will be delivered locally via highly specialist multi-disciplinary staff. Recovery and Renewal funding (RRF) of £375,311 in 2021/22 and £643,917 in 2022/23 has been provided to support delivery of the national Neurodevelopmental Service Specification to include clearance of all waiting lists by March 2023. The main areas of focus of the Neurodevelopmental Services in Lanarkshire are: Consolidation of a dedicated NDS team with appropriate line management and professional support by January 2023 Progress of delivery towards full implementation of the national NDS specification by March 2023.
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9 Choices & Partnership Approach (CAPA) CAPA is a service transformation model that combines collaborative and participatory practice with service users to enhance effectiveness, leadership, skills modelling and demand and capacity management. Implementation of this model is wholly dependent on our ability to recruit workforce and secure accommodation, IT and supportive administrative infrastructure. A plan has been developed to expand CAMHS age range from 18-25 and to implement the transition care protocol. A series of workshops have been held, attended by representatives from the Directorate for Mental Health at the Scottish Government, and the outcomes of these cascaded to staff across the service and support services. These workshops included CAPA engagement sessions for the CAMHS management team, a CAPA Master Class for CAMHS clinicians and a separate information session for HSCP leaders. CAMHS in Lanarkshire visited CAMHS colleagues in NHS Grampian to establish a supportive network and learn lessons from their implementation of the CAPA model. CAMHS are currently in receipt of improvement support via the SG Mental Health Division Performance Unit Liaison Lead, Professional Advisor and Improvement Advisor. This support will continue for the duration of the Modernisation Programme. A series of workshops/away days for locality teams were held in late November and December 2022. All teams are being supported by service improvement, project leads and waiting list coordinators. A key to successful roll out of CAPA model will be the quality assurance work that precedes it. This includes caseload review with support and supervision from clinical coordinators and delivery of a Duty Team that can field and appropriately respond to unscheduled care requests and crisis. Workforce Work has been completed with the Scottish Government Improvement Advisor and Professional Advisor to analyse CAMHS capacity (based on current funded establishment) against demand (numbers of referrals per head of population). From the analysis, it is evident that in order to meet Referral to Treatment (RTT) trajectory, CAMHS requires 131 WTE of which 90 WTE must deliver services that contribute to the RTT. CAMHS recruitment continues and Recruitment Landing Page is in development. An exercise has taken place to review locality capacity in each CAMHS team with a view to building a capacity calculator to facilitate modelling and forward projections of the numbers of new/return CAPA appointments required to meet Waiting Lists and ongoing demand. Skill mix is being reviewed with the of produce job plan/clinic templates for beginning of roll out of CAPA towards the end of January 2023. An expected outcome of this is the design and implementation of a CAPA calculator/ timetable to provide an even spread appointments across teams, with regular review (every 12 weeks) of capacity against demand to allow enhanced/ sufficient capacity for new/return patient appointments, with the correct ratio for staff groups to ensure waiting time management. It is anticipated that this will be in place following the waiting list initiative described below to ensure seamless transition.
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10 Recruitment is also underway within the Neurodevelopmental Service to complement and expand the current workforce. All posts are live and interest was received. Waiting List Management and Initiative A Waiting List validation exercise has been completed which saw a reduction in the list of 15%. These patients either no longer wanted treatment or did not opt in to remain on the Waiting List as per NHS policy. Patients on the list were divided by age group: over 16’s were written to individually and under 16’s the parent/carer or guardian were contacted. A waiting list initiative commenced at the end of August 2022 to provide additional sessions to complete new patient assessments both in and out of current working hours. Since then more than 600 patients have been taken from the waiting lists. As anticipated, compliance against the Referral to Treatment target has reduced due to the waiting list initiative clinics now being in place and new capacity being focused on seeing individuals who have already breached the 18wk target. 15% of the children and young people seen are discharged and less than 1% transferred to other support. A greater understanding is needed of the circumstance of children and young people who are in this position. This has potential to inform wider thinking on how we could deliver a whole system response that is capable of diverting them earlier in care journey. Work is at an advanced stage with procurement colleagues to seek an external supplier to support a cohort of children and young people over the age of 12 with their neurodevelopmental assessment and diagnosis. Young people who are in the later stages of transition to further education or work will be prioritised. It is recognised that this will not suit all our families, children and young people, so the Service will continue to offer assessments from the Neurodevelopmental Service for children over 12 years of age. Accommodation The new South Lanarkshire CAMHS facility within Udston Hospital, supporting CAMHS, the Eating Disorders team and the Neurodevelopmental Service opened to patients on 5th September 2022 and is now fully operational. It hosts South locality teams as well as our Neurodevelopmental Service. We have received positive comments from the children, young people and their families who have been seen within the building. Work is ongoing to develop artwork that will complement the space. An official opening of the building is planned for early 2023. This facility is in addition to the remaining satellite clinics within South Lanarkshire health centres which ensure local access for those who are unable to travel. Monies have been identified that will support refurbishment of our North Lanarkshire estate to bring it to same standard of Udston site. eHealth A cleanse exercise has been undertaken of Trakcare, the NHSL patient management system. This includes a refresh of the options available for staff to book patients in different locations and under specific clinicians. Once completed, this will have a positive impact on the data being extracted which will be used to report 18-week RTT performance to Public
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11 Health Scotland. This will also allow the Service to understand capacity versus demand more robustly, which in turn will allow better planning and leaner pathways for children and young people. In addition to this, NHS Lanarkshire is working with GPs to enable electronic referrals to be sent to CAMHS using the national system. SCI Gateway for CAMHS went live on 1st November 2022 and the Service has been receiving approximately 8 electronic referrals per day (which is in line with referral rates). Those GPs who continue to refer by paper are being asked to use the SCI Gateway platform. The benefits of using this system means that information is available to referrers about the services CAMHS provides, as well as other support services, and accurate/robust information at the point of referral. This will ultimately allow CAMHS to make decisions at the point of vetting more timeously and which are more clinically appropriate. All our mental health inpatient estate has embedded ward Quality Groups which has supported development of local outcomes around meaningful activity for individuals within our acute admission areas. Current paper records have been moved to an electronic patient record (MORSE). This will release time for clinicians and administrative staff as well as enhance information governance security. Interfaces between systems are also key to allow a more streamlined approach to working with the necessary information between electronic referrals, appointments and record systems. Communication and Engagement Extensive staff engagement in conjunction with Human Resources and Partnership is ongoing in order to embed the Modernisation Strategy with particular reference to the CAPA transformation model. Stakeholder engagement events were organised in 2021 to include HSCP Core and Strategic Leadership Teams. A CAMHS Communication and Engagement Task Group has been established to develop a Communication and Engagement Plan for the delivery of the programme. The programme also has a dedicated engagement officer to support and lead on engagement activities and events. The engagement activities have included attendance at various children’s, young people’s and family forums and networks as well as organising stakeholder engagement events with the third sector groups and local communities. A brand new CAMHS logo is being designed by New Lanarkshire College students. This is planned to be completed and approved in January 2023. 6.3.2 Children and Young People’s Community Mental Health and Wellbeing Support and Services Delivering improvements for children and young people’s mental health and wellbeing is embedded in the North and South Lanarkshire Children’s Services Plans and associated workstreams, led by the children’s services partnership boards. Since the launch of the Lanarkshire Strategy, the focus has been on continuing to deliver priorities through existing children’s services planning structures and workstreams with a focus on prevention/early intervention and promoting positive mental health and resilience. Funding from the National Children and Young People’s Mental Health and Wellbeing Programme is being provided for the delivery of community mental
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12 health and wellbeing supports and services for children and young people. This is to support the development and provision of bespoke services that are right for each local authority and direct support for children and young people. The Scottish Government is clear that funding is to be used for new or enhanced services. Project officer have been recruited by both local authorities and gap analysis, benchmarking and co-production of services has been undertaken. Key developments in North Lanarkshire The GIRFEC in NL website is live and includes a section on supports and services which is under development. The website will include information on mental health and wellbeing resources, in addition to links to relevant NHS and other websites in line with target audience. Pan-Lanarkshire discussions have been taking place on a specific Mental Health and Wellbeing section for children and young people, parents/carers, and professionals and this will be procured by NHS as part of the Elament update. The intention is to co-design this site with target groups. Further to feedback from focus groups, we are hoping to organise events for young people, in both North and South Lanarkshire in February 2023 to celebrate Youth Mental Health. The idea is supported by Education, Community Learning and Development (CLD), NHS Health improvement, Stigma Free Lanarkshire and other partners as an opportunity for young people to both design an event and showcase the work that has been ongoing. In relation to Community Mental Health Framework funding, the below developments are ongoing: o Empowering cluster work through Community Solutions o Family support workers x 2 (Neurodevelopmental/ASN) o Family support workers x 1.5 – cluster-based (CAMHS referrals) o CLD Living Life to the Full programme with additionality in workforce. o Active and Creative communities – peer mentoring and diversionary mental health work. o Procurement of a digital platform for mental health and counselling support (underway) o Procurement of counselling support for care-experienced young people, as part of a co-production exercise with TNT (underway) School counselling continues to be accessed within each cluster, with increased promotion of self-referral for those who wish to access it this way. As the School nurse workforce grows, the emotional and wellbeing pathway will offer additional access to health support for children and young people. Let’s Introduce Anxiety Management (LIAM) training continues to be delivered across NLC and discussions are underway regarding expansion of training within education and other partners. Early discussions are underway to address the identified gap for 16-26 year-old care experienced young people to access Health services supported by a multi-agency sub-group. Suicide and Self Harm Prevention Training to support the implementation of the Lanarkshire Lifelines resource and Critical Incident procedures continues which will support with the emerging issue of self-harm.
