What mental health services can learn from Sandwell’s integrated approach

Sandwell in the West Midlands has re-engineered its services to support more people at an earlier stage in their illness, with impressive results

It is good news that the chief medical officer, Dame Sally Davies, has turned the spotlight on mental health in her latest report. She is right to argue for a big drive on public mental health.

There is already some great practice out there. I would urge Davies to take a trip to Sandwell to find out how and why the area is doing so well on violence reduction and reducing levels of depression.

Earlier this month, I travelled to Sandwell and Dudley to find out for myself. The answer is not rocket science, it is all about relationships. Focusing on building relationships helps people to become more resilient and capable.

Sandwell’s approach to mental health and wellbeing is all about recognising and developing people’s relational assets and never turning people away.

Rather than opting for ever higher thresholds to ration access, keeping people out of services, Sandwell has re-engineered its service to open access to a wider population of people with mild to moderate mental health problems. This has been done by setting up a wellbeing hub which acts as a fully integrated one stop shop, where people can address their mental health, substance use, health behaviours and life stressors at the same time as their physical health needs.

The hub has mapped the wealth of local authority, NHS, and non-NHS support on its doorstep. Available support includes debt counselling, anger management, support with self-esteem, or simply the opportunity to chat with others who have the same issues in a self-help group.

One service offered at the wellbeing hub is the “esteem team”, which co-ordinates and signposts services for people with complex needs. The team employs six link workers who typically have a mental health care background and/or personal experience with mental health conditions.

The esteem team doesn’t do things for or to people, its role is to work alongside people to help them develop the skills they need to solve their own problems and help themselves. This is not “sink or swim”, it’s about teaching skills. It operates what it calls a “warm hands on, warm hands off” approach, which recognises that simple signposting is not enough; team members have a supportive relationship with patients, which might mean making a phone call to remind them about an appointment or coming along to offer moral support.

Dr Ian Walton, who has led the development of the hub and services like the esteem team, says it is all about listening to people and focusing on their most pressing needs, which are not always medical. This is not reactive, it’s about building a relationship.

What the hub does has a measurable effect. It uses tools to see the impact on people’s wellbeing before and after. The esteem team has chalked up some impressive scores. By calling back patients and ensuring excellent customer care service, it has shown that the numbers of people who do not attend appointments can be cut to as low as 4%.

And if this all seems a bit fluffy at a time when NHS mental health budgets are so hard pressed, the number of mental health bed days fell by 52% between 2009 and 2011, with fewer people using secondary mental health services but more often. In other words, the wellbeing hub and its network of support and interventions is helping to reduce demand and enabling secondary mental health target services more effectively.

Walton added that “the problem in the current system is that mental health trusts and finance directors are forced to prioritise high cost services for the minority of patients who end up in secondary care but it costs relatively little to meet the needs of the majority of patients in primary care and the community and prevent an awful lot of pain and suffering”.

After a year of evidence sessions, field trips, roundtables and debate, the CentreForum Mental Health Commission concluded that a focus on wellbeing was needed, with an emphasis on nurturing people’s resilience and capability, mapping the networks of support, the community assets and making better use of them to help people to help themselves.

Sandwell has shown what is possible, recognising that the right support at the right time can make a huge difference.

• Paul Burstow, Liberal Democrat MP for Sutton and Cheam, was minister of state for care and support 2010-2012. He chairs the CentreForum Mental Health Commission.

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