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4.3 Treatment, recovery and rehabilitation

Treatment, recovery and rehabilitation refers to the mental health care system ranging from primary care, talking therapies and secondary community and inpatient services. South Gloucestershire services provide a stepped approach to treatment and interventions.

There are a range of services that residents can access directly or through the Primary Care system (their GP), including the Community Connectors programme (social prescribing), the Wellbeing College (a programme of wellbeing activities) and South Gloucestershire Talking Therapy services.

The Primary Care Liaison Service delivered by the Avon and Wiltshire Mental Health Partnership NHS Trust works alongside family doctors to provide full assessment of mental health needs and support with short term interventions. If a resident has acute needs this service works with the wider community mental health services to ensure timely access to specialist services. All these services are building an offer of a Primary Mental Health system with more capacity for the public and practitioners alike to use. Ensuring consistency of our signposting to these services is an aim of ongoing work.

For people in crisis or with more acute, longer term or severe and enduring mental health needs, there is a range of specialist secondary and community provision provided by Avon and Wiltshire Mental Health Partnership NHS Trust and voluntary sector organisations. All teams work to support people to stay safely at home whenever possible.

North Bristol NHS Trust and University Hospitals Bristol NHS Foundation Trust provide liaison psychiatry services for people with mental health needs in the acute hospitals.

All of the mental health services work to support people to sustain their mental health recovery. A key issue is the poor physical health that is experienced by people with a mental illness. Integration of mental and physical health is a key element of the Sustainability and Transformation Partnership (STP). We are working across health and social care to give equal value to mental and physical health and so that those who experience mental health problems are able to access evidence based services and support at the right time and in the right place for them.

As such rehabilitation can be defined as a whole systems approach to recovery from mental illness that maximises an individual’s quality of life and social inclusion by encouraging their skills, promoting independence and autonomy in order to give them hope for the future. This leads to successful community living through appropriate support.

The five year forward view for mental health recommendations form the framework for government, statutory and voluntary sector services to deliver better services and improve outcomes for people with mental health needs by 2020/21. Locally this underpins our operational and strategic priorities. Organisations across the area of Bristol, North Somerset and South Gloucestershire (BNSSG) are working closely together to deliver transformational change in health and social care within a challenging economic climate. The approach to this work is set out in a Sustainability and Transformation Partnership (STP), which will require a system wide response to ensure that access to and quality of services is maintained and improvements delivered. The outcomes of this system response will be:

  • People with serious mental illness will have access to evidence based physical health checks and interventions.
  • Inappropriate out of area placements (OAPs) will have been eliminated for adult acute mental health care. All placements will be reviewed at least six monthly to ensure individuals are supported closer to home and in the least restrictive setting possible.
  • New models for tertiary mental health care (predominantly people being cared for in low secure settings) will deliver quality care close to home, reducing inpatient spend and increasing community provision.

The targets set out in The five year forward view for mental health represent a significant challenge to local health and social care partners, who are working together to secure better services without additional investment being available at the present time.   Some progress is already being made:

  • Increased access to evidence-based psychological therapies to reach 25% of need by 2020/21. IAPT services will be re-commissioned in the next year taking account of local need projections, and aiming to increase access rates.
  • Access to employment support and work based support for people with serious mental illness.
  • Intensive home treatment will be available in every part of England as an alternative to hospital. The South Gloucestershire Intensive Support Team is now operational 24/7 from 1 October 2017.

No acute hospital is without all-age mental health liaison services, and at least 50% are meeting the ‘core 24’ service standard.

Links to housing and employment

Safe and secure housing has a profound impact on mental health, and a lack of appropriate housing can make mental ill health more difficult to manage. South Gloucestershire Council ensures that a high proportion of people with Serious Mental Illness have access to stable housing. There are challenges within the housing market for everyone and this ongoing work is key to ensuring that people have a home. Access to housing for people from secure hospitals is a focus of the mental health national strategy.

Mental ill health can be a barrier to, or make it difficult to remain in, employment or training. However, evidence shows that having ‘meaningful work’ like employment, training or volunteering in supportive environments has positive impacts on mental health and can help people with serious mental illness to sustain recovery. A number of initiatives exist or are due to be introduced, which will support people with mental ill health to begin or return to meaningful work. Partners across South Gloucestershire are working together to deliver and support programmes such as Building Better Opportunities and the Work and Health Programme.

Our vision for mental health treatment, recovery and rehabilitation

South Gloucestershire provides mental health services that consistently provide high quality and timely care appropriate to an individual’s needs. The services will work with the individual to support independence and personal support whenever possible.
Priorities for treatment, recovery and rehabilitation:

  • Consistent and high quality support GPs for those experiencing mental ill health.
  • A high quality IAPT programme achieving national standards for service targets.
  • High quality and timely services for people with ADHD or on the autistic spectrum.
  • Holistic and timely mental health inpatient care that includes physical healthcare needs and timely support to get people back home when they are ready.
  • Support to help people with mental ill health to access training and employment.
  • Reduced delays in assessments for section 136 referrals.
  • Reduced hospital admissions for self-harm.
What is working well?

  • Talking therapies (IAPT) programme achieving national 50% recovery rate, access rates have increased and waiting times have decreased.
  • Voluntary sector initiatives will help GPs to offer alternative ways of support.
  • CCG investment in ADHD and Autism services increased in 2016/17 and have been maintained.
  • South Gloucestershire is part of a system wide review of crisis support with police, mental health, social care, acute hospitals and ambulance services.
Measures of success for treatment, recovery and rehabilitation

  1. Additional psychological therapies so that at least 25% of people with anxiety and depression access treatment, with the majority of the increase to be integrated with primary care.
  2. Expand capacity so that more than 53% of people experiencing a first episode of psychosis begin treatment with a NICE recommended package of care within two weeks of referral.
  3. Increase access to individual employment placement support for people with severe mental illness in secondary care services by 25% by April 2019 against 2017/18 baseline.
  4. Ensure delivery of the mental health access and quality standards including 24/7 access to community crisis resolution teams and home treatment teams and mental health liaison services in acute hospitals.
  5. Eliminate out of area placements for non-specialist acute care by 20/21.
  6. Increased number of people being treated at home or within their own community.
  7. Reduction in level of premature mortality for people with mental ill health.
  8. Ensure that high quality transition pathways are in place, and reflect the needs of services users and their families.
  9. Meeting requirements of the Police and Crime Act 2017.
  10. Increase the number of people with moderate to serious mental ill health who access training and employment support, leading to an increase in the number of people in meaningful work.