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13 The Suicide Prevention Group will oversee resources and scope any gaps. Key developments in South Lanarkshire South Lanarkshire Children’s Services Planning Continue to engage with children, young people and families about mental health and wellbeing needs in the community. Implementation of Kooth (online mental health support). Engagement with workforce around Whole Family Wellbeing Fund. Family Support Hubs have been launched across the 4 localities of South Lanarkshire. The focus of the work is to provide earlier intervention and holistic support to families to prevent escalation to statutory social work. Between July and December 2022, 1,640 referrals were received from Police Scotland, Education Resources, NHS Lanarkshire, housing, community groups and families. Initial feedback has been very positive. Engagement with Young People on Mental Health Services In line with the increased focus on the UN Convention on the Rights of the Child (UNCRC), and recognition of the importance of including young people in planning and participating in service design, a large-scale survey was co-designed with young people. In addition, focus groups were completed with young people, including a number of at-risk groups. The views of 3,536 young people were sought and fed into a report with the following recommendations: o Increase capacity for mental health supports within primary schools o Exploration of peer support programmes o Easier access into services – clear pathway to access support o Look at more universal supports available within our communities o Focus on increased supports for families o Improved signposting / advertising of services o Ensure groups which are at higher risk of experiencing mental health difficulties are able to access appropriate mental health supports o Ensure teachers are aware of supports with regard to signposting o Review mental health curriculum and supports within schools, in line with the PSE review o Establish reference groups for parents/carers and young people moving forward Early Intervention Theraplay play therapy is being offered for 5-9-year-olds. Theraplay is a child-centred, resilience focused approach in which the practitioner works collaboratively with the school and family over eight weeks. Play therapy has been introduced as part of a broader set of supports for children under 10. Referrals are via primary schools. Action for Children programmes o Bouncing Back - 22 targeted schools are accessing two CBT-based workshops with a focus on resilience-building for primary 4 and 5 pupils. Approximately 1,000 children will take part. o The Blues Programme roll out in secondary schools is continuing, with 258 young people taking part from August-December 2022. SAMH o Plan to deliver peer support programmes for secondary schools is underway. Workshops for parent/carers and staff have been trailed and will to be rolled out soon.
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14 Suicide Prevention/Self Harm Briefings and Training Lifelines Lanarkshire - a training plan to support the roll out of Lifelines Lanarkshire multi-agency guidance for staff supporting children and young people who may be at risk of suicide and self-harm is underway. Thus far the following have been completed: o A range of briefings both at the strategic level and the practitioner level across SL Children’s Services has taken place, including all staff in Education Resources via the annual Child Protection Briefing in August 2021/August 2022. o Half day Skilled Level training for key staff: • 261 key staff from all mainstream secondary schools • 2 cohorts of Children’s Services social work staff • 2 cohorts of Youth, Family and Community Learning staff o Next steps: • Pilot training for key primary school staff and ASN staff • Develop an online module at Informed Level for all staff • Planning to develop a Training for Trainers manual/training for key Children’s Services staff Applied Suicide Intervention Skills Training (ASIST) has restarted. Thus far: o 42 staff trained in this period o Future courses running at full capacity Children’s Mental Health Week – Celebrating Mental Health Events taking place to coincide with Children’s Mental Health Week on 6 - 13 February 2023. Focus is to share good practice, signpost resources and link in third sector and other partners in conversations about supports. The South Lanarkshire Youth Council is has worked with partners to help us plan the week. Kevin Stewart, MSP, Minister for Mental Wellbeing and Social Care plans to speak at the conference on Wednesday 8th February, with young people representatives in attendance. Workforce Wellbeing – Supervision/Reflective Practice Plans There has been an increased awareness of and focus on staff wellbeing across Children’s Services. Thus far, Social Work Resources has trialled two reflective practice models, which were evaluated positively. Next steps for workforce wellbeing: o Piloting and evaluating Place to Think reflective groups for school Child Protection Coordinators o Piloting Counselling Skills training modules for education staff o The Education Resources Mental Health and Wellbeing Group are undertaking a needs analysis to consider further the supports that may benefit education staff when working with vulnerable children and young people. 6.4 Specialist Services 6.4.1 Older Adult Inpatient Provision Hospital Based Complex Clinical Care (HBCCC) Before the pandemic IJB approval was given to commence an engagement exercise with service users, next of kin, and care home with a view to consolidating contracted HBCCC beds onto a single care home
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15 site. The aim being to support new opportunities for multi-disciplinary team-based working and a range of services provided that will benefit the patients. Owing to the COVID-related risks associated with care home transfers, this proposal was put on hold. IJB approval was given in September 2021 to recommenced this work. In line with HIS ‘Planning with People’ guidance, an Engagement Planning Group was established, comprising key staff and stakeholder groups, to enable effective engagement with all those impacted by the planned service change. The Engagement Planning Group completed an options appraisal with the option of consolidating provision at Hatton Lea Care Home proposal scoring highest. EQIA completed for the planned service change. Business case subsequently approved by North Lanarkshire IJB and endorsed by NHS Lanarkshire and South Lanarkshire IJB. EQIA drafted for review by with Engagement Planning Group. Next tasks: o Review existing Cumbernauld patients’ on-going care requirements; confirm funding arrangements for each patient; and hold individual meetings with patients/carers/families to agree future care arrangements. o Agree Cumbernauld exit plan with Four Seasons. Camglen inpatient provision Letter received from Glasgow City HSCP giving 6 months’ notice of termination, effective from 23rd May 2022, of the agreement to provide access to NHSGGC Older People’s Mental Health in-patient beds for residents of the Camglen area. Admissions of Camglen patients to Udston commenced on w/c 17th Oct. It was agreed that no NHSGGC inpatients would transfer at this time. Solution implemented enabling Camglen CMHT Morse access to input admission information and access discharge information. No new medical staff have been recruited at this time to support the transfer of patients from Camglen; therefore, two designated medical staff from within Older Adults have been designated responsibility for in-patient care as an interim measure. Further discussion required with NHSGGC to clarify the final steps of the transfer of OPMH in-patient beds for residents of Camglen area. 6.4.2 Review of Adult Rehabilitation and Recovery The objectives of this workstream are to: Develop a single referral process and electronic referral form and agree the process for assessment of referrals Review discharge planning processes; establish a notional timeframe for discharge planning on admission; identify barriers to discharge; and establish a process to ensure that potential/actual delayed discharges are escalated. Review the current Community Rehabilitation Team model. Completed work: Mapping of Glencairn and Community Rehab referral and assessment processes completed. New referral form in place with a single point of referral.
