Presentation by Dr Leon Le Roux, Clinical Director/ Consultant Psychiatrist, Lancashire Care NHS Foundation Trust: Introducing the framework for community mental health support, care & treatment on Wednesday 13 March at Haydock Park Racecourse.

1. The Mental
Health Network
A New Framework for
community mental health
support, care and
treatment
Dr Leon le Roux
Consultant Psychiatrist
Clinical Director – Mental Health Network
Lancashire Care NHS Foundation Trust

2. Developments in the LCFT footprint
Local pressures & drivers
• MH Services under pressure
– High referral rates
– High CMHT case loads
– Ongoing use of OAPs beds
• Primary Care under pressure
– Limited capacity
– Concern wrt management of
complex MH patients
• Increasing pressures on A&E
Observable “distance” between
1⁰ care & MH Services
Recognition of a need to work
differently
(NHS Benchmarking, NELFT,
Tavistock, NTW)
Mental Health Network

3. The Principles of the Model
• Closer working with Primary Care through:
– Development of closer working relationships in the Primary Care Setting
– Development of Mental Health “Link practitioners”* attached to GP Practices
• Named practitioners to be linked to practices or practice groups
– Development of an “Easy in, Easy out, Self-Refer” ethos for mental health
provision between Primary and Secondary Care
• Care Co-ordinators* and SPA (or CRHTT) Practitioners*
Mental Health Network

4. MH “Link” Practitioner Roles – 1
• “Acute” Mental Health Link Worker
– Three types of activity rather than a single CPA-style assessment
• Brief (verbal) consultation with GP and/or patient (Recorded on GP records)
• Brief face-to-face assessment (Triage purpose; findings and opinion recorded on
GP records)
• Full mental health, CPA-style assessment (Recorded in MH electronic record
system)
– Spends ~80% of time in GP practice (~20% with MH team)
• Dependant on GP practice facilities.
– Able to engage mental health MDT for discussion, consultant assessment or
input from a specific arm of secondary care.
Mental Health Network

5. MH “Link” Practitioner Roles – 2
• “Chronic” Mental Health Link Worker / Care Co-ordinators
– Provides Care Co-ordination of patients in the CMHT
– Aligned to GP practices or practice groups
– Supports management of GPs’ SMI Lists
• Improvement in a SMI person’s physical health care
– Spends ~40% of time in GP practice
• Practice dependant on facilities and patient need (often homes based)
• Encourage development of working at the practices for efficiency and relationship /
engagement purposes.
– Allocation and implementation more complex
• Challenges in matching patient need to care co-ordinator skill due to “smaller
pool”
Mental Health Network

6. Likely improvements and areas of focus
• More integrated provision of physical and mental health care
– Physical Health support for people with SMI
– Mental health support for people with long-term physical health problems
• Closer to home care in a less stigmatised setting
• Shared ownership of case management / care navigation
• Support to GPs with complex mental health needs which result in frequent health service use
and pressure on general practice
• Mutual upskilling of Staff: Mental Health  Primary Care
• Improved triage and closer working will result in overall improved accessibility and response
time.
• Identification of resource deficiencies (or excesses) through dialog
– Monitoring of referral rates and waiting times
Mental Health Network

7. Summary Graphic
CMHT
SPA / START
GP GP GP
GP Practices
IAPT
Each Locality to have a number of staff
providing assessment, treatment and
Care Co-ordination based on need.
High Risk /
Severity
Secondary Care
Complex
Patients
Medium
Risk /
Severity
Moderate
Mental Health
Problems
Low Risk /
Severity
Mild &
Common MH
Problems i.e.
IAPT, stable
patients

8. Introducing the
Framework for Community
Mental Health Support, Care
and Treatment
NATIONAL COLLABORATING
CENTRE FOR MENTAL HEALTH
AND
NHS ENGLAND

9. Place-based systems of care
(Kings Fund, 2015)
▶ “providers of services should establish place-based ‘systems of care’ in
which they work together to improve health and care for the populations
they serve. This means organisations collaborating to manage the
common resources available to them”.
▶ The proposed Community Framework applies this model to the delivery of
community mental health care.
▶ In this case providers include VCSs, the local authority and other providers
of social care, as well as statutory primary and secondary healthcare
providers, recovery colleges and care homes and home care.
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10. What is being proposed?
A radical change in the approach towards the delivery of community mental health care
(NHS – both primary and secondary care, social care, VCS, public health, communities):
▶ Integration of community-based services into a network of health and social care services for
adults and older adults, from less complex to complex mental health needs (this does not mean
ageless services)
▶ Primary care being enabled to provide a broader range of services in the community that integrate
primary, community, social and acute care services, and bring together physical and mental health
care
▶ Organised at the local community level for a population of around 30,000 - 50,000 people (approximately 5 to 12
GP surgeries). Most people will receive treatment here
▶ Linked closely with wider community services (populations typically of 150,000 to 200,000) that focus on more
complex needs where services are provided by specialist multidisciplinary mental health teams
▶ Local needs, local geography and specialist services arrangements may contribute to variation in population size
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11. 04/12/2018
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Principles for a community mental health
framework
▶ The organising principles of the community mental health framework are that they should:
▶ Organise care around their communities
▶ Dissolve barriers between primary and secondary care, and between health care, social care and VCS
services
▶ Step up and step down care to meet a person’s complexity of needs
▶ Know their communities and use this knowledge to understand and address inequalities
▶ Be proactive, flexible and responsive to individual needs
▶ Understand and take a partnership approach to addressing the social determinants of serious mental ill
health
▶ Make use of community assets and resources, including VCS, online resources and personal contacts

12. Thank You!
Q & A
Mental Health Network