Daphne McKennaPart-time Independent Reviewing Officer, London Borough of Lewisham

Chris McCReeCommunity Manager Leading on Safeguarding, Southwark Adult Mental

Health, Children & Families

Workshop B:Putting the SCIE Parental Mental Health & Child Welfare Guide recommendations into

practice in the London Boroughs of Lewisham & Southwark

Putting the Guidance into Practice

Different Approaches