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16 Pathway to community rehab now live Planned date of discharge is in place. Review of the Community Rehabilitation Team model has been completed. The new nursing model is now embedded in practice. Rehabilitation & Recovery Service Operational Policy is being finalised EQIA drafted 6.4.3 South Lanarkshire Integrated Community Mental Health Teams (CMHTs) Interim centralised operational management structure agreed. CMHT Service Manager in post. Clinical & Professional governance structure agreed by Mental Health & Learning Disabilities Clinical Governance Group & South Lanarkshire Support, Care & Clinical Governance Group. Principles agreed for disaggregating hosted services and transfer of funding to South Lanarkshire. Transfer approved by North Lanarkshire and South Lanarkshire IJBs. Funding and nursing staff transferred to South Lanarkshire HSCP. 6.4.4 Perinatal and Infant Mental Health A successful funding bid was made (in Sept 2020) to the National Perinatal and Infant Mental Health Programme for the development of a whole-system model for perinatal mental health care that enables women, their partners and families to be supported in their own communities; the establishment of a multi-disciplinary Community Perinatal Mental Health Service; and the establishment of a designated multi-disciplinary NHSL maternity and neonatal psychological intervention service. Separate funding has also been granted to enable the development of shared strategic goals and agreed pathways for indicated high risk infants and their parents who are not currently accessing clinical services; the development of a model of infant mental health provision; and the establishment of a designated multi-disciplinary and multi-agency Infant Mental Health Service. Perinatal Mental Health, Infant Mental Health and Maternal & Neonatal Psychological Interventions Service Development Groups were established, reporting into the PIMH Steering group. Engagement with lived experience activities planned out and underway NHSL Perinatal Mental Health Service: Dedicated specialised community perinatal mental health team established, incorporating psychiatry, community mental health nurse, clinical psychology, community nursery nurse, midwifery, occupational therapy and social work staffing. Recruitment to the expanded team completed. Education and training models rolled out. Clinical Quality Group set up. Clinical pathways established to ensure timely and equitable access for women to specialist perinatal mental health services. Systems in place to ensure that professionals working in universal services with women and their partners and families can access consultation, information and advice in a timely manner.
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17 Improved access to third sector support services. Information materials and webpage developed to provide access for women and their partners/families to timely information to help them to make informed choices. Systematic engagement with lived experience and third sector in place – ensuring feedback incorporated into service design Data collection in place to measure access to service and impact of service and development of a system of continuous quality improvement 6-monthly progress reporting against outcomes to the National Perinatal and Infant Mental Health Programme NHSL Infant Mental Health Service: Funding secured from the Scottish Government for a Lanarkshire Infant Mental Health Service Multi-agency, multi-disciplinary Infant Mental Health (IMH) team established Clinical model developed. Multi-disciplinary multi-agency IMH training programme in place for all agencies including third sector Infant Mental Health Easy Access Telephone Advice Line & Consultation System established for Health Visitors NHSL LearnPro Foundation level module on Infant Mental Health: When to be Concerned for all NHSL staff working with infants and their parents Development of a Pan-Lanarkshire Multi-Agency Infant Mental Health Observational Indicator Set [birth to 3rd birthday]. Systematic engagement with lived experience and third sector in place – ensuring feedback incorporated into service design. 6-monthly progress reporting against outcomes to the National Perinatal and Infant Mental Health Programme Study of Barriers to Access to Mental Health Service and Mental Health Support for Infants in Lanarkshire planned NHSL Maternity and Neonatal Psychological Interventions Service: Funding secured from the Scottish Government until 2023 for a Maternity and Neonatal Psychological Interventions (MPNI) Service. MNPI Team recruited. Induction and training programme for new staff developed with reference to the NHS Education for Scotland Perinatal Mental Health Curricular Framework, and ‘Essential Perinatal and Infant Mental Health’ e-learning resource. Clinical model and pathways developed to ensure timely equitable access. Systematic engagement with those with lived experience and third sector representatives to ensure feedback incorporated into service design, information leaflets and website. Website content developed in draft form and linking with communication department Experts by Experience consultation organised for Neonatal Parents. Continued links with Maternal mental health participation officers. Increased access to third sector services for service users Data collection in place to measure access to service and impact of service and development of a system of continuous quality improvement Evaluation and impact assessment – 6-monthly reporting of progress against outcomes
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18 6.4.5 Forensic Mental Health Forensic Mental Health Services did not stand down during the pandemic. Community Team and 2 wards continued to function with the Scottish Government framework with limited face-to-face contact. Two significant reports have been published: Independent Review into the Delivery of Forensic Mental Health Services: o 67 recommendations – some will have a fairly big impact if implemented, whilst others are ‘housekeeping’. o Scottish Government have had 2 option appraisal events. Initial 9 options were shortlisted to 4 although one option, status Quo would not be considered by Scottish Government as they had accepted that this was not acceptable following the Barron report o The first round of options had a new ‘national Board’ as the 1st ranked option. We await the report of the latest option appraisal held in June Pathways for Women Through Forensic Mental Health Services (The Forensic Network): o Options appraisal produced recommendations for high, medium and low secure provision o Work progressing on provision of beds for females at TSH. No report as yet There is significant concern nationally over a lack of secure accommodation across Scotland. Work is ongoing to create capacity but there are pressures in the short to medium term. A Bed Capacity Group organised by Forensic Network meets regularly to review capacity across the forensic estate. 6.4.6 Tier 3 Eating Disorder Specialist Service (TESS) NHS Lanarkshire was allocated £545,796 over financial year 2021/22 from the Scottish Government’s Mental Health Recovery & Renewal Fund in response to the National Review of Eating Disorder Services’ Recommendation 1 to support services to meet the urgent needs of eating disorder patients and services as a direct result of an increase in the number and severity of eating disorder presentations related to the Covid- 19 pandemic. Avoidant and Restrictive Food Intake Disorder (ARFID training) has now been completed. This has highlighted how wide the scope of ARFID presentations is. There is staff opinion that TESS may be best placed to treat people who are deemed high physical risk because of their Feeding Disorder (as per interim ARFID agreement); however, there is no additional resource attached to this. Our 8B Clinical Psychologist will undertake a needs assessment of this group. Eight CBT-ED (cognitive behavioural therapy for people with eating disorders) supervision groups have now been set up to support implementation of CBT-ED training and have been running monthly. Good uptake of B-EAT Eating Disorders training workshops for staff Work is ongoing to set up GP pilot for Momentum and Carers interventions Family-Based Treatment (FBT) supervision has been arranged and supervisors allocated. There have been difficulties recruiting to a number of posts (dietetic, OT and nursing)
