NHS Clinical Commissioners recently launched a new publication showcasing projects that promote early intervention in mental health and gives tips from commissioners and practitioners involved in their development and delivery.
The publication, Support from the Start: Commissioning for early intervention in mental ill health, highlights four projects where CCGs and their partners are tackling the challenge of early intervention.
One of the projects – early intervention in psychosis in Salford – features our very own Judd Skelton, (pictured right) Interim Head of Integrated Commissioning.
It is thought that between a quarter and a half of adult mental illness could be prevented through early intervention during childhood and adolescence.
Being emotionally and mentally resilient also makes it far more likely a child will achieve his or her full potential. In addition, such interventions improve a person’s ability to parent, so their children in turn have a decreased risk of mental ill health.
In early 2015, commissioners from Salford CCG visited the area’s early intervention in psychosis (EIP) team. The meeting was a scheduled one, part of the CCG’s quality visit programme.
“The visits enable us to check that, for the services we’re commissioning, staff teams on the ground feel they’re able to deliver them in the way they – and we – need them to,” explains Judd.
In the case of the EIP service, the answer at the time was unfortunately no.
Caseloads were high, and staff were concerned that weren’t able to give the patients as good a service as they would like.
The visit made the need for change clear, and coincided with the introduction of a new two-week referral to treatment time target from NHS England.
Judd continues: “We came away from the meeting saying there’s clearly a piece of work we need to do around the referral to treatment time, but actually we want to go beyond that and really explore what we need to do to ensure we can better support people with first onset psychosis.”
To that end, commissioners worked with the provider organisation, Greater Manchester West Mental Health NHS Foundation Trust, to make several important changes to the local EIP service.
Judd says that one of the most significant is the introduction of support workers:
“Previously, there were no support workers in the team.
“What that meant was that supporting people to access activities, or engage with job centres, or help with physical health, was all falling on the shoulders of care coordinators.
“Their caseload was already higher than it should have been, and it was inefficient and often impractical for them to do this work.”
Commissioners therefore approved funding for four and a half support workers in the service, as well as an assistant practitioner to focus on physical health checks for those experiencing psychosis.
Five more care coordinators will also be recruited. “There are some opportunities to get in there early and start talking to people about lifestyle,” says Mr Skelton.
“So we’ve actually now got the resource to be able to say ‘there’s a walking group down the road from you’, or ‘there’s a dance group on your corner’, ‘how about someone supports you to access that?’”
There will be extra support for carers, too. “We had a carer support service via the voluntary sector, and we decided to change the focus of one of those carer support workers and make them purely focused on working with carers of those with first onset psychosis,” says Judd.
“Because everything that a service user goes through when they’re diagnosed with first onset psychosis, there’s a similar sort of experience and learning that the carer and family member has to go through; whether it’s mum, dad, husband, wife, whatever.”
The commissioning of these new service elements is not only in response to staff feedback: a focus group, led by one of the CCG’s engagement workers, asked those who had experienced psychosis and their carers what would make their lives better.
“These were the things that keep us all well: having a job, seeing friends and family, having a settled home, having something to do. The support in getting to and reaching those outcomes is absolutely crucial.”
Such input will also inform the development of the outcomes framework for the service.
Specific feedback on consultant cover, meanwhile, has seen a dedicated consultant re-introduced to the team.
A previous re-design of community services meant a generic community consultant resource replaced a specific consultant for early intervention in psychosis, but the collective opinion was the re-design had not worked for EIP.
Judd suggests commissioning strong mental health services will sometimes be a matter of reconsidering previous changes.
“We had to provide our assurance to our executive team that this was new investment, but there had to be acceptance that those decisions were made [to introduce a generic resource rather than have a specific EIP consultant] but the referral to treatment time is new.
“It does represent a significant shift in terms of timescale and in eligibility criteria. So there were new things that we needed to play-in.”
These sort of complex considerations are, he believes, greatly aided by the clinical input offered by the CCG setup.
“When you have the GP clinical lead who is respected by the clinicians in a service,” says Judd, “It is a huge advantage in terms of credibility and invaluable in really understanding and informing what a clinical pathway needs to look like.”