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19 Physician session and recruitment of a GP outstanding. Half day team session took place on 6th September to review service criteria and implications of supporting patients who present with ARFID. Developing a dietetic pathway for local Eating Disorder inpatient admissions and the interface between Mental Health and TESS dietitians Linking in with providers and third sector organisations who will deliver implementation of additional clinical services and pilot projects. Short term funding impacts on ability to appropriately plan and take a strategic vision -2022-23 funding still to be confirmed. The inpatient test of change proposal was dependant on utilising SG monies to support significant additional recruitment – this is looking less feasible as the year progresses NHSL has no specialist Eating Disorder Admission route for males with eating disorders across Scotland – and more men considered very high risk are attending the service 6.4.7 Psychotherapy The objective for this workstream is to establish a single Lanarkshire-wide Psychotherapy Service to ensure consistency in: o Structure and roles/responsibilities o Service delivery o Treatment interventions offered pan-Lanarkshire. Full time consultants are now in post in North and South Lanarkshire with an additional part-time consultant working 3 sessions per week in North. The key areas for development are the establishment of a pan-Lanarkshire quality group and also the organisation of a series of development days to look at systems and processes, including a patient’s journey from start to finish which will inform the content of an operational policy. 6.4.8 Mental Health Pharmacy The lack of dedicated proactive clinical pharmacy input has been identified as a significant risk into the care and treatment of patients accessing specialist mental health services in NHS Lanarkshire: o compromising safe, effective and person-centred care o introducing unwarranted variation in care o increasing risks of patient harm associated with polypharmacy, high risk medicines and care of those with complex conditions and multi- morbidities by lack of access to medication reviews in line with national standards o lack of access to pharmaceutical advice including evidence-based treatment to patients within these services Following a joint submission from NES and the Mental Health Pharmacy Strategy Group, the Scottish Government, announced funding to NHS Boards for 2021/2022 for Mental Health Pharmacist and Technician recruitment as part of an overall investment to be made available over four years until 2024/25, subject to successful recruitment and delivery of outcomes. A short-life working group was set up to agree plans in response to the funding announcement and a proposal developed for the use of SG funding in 2021/22 and 2022/23. It is understood that the recovery funding from Scottish Government is no longer going to be forthcoming. We are still waiting on a formal letter from SG regarding what is happening, but in the meantime, everything is on
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20 hold (and Finance are looking into what the state of play will be regarding ongoing funding of posts that we have recruited to) Further key issues include: o Pharmacy recruitment remains a challenge both within NHS Lanarkshire and within specialist MH services. o the need to maximise and optimally use the skills of the entire pharmacy workforce o the need to address challenges associated with the changing workforce of pharmacy and the wider MHLD multidisciplinary team o with all Scottish health boards potentially looking to recruit to similar posts at the same time, we need to be able to attract talent o the need to ‘grow our own’ within the service, with training posts, rotational posts, development opportunities, etc. o shoring up specialist MHLD pharmacy services in order to be better placed to offer support/ training to generalist colleagues working within acute services and/or primary care. Discussions have taken place with Acute and Primary Care colleagues about the potential for split roles/secondments in an attempt to address unsuccessful recruitment. 7 COMMUNICATION AND ENGAGEMENT 7.1 During the development of the Lanarkshire MHWB Strategy, a Communications and Engagement group was established with membership from service users, carers, and community and voluntary sector organisations to act as a reference point and influence and inform all aspects of GIRFEP. 7.2 As the Lanarkshire Mental Health and Wellbeing Programme moved into its implementation phase, the Communication and Engagement Reference Group has reviewed the Communication and Engagement Strategy to ensure that: communication is coordinated across all partner organisations and that all messages are transparent and consistent there is ongoing meaningful involvement with the communities impacted by poor mental health and wellbeing, particularly those with lived experience the right systems and supports are in place to enable effective engagement and participation between all stakeholders involved in strategy implementation 7.3 Communication and Engagement Plans for all Strategy workstreams have been presented to the group. These were welcomed with a number of questions asked including how communication and engagement outcomes would be measured and how workstreams might incorporate service user feedback. It was noted that the reports were useful in highlighting emerging issues and could be used to escalate responses. 7.4 A workshop took place in October 2022 to review the role of the Group as we move into the final year of delivery of the current Strategy. The following was agreed at the workshop: A group is still required to support projects with communications and engagement ideas and identify channels through which activities can take place.
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21 A new Communications and Engagement Strategy and supporting plan is required. We need to follow up with projects on progress, challenges, etc. and be assured that communications plans are being acted upon. The format of meetings to be more flexible, allowing for workshop-type sessions and sharing of information and ideas. Equality Impact Assessments should help in identifying themes for these. Communications and Engagement group meetings can be used as a platform for identifying and sharing new groups for engagement, etc. The group needs a Chairperson from the Strategy Board who has a broad overview of all the activities/projects underneath. The Chairperson should either be, or be supported by, a communications professional. Communications and Engagement meetings/workshops to be opened up to any Strategy Board ‘Lead’, allowing them to drop in and ask questions request help/support. To ensure any future Strategy is aligned with existing NHS Lanarkshire and Health and Social Care Partnership engagement structures and other related strategies. Planning the development of the next Strategy needs to start now and we need to think who we need to engage with and how to create a Strategy that is co-produced and meaningful. 8 EVALUATING IMPACT 8.1 Achievement Framework An outcomes-focused Achievement Framework has been developed (Appendix 2) for the Mental Health and Wellbeing Strategy that links the contributions made by projects and workstreams to outputs and the achievement of short and long term outcomes This can only be used to evaluate and report on work that has reached the implementation stage. Evaluation findings will therefore become available at different times. As we start planning the development of the new Mental Health and Wellbeing Strategy, work is underway with Strategy leads to evaluate impact across all areas of the Strategy 8.2 Performance Framework A short-life working group has developed a performance framework, consisting of a set of output measures aligned with the Achievement Framework, to assist in monitoring service delivery and directing future planning and investment (Appendix 3). These will include KPIs that are currently in use for reporting at national and/or Board or Partnership level. A prototype performance report is currently being collated based on these. Once this has been achieved a process will be established to enable quarterly production of this report. 9 CONCLUSIONS 9.1 In the wake of the Covd-19 pandemic, we looked to move forward and take advantage of the opportunities and experiences of working in different ways rather than, by default, returning services to the way were delivered pre- COVID.
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22 9.2 To this end, we have reviewed the delivery plans for all workstreams to ensure that they build on our recovery plans and focus our recovery efforts on the objectives set out in the Getting it Right for Every Person. 9.3 In support of this, an Achievement Framework has been developed to and a Performance Report is being finalised that will link the improved capability delivered by projects and workstreams to improvements in key performance indicators and the achievement of short and long term outcomes and benefits. 10 IMPLICATIONS 10.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community People who use Health and Social Care Services have positive experiences of those services, and have their dignity respected Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services Health and Social Care Services contribute to reducing health inequalities People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing People who use Health and Social Care Services are safe from harm People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide Resources are used effectively and efficiently in the provision of Health and Social Care Services 10.2 ASSOCIATED MEASURE(S) A Mental Health & Learning Disability Performance Review is currently produced 6-monthly which includes the following measures: Admissions and readmissions to Mental Health Wards Bed occupancy Psychiatry: numbers waiting more than 12 weeks (Adult/Older Adult/Learning Disability) Treatment Time Guarantee: % completed waits within 12 Weeks Psychological therapies: 18-weeks referral to treatment (Adult Psychological Services/CAMHS) Dementia: Number of patients diagnosed with dementia in the reporting quarter
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23 Percentage of patients on the waiting list for Dementia Post Diagnostic Support that have been waiting for less than 12 months The performance review includes other measures such as staff absence and training levels, DATIX incidents, complaints, out of area patients. 10.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A The landscape in relation to additional funding streams including Mental Health, released throughout the year by Scottish Government is complex with continued uncertainty around the scale and timing of future funding. The costs and funding available for 2023/24 will be closely monitored and reported. 10.4 RISK ASSESSMENT/RISK MANAGEMENT A Risk Management Strategy has been developed which aligns with the NHS Lanarkshire Risk Management Strategy. The risks currently on the Programme Risk Register are set out in Appendix 4. 10.5 PEOPLE The population and system approach adopted by the Strategy identifies the need to develop an integrated workforce plan, including training & developments plans and giving real consideration to the recruitment & retention of our workforce an essential component of its delivery. This recognises the importance and priority attached to developing a mental health and wellbeing workforce to meet the current and future needs of the population, including all staff (not just staff employed in mental health posts) is a challenge for the whole of the NHS and Partners in local government; education, social work and other public, voluntary and third sector organisations. The Strategy also highlights the need to improve current and future accommodation requirements, in order that we can ensure that the people who use and provide mental health services feel valued. 10.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A EQIAs have been completed for most Strategy workstreams with the remaining in progress. 11 BACKGROUND PAPERS Lanarkshire Mental Health and Wellbeing Strategy Lanarkshire Mental health and Wellbeing Strategy Summary Lanarkshire Mental Health and Wellbeing Strategy Communication and Engagement Report
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24 12 APPENDICES Appendix 1: Refreshed Implementation Plan Appendix 2: Achievement Framework Appendix 3: Output Measures Appendix 4: Programme Risks ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Maggs Thomson Head of Health on telephone number 01698 752591
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 25 Appendix 1: Refreshed Mental Health and Wellbeing Strategy Delivery Plan Good Mental Health for All Develop multiagency Good Mental Health for All Action Plans for North and South Lanarkshire that have the full buy-in of all partners. Support the shift in the balance of care from hospital to locally based community care increasingly being delivered through a blended model. Focus on Health Inequalities, the unfair and avoidable differences across social groups and between different population groups. Define the delivery, performance management and accountability structures for implementing and monitoring the action plan reflecting the prevention, promotion and support and recovery agenda. Support and influence partner organisations, strategies and plans that impact on mental health and wellbeing. Establish and participate in networks both within and outwith North and South Lanarkshire for the purposes of developing the evidence base and for sharing of good practice. Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Cross-Cutting Whole Population Mental Health 1.1 Clear Your Head 1.2 Measuring Population Mental Health 1.3 Physical Activity 1.4 Participation in Sport 1.5 Behaviour Change 1.6 Tackling Stigma Develop Performance ‘Dashboards’ across all 6 areas of GMHFA Develop a Comms plan incorporating a year- round, co-ordinated campaign strategy capitalising on national initiatives and awareness days and campaigns
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 26 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Mentally Healthy Infants, Children and Young People 6.1 Family Support. 6.2 Signposting to Help and Support. 6.3 Emotional Wellbeing 6.6 Training and Learning 6.7 Educational Psychology and School Counselling Services. 6.8 National Guidance. 6.9 Whole School Approach 6.10 Children and Families Workforce 6.12 Community Support 6.14 Emotional Distress. 6.15 The Promise Develop a repository of mental health resources for schools which encourage a whole school approach to mental health and reducing stigma and discrimination. Review, develop and support the roll-out of evidence-based parenting programmes in line with the Lanarkshire Parenting Pathway Establish working groups in both partnerships in the wake of the Covid-19 pandemic to prevent and mitigate child poverty, specifically working toward the ambitious income-based targets set out in the Child Poverty (Scotland) Act. Mentally Healthy Later Life Older People 9.1 Ensuring Mental Health Support & Build capacity within the third sector to address the needs of isolated and/or lonely older adults utilising the Community Mental Health & Wellbeing Fund
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 27 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Services for Older People 9.4 Loneliness Raise awareness and increase uptake of Carer’s Assessments and implement the 2018 Carer’s Act Promote active ageing, resilience and connectivity through asset based approaches, particularly for people diagnosed with dementia and other long term conditions. Mentally Healthy Environments and Communities Socio-Economic Inequalities 4.1 Tackling Poverty. 4.2 Mental Health Support for Those Living in Poverty 4.3 Benefits System Whole Population Mental Health 1.1 Clear Your Head 1.3 Physical Activity 1.4 Participation in Sport Improve engagement with communities Harness the Community Mental Health and Wellbeing Fund, to promote mental health and wellbeing Support a partnership approach to maximising our natural community assets through the Green Health Partnership Group Increase access to quality affordable and safe housing Prevent, reduce and mitigate the negative consequences of homelessness Work in partnership to address poverty across Lanarkshire Work with local sporting organisations, bodies and clubs to promote links between wellbeing, sport and inclusion
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 28 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Mentally Healthy Employment and Working Life Employment 2.1 Redundancy. (PACE) initiative. 2.2 Employability 2.3 Mentally Healthy Workplaces 2.4 Fair Working Practices 2.5 Home Working. 2.6 Support for Health and Social Care Workforce 2.7 Debt Challenge stigma and discrimination in the workplace through Stigma Free Lanarkshire Raise awareness of the importance of mental health and wellbeing and local supports with key agencies who support vulnerable clients back into employment Promote staff mental health and wellbeing following first-wave COVID 19 pandemic Staff Surveys to monitor mental health and wellbeing/inclusive cultures at work Training for Managers on Mentally Healthy Workplaces (including Home & hybrid Working) Collaborate with Community Planning Partners and Employability around the centrality of mental health and wellbeing, including the availability of training, stigma free workplaces, availability and inclusivity of supports Reducing the Prevalence of Common Mental Health Problems, Distress, Self- Harm and Suicide Relationships 5.1 Relationship Support 5.3 Relationship Trauma Continue to develop and extend accessible community assets and non-clinical sources of support to empower people to protect and improve their health and wellbeing
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 29 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 People Who Have Suffered Bereavement & Loss 10.1 Grief 10.2 Bereavement Support. 10.3 Compassionate Support 10.4 Bereavement by Suicide Distress Interventions 11.1 Distress Brief Intervention Suicide Prevention 12.1 Suicide Prevention Action Plan 12.2 Public Health Response 12.3 A Pandemic- Specific Response Maximise opportunities to promote mental health and wellbeing through technology Develop North and South Lanarkshire Suicide Prevention Action Plans which are informed by the Scottish Government’s Suicide Prevention Action Plan Review all suicides which take place in Lanarkshire including a focus on locations of concern (awaiting Scottish Government guidance) Review mental health awareness and suicide prevention training, identify gaps and develop a strategic approach to delivery
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 30 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 12.4 Future Long-Term Strategy 12.5 Suicide Reporting and Learning System 12.6 Veterans 12.7 Self-Harm Continue to develop and deliver the DBI programme across Lanarkshire Improving the Quality of Life of Those Experiencing Mental Health Problems Mental Health Services 16.4 Workforce 16.11 Clearer Pathways to Support and Treatment. Develop partnerships across workplaces , communities, schools and health and social care to create a Movement for Change in relation to challenging stigma in partnership with See Me and Lanarkshire Recovery Network Promote national and local campaigns to raise awareness and drive attitudinal change Build capacity through creating Stigma Free Champions across health and social care Service users and carers are involved in mental health services and service development Increase the strategic priority given to the physical health needs of people with Severe and Enduring Mental Health Problems Ensure patients and carers using mental health services are empowered to access the range of health improvement opportunities and
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 31 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 supports available to aid recovery and promote wellbeing. Improving Access to Mental Health Support and Services Objectives Improve access to treatment and joined-up accessible services. Improve access to mental health services within a clinically appropriate timescale. Provide access to high quality, specialist mental health care for those who have higher levels of need, as well as general health care which can deal with an issue there and then for people with a mental health problem. Ensure that general health care also addresses the conditions that can contribute to people becoming unwell, with the ultimate aim of reducing the need for specialist services. Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Custody Suites 17.4 Criminal Justice System Approved access to Mental Health Care in Custody implemented Telephone / Audio Assessment Pilot completed Scope introduction of Third Sector support Digital Solutions 15.1 Computerised Cognitive Behavioural Therapy 15.2 Video Enabled Therapy 15.3 Rural Communities. Mental Health Services process maps produced Gap analysis completed and prioritised solution tests of change agreed Gather intelligence of digital solutions being incorporated within Lanarkshire’s Mental Health and Learning Disability services
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 32 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 15.4 Digital Inclusion 15.6 Evaluation 15.7 Innovation Hubs Move all Mental Health & Learning Disability services onto a safe electronic record keeping documentation system Identify, support and promote digital use by service users Identify digital skills gaps and identify appropriate learning for staff Establish a network of Mental health & learning Disability digital champions Transforming Mental Health in Emergency Departments Mental Health Services 16.3 Unscheduled Care 16.4 Workforce Recruitment of Psychiatric Liaison Nurses and Advanced Nurse Practitioners Pathways for face to face mental health assessment in Douglas Street introduced Pan Lanarkshire Community Police, Transport Police and Scottish Ambulance Service Triage model operating 24/7 Mental Health & Wellbeing in Primary Care 8.3 Access to Services – a specific pathway for those who have been shielding 9.1 Ensuring Mental Health Support & Services for Older People 16.4 Workforce 16.11 Clearer Pathways to Support and Treatment PCMH & Wellbeing Services providing sessional MH Liaison Nurse input to all GP practices Assessment Plus Service (psychological therapies) transitioning to be part of PCMH stepped/matched care model Mental Health & Wellbeing Worker service commissioned to provide non-clinical interventions within the stepped/matched care PCMH & Wellbeing Service model.
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 33 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Establish a Mental Health and Wellbeing in Primary Care (MHWPC) Service model as proposed in the national Mental Health in Primary Care Short-Life Working Group Report Prisoner Mental Healthcare 17.4 Criminal Justice System Develop Prison Stepped Match Care Model Develop proposal for additional working space in conjunction with Scottish Prison Service Complete recruitment process
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 34 Children and Young People’s Mental Health and Wellbeing Objectives To ensure an integrated whole-systems approach to the planning and delivery of support and services across the NHS, social work and education, the voluntary sector and other community planning partner agencies, underpinned by GIRFEC principles, and including children and young people. To invest in prevention and early intervention and to develop a menu of support that will improve communication, help providers understand where they fit in the continuum of mental wellbeing; and ensure that there is consistent support for the whole family across ages and stages of a young person’s life. To reconfigure CAMHS to improve capacity and coverage and provide economy of scale in relation to medical and admin cover. To establish a new Neurodevelopmental Service to reduce the number of young people, particularly with symptoms of Autistic Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (DHD), waiting on a variety of services’ waiting lists to be seen and engaging in a prolonged assessment with handovers. To be a centre of excellence for the mental health care and treatment of accommodated infants, children and young people where effective, informed assessment, formulation and treatment begins at the point of referral. To improve our ability to evidence the impact of support and services on the health and wellbeing of children and young people To develop a workforce strategy that will ensure a confident and competent workforce that will make best use of ability and resources across all sectors. Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Community Mental Health and Wellbeing 6.1 Family Support. 6.2 Signposting to Help and Support. 6.3 Emotional Wellbeing 6.6 Training and Learning 6.7 Educational Psychology and School Counselling Services. 6.8 National Guidance. North Lanarkshire Establish Children and Young People’s Mental Health, Wellbeing and Resilience Task Group Embed Children and Young People’s Mental Health and Wellbeing in North Lanarkshire Children’s Services Plan and ensure governance in place Identify priorities for North Lanarkshire’s Children’s Services Plan 2021/23 Complete initial mapping of mental health and wellbeing supports and services provided by
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 35 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 6.9 Whole School Approach 6.10 Children and Families Workforce 6.12 Community Support 6.14 Emotional Distress. 6.15 The Promise universal, 3rd sector and specialist services that can be accessed by parents, children and young people Maintain map to ensure that it consistently presents a complete and current picture of mental health and wellbeing supports and services that can be accessed by parents, children and young people Develop and implement plan to deliver the mental health and wellbeing elements of the North Lanarkshire Children’s Services Plan and implement the National Community Mental Health and Wellbeing Supports and Services Framework Evaluation of services currently in place for Community Mental Health for Scottish Government feedback South Lanarkshire Establish Children and Young People’s Mental Health and Wellbeing Sub Group as part of the Children’s Services Planning Structure Identify priorities for South Lanarkshire’s Children’s Services Plan 2021/23 Complete initial mapping of mental health and wellbeing supports and services provided by universal, third sector and specialist services that can be accessed by parents, children and young people.
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 36 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Carry out large scale school survey and collate findings Establish early intervention hub to take referrals from Police and Social Work to supporting families that do not meet the threshold for formal supports from Social Work Parent consultation Roll out Lifelines Lanarkshire training across South Lanarkshire secondary schools. Evaluation of services currently in place for Community Mental Health for Scottish Government feedback Specialist CAMHS 6.16 Demand for CAMHS 6.17 CAMHS Service Specification 6.18 CAMHS Access Improvement 16.1 An Immediate Focus on Services 16.2 Renewal 16.5 Setting High Standards Establish Programme Board to oversee the CAMHS Modernisation Strategy 2021-23 IT enablement review Waiting times management and clearance of waiting lists Investment of national Recovery and Renewal funding Demand, Capacity, Activity and Queue (DCAQ) planning in line with Choices and Partnership Approach (CAPA) Calculator Workforce recruitment Unscheduled care Accommodation review
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 37 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Children and Young People’s Neuro- developmental Pathway 6.19 Neurodevelopmental Services – National Specification 6.20 Neurodevelopmental Services – Digital Support Identify staff resource release from existing multi- disciplinary services Roll out of clinic Waiting times management Evaluation of outcomes Investment of national funding
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 38 Specialist Mental Health Services Objectives Review Older Adult inpatient provision to develop a more cost effective and flexible model that will better meet the expectations of patients and staff, whilst providing more control over the quality and safety of care provided. Adapt our clinical model to enable discharge and preventative readmission through enhanced community based services that offer flexibility, more control over the quality and safety of care provided. Review the models for Forensic Mental Health Services and Mental Health Rehabilitation and Recovery Services to replace the 12 beds previously available prior to the alignment of Gigha Ward, Beckford Lodge from Adult Rehabilitation to Forensic Services. Update the referral pathway for the Mental Health Rehabilitation and Recovery Service. Establish fully integrated Community Mental Health Services within locality services in South Lanarkshire. Establish a dedicated specialised community perinatal mental health team, including psychiatry, community mental health nurse, clinical psychology, community nursery nurse and social work staffing. Develop a model of infant mental health which integrates the approaches currently adopted in Health, Community and Voluntary Sector, Early Years and Social Work Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Older Adult Inpatient Provision 16.8 Bed Availability IJB approval to engage with patients and providers on consolidation of contracted HBCCC provision. Agree business case for the consolidation of contracted HBCCC bed provision on one central site and enable the establishment of a new MDT model of enhanced provision. . Engage with patients currently supported in contracted hospital-based complex clinical care beds in Cumbernauld Care Home and their families and carers to agree a plan for their continuing care Engage with care home providers Establish enhanced MDT model of care
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 39 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Ensure access to OPMH in-patient beds for residents of the Camglen area who would previously have been admitted to Glasgow hospitals Review of dementia and functional inpatient provision Rehabilitation and Recovery 16.8 Bed Availability 16.9 A Modern Understanding of Mental Illness 16.11 Clearer Pathways to Support and Treatment Map Glencairn referral and assessment process Review referral documentation Review Operational Policy and referral criteria Review the current Community Rehab model Develop new model of Community Rehabilitation mapped onto Royal College of Psychology Accreditation for Inpatient Mental Health Services (AIMS) standards Implement new Community Rehab Model Review role and function of mental health inpatient beds at Cleland hospital with a view to future-proofing in relation to population needs South Lanarkshire Community Mental Health Services Integration 16.10 A Joined-up Approach 16.11 Clearer Pathways to Support and Treatment Transfer nurses to South Lanarkshire HSCP: Agree operational management structure for community based mental health services in South Lanarkshire Develop Clinical and Care Governance Framework Transfer funding to South Lanarkshire HSCP Transfer nursing staff to South Lanarkshire HSCP
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 40 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Unscheduled Care 16.3 Unscheduled Care Establish Flow Navigation Centre (FNC) Develop in-hours and out-of-hours care pathways available for those referring in to the FNC Agree and recruit to staffing model Establish CMHT unscheduled care pathway Develop comms plan to increase awareness of new pathways across all referring agencies Evaluate impact of establishment of the FNC Eating Disorders 16.13 Eating Disorders Support development of TESS and other tiers of the NHSL Eating Disorders (ED) pathway in response to recommendations from the Mental Welfare Commission, National Eating Disorders review, and SIGN Eating Disorders guidelines Address gaps in ED services within NHSL particularly in relation to equipping and upskilling staff in all tiers of the NHSL pathway Mental Health Pharmacy Improve current level of pharmacy service to optimise safe, effective and person-centred care by utilising additional SG funding and maximising and making optimal use of the skills of the pharmacy workforce Forensic Mental Health Forensic Mental Health Services 17.1 Changes to Practices 17.2 Secure Mental Health Services Plan for implementation of Independent Review into the Delivery of Forensic Mental Health Services Plan for implementation of recommendations of The Forensic Network Report on Pathways for Women Through Forensic Mental Health Services
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 41 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 17.4 Criminal Justice System Psycho- therapy 16.1 An Immediate Focus on Services Establish a single Lanarkshire-wide Psychotherapy Service to ensure consistency in: Structure and roles/responsibilities Service delivery Treatment interventions offered pan-Lanarkshire Perinatal Mental Health 6.5 Access to Perinatal and Infant Mental Health Services 7.3 Perinatal Mental Health Design future staffing model for a Lanarkshire Perinatal Mental Health Service: Secure funding from Scottish Government Design achievement framework to identify final outcomes Establish a dedicated specialised community perinatal mental health team, including psychiatry, community mental health nurse, clinical psychology, community nursery nurse, midwifery, occupational therapy and social work staffing Develop clinical pathways and structures to ensure timely and quality of access, and equality of access, for women to specialist mental health services Put in place systems to ensure that professionals working in universal services with women and their partners and families can access consultation, information and advice in a timely manner Develop leaflets, webpage and third sector linkages to enable women and their partners/families have access
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 42 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 to timely information to help them to make informed choices Increase access to third sector support services for service users Data collection to measure access to service and impact of service and development of a system of continuous quality improvement Evaluation and Impact Assessment – 6-monthly progress reporting against outcomes Infant Mental Health 6.5 Access to Perinatal and Infant Mental Health Services Staffing model Secure funding from Scottish Government for a Lanarkshire Infant Mental Health Service Establish multi-agency, multi-disciplinary IMH team Develop clinical model Multi-disciplinary multi-agency IMH training programme for all agencies including third sector Infant Mental Health Easy Access Telephone Advice Line & Consultation System for Health Visitors NHSL LearnPro Foundation level module on Infant Mental Health: When to be Concerned for all NHSL staff working with infants and their parents Pan-Lanarkshire Multi-Agency Infant Mental Health Observational Indicator Set [birth to 3rd birthday] Systematic engagement with lived experience and third sector in place – ensuring feedback incorporated into service design
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 43 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Study of Barriers to Access to Mental Health Service and Mental Health Support for Infants in Lanarkshire Maternity and Neonatal Psychological Interventions 6.5 Access to Perinatal and Infant Mental Health Services Design future model for Maternity and Neonatal Psychological Interventions (MPNI) Service and secure Scottish Government funding until March 2023 Recruit MNPI Team Provide induction and training programme for new staff with reference to the NHS Education for Scotland Perinatal Mental Health Curricular Framework, and ‘Essential Perinatal and Infant Mental Health’ e- learning resource. Develop clinical model and pathways to ensure timely and quality of access, and equality of access. Systematic engagement with those with lived experience and third sector representatives to ensure feedback incorporated into service design: - MNPI experts by experience group - lived experience member on development group Women and their partners/families have access to timely information to enable them to make informed choices: service leaflets & webpage Data collection in place to measure access to service and impact of service and development of a system of continuous quality improvement Increase access to third sector services for service users
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 44 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Evaluation and impact assessment – 6-monthly reporting of progress against outcomes Cross-Cutting Workstreams Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 2023 2023- 2024 Ensuring Equity and Equality 3.1 Causes of Inequality 3.3 Rural Isolation 3.4 Data Collection Complete Equality and Diversity Impact Assessment on the Mental Health and Wellbeing Strategy Carry out EQIAs of all workstreams to ensure that we are aware of systemic inequality faced by any part of the Lanarkshire population Identify common themes, refresh Strategy EQIA and develop an action plan to address mental health inequalities on an individual and structural level Workforce Development 2.6 Support for Health and Social Care Workforce 6.10 Children and Families Workforce 16.1 An Immediate Focus on Services 16.2 Renewal Define the required workforce plan: purpose, scope and ownership Identify proposed service changes that will impact on future workforce requirements Identify the skills required and the type and number of staff across all sectors to deliver new service models Description of the existing workforce across all sectors, its existing skills and deployment, including an assessment of any problem areas arising from e.g. supply of staff with particular skills, age profile, turnover, movement between sectors
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 45 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 2023 2023- 2024 Develop a plan to deliver the required workforce (new skills in new locations) and manage the change Implement the plan, measure progress and refresh the plan as required. Data, Evaluation, and Performance Reporting 1.2 Measuring Population Mental Health 3.4 Data Collection 16.6 Access and Quality Develop an Achievement Framework to define the fully define the outcomes and benefits to be delivered, understand contribution of projects and workstreams to the delivery of these and inform the development of appropriate measures of success Develop a Mental Health and Wellbeing Strategy Performance Framework and measurement plan and commence regular reporting Stakeholder Engagement 5.4 Carers 16.15 Delivery Role of the Third Sector 16.16 Strategic and Partnership Work with the Third Sector Develop a Stakeholder Engagement Strategy Establish a Communications and Engagement Reference Group Ensure that the 3rd Sector is represented on the Strategy Board, Communications and Engagement Reference Group and is involved as required in workstreams Develop and implement stakeholder engagement plans for each workstream Review Communication and Engagement Strategy and role of Communications and Engagement Reference Group Estates Assess accommodation requirements across all workstreams with a view to enabling more integrated team working and feed into wider estates/
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 46 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 2023 2023- 2024 accommodation strategies of the health and social care partnerships and parent organisations
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47 Appendix 2: Achievement Framework What we start with: Time Funding Expertise Leadership Staffing Communicati on Governance Evidence base National policy What we will do: Consult with key stakeholders Create a Mental Health & Wellbeing (MH&WB) Strategy Implement the MH&WB Strategy. Actions will include: Increasing mental health service provision in community settings Ensuring all staff are trained in current practice Ensuring capacity to manage MH&WB issues meets demand Providing integrated services, including shared information Focusing on early What we will achieve in one to two years: People have access to the services that meet their needs People have access to the information they need Staff have the knowledge they need to deliver MH&WB services Lanarkshire people are aware of MH&WB issues Lanarkshire people are aware of the impact of MH&WB on their own and others’ lives What we will achieve in two to five years: People have enough resilience to manage life events and trauma People maintain their independence, avoiding hospital admission where possible, and achieving timely discharge following any admission People feel more connected to their local communities and have adequate social networks Having mental health issues is viewed no differently to having physical health issues Lanarkshire people are comfortable talking about mental health What we will achieve in the longer term: Lanarkshire people have good MH&WB Lanarkshire communities are compassionate Lanarkshire people have a good quality of life Inequalities in MH&WB are reduced or eliminated What outputs we will measure: No. complaints related to access to different parts of the service Waiting times/list size for different services No. Emergency Department mental health referrals Feedback from service users – possibly develop a generic survey (including access and information) No. people from SIMD 1 & 2 accessing mental health services No. people accessing mental health & wellbeing resources (including online, DBI, voluntary sector) No. staff achieving all mandatory training requirements No. people accessing income maximisation resources
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48 Appendix 3: Proposed Output Measures Output measure Definition - to be tested when first collated Source Baseline start date Reporting period Workstreams involved No. complaints related to access to different parts of the service Any complaint related to accessing any mental health, LD, addictions services Patient Affairs complaints, Care Opinion, Objective N/A Quarterly Children's Services, Specialist Services, IAMHSS Waiting times/list size for different services % patients started treatment within target time from referral TrakCare Mar-19 Quarterly Children's Services, IAMHSS % waiting within the target time TrakCare Mar-19 Quarterly Children's Services, IAMHSS No. Emergency Department mental health referrals No. patients referred to psychiatric assessment nurses directly from ED triage Service database 2020 Quarterly Specialist Services/IAMHSS Feedback from service users – possibly develop a generic survey (including access and information) Standard question examples: Did you feel the service met your needs? Did you have enough information in advance? How do you feel the staff responded to your needs today? Online survey, paper option for digitally excluded tbc Quarterly All workstreams No. people from SIMD 1 & 2 accessing mental health services Convert postcodes to SIMD quintiles for every new episode of care on TrakCare, SWIS, other systems TrakCare & SWIS to SIMD convertor Mar-19 Annually All workstreams No. people accessing mental health & wellbeing resources (including online, DBI, voluntary sector) No. people accessing Elament, Calm Distress, Well Connected, Silvercloud (MH-related) Online/App analytics Mar-20 Quarterly GMHFA No. people accessing Distress Brief Intervention DBI reports Mar-20 Quarterly GMHFA No. people benefiting from Community MHWB Fund VANL/VASLan reports tbc Quarterly GMHFA No. staff achieving all mandatory training requirements Mandatory modules relevant to each service Relevant learning platform tbc Quarterly All workstreams
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49 Output measure Definition - to be tested when first collated Source Baseline start date Reporting period Workstreams involved No. people accessing income maximisation resources No. people accessing income maximisation resources and total amount of money received NLC/SLC N/A tbc GMHFA No. reports of reduced isolation and loneliness No. reporting reduced isolation from Community MHWB Fund VANL/VASLan reports tbc Quarterly GMHFA No. people engaging with mental health & wellbeing events No. attending events organised during national & local campaigns and sessions Eventbrite, Service Leads tbc Annually All workstreams
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50 Appendix 4: Programme Risks Description Mitigation/Action Plan Likelihood Impact RAG There is a risk that the delivery and implementation of the Strategy is delayed or not completed as a result of the lack of continued specialist resources to lead, manage the programme and to provide dedicated programme and project management expertise. NSS Programme Team retained to support NL Strategic Commissioning Plan Programme of Work in the wake of the Covid-19 pandemic and develop HSCNL programme and project management - including continued support for Mental Health and Wellbeing Strategy implementation. No confirmation at this stage of programme support beyond 31/03/23. Likelihood of risk increased. 4 3 12 There is a risk that the Mental Health and Wellbeing Strategy workstreams cannot be progressed whilst NHSL, HSCNL, SL HSCP and other partners are on an emergency footing to respond to the COVD-19 pandemic resulting in delays to delivery of planned improvements and serious impact on services, patient care and the mental health and wellbeing of the population of Lanarkshire. Delivery plans for all workstreams reviewed in light of National Transition & Recovery Plan and Mental Health Recovery and Renewal Fund Covid is now receding; however, this remains a significant risk moving into the winter period. The response and management of Covid will continue to prove challenging. 2 4 8 There is a risk that a lack of a staff base to accommodate the expansion of the Primary Care Mental Health & Wellbeing Service will result in significant difficulties in provision of clinical supervision; development reviews; case management, the ability to deliver in house training, which have a serious impact on the delivery of the service and patient care. Raise risk to both North and South Property Strategy Meetings Identify suitable accommodation bases in North and South Lanarkshire 4 4 16 Through additional SG funding, Psychological Services has recruited recruit an additional 17 staff across localities. There is a risk that the existing shortage of suitable clinical space impacts on the ability of Psychological Services to increase staffing levels / offer trainee placements; and to see a significant proportion of patients Operate a hybrid of face-to-face and remote consultation, enabling clinicians to have the option to continue with home working for part of the week – where this is efficient and effective and safe. The Psychological Services Advisory Committee has established a SLWG to review of flexible/agile working with staff, to determine perspectives, 5 4 20
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51 Description Mitigation/Action Plan Likelihood Impact RAG resulting in a failure to meet the HEAT Standards set out by Scottish Government, inadequate patient care and poorer outcomes for patients. There is also the risk of detrimental impact on team functioning and staff wellbeing. attitudes, challenges, and opportunities around changes in working practices – including 0800-2000 working, and weekend working. There is a risk that we are unable to recruit suitably qualified staff for CAMHS resulting in an inability to provide a timely quality service due to a combination of rapid change (including but not exclusively the introduction of the CAPA model and move to Udston) and the high level of demand on the service. This is a particular risk for those children and young people with the most complex medical needs given the shortage of medical staff. Dedicated recruitment team Both AMDs for psychiatry and paediatrics will be involved in the workforce planning HR workstream with support from the comms and engagement workstream will ensure staff comms and involvement are appropriate and supportive of the needs of staff to be as efficient and effective as possible 4 4 16 There is a risk of over medicalisation of stress and distress due to lack of visibility of referral criteria and alternative options to referrers, particularly early interventions. This has an impact on CAMHS being able to provide a timely quality service. Provision of referral criteria information to referrers in the referrers preferred format Close linkage between the programme and LA provision, with comms, in order that the ‘no wrong door’ policy can be effected 2 5 10 There is a risk that the short term and long term outcomes for children with neurodevelopment disorders will be adversely affected by restricted access to services and support due to waits of several years for assessment and diagnosis. Short term: Commissioning of external service to provide diagnostic pathway; reappraisal of feasibility of NHS Lanarkshire provided pathway to avoid duplication of assessment; waiting list cleansing exercise. Long Term: Recruitment where possible to ceiling of current SG funding; appraisal of service model and resources required to deliver long term pathway flow and liaison with SG to secure same 4 4 16 There is a risk that we are unable to implement CAPA due to lack of IT infrastructure, specifically TrakCare. Development days with leadership team and local teams have been arranged/taken place to inform delivery of Trakcare. 3 4 12
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52 Description Mitigation/Action Plan Likelihood Impact RAG IT infrastructure is in place and awaiting job plans from CAMHS staff. Assurance provided from IT that Trakcare build will be reviewed and flexibility for adapting and developing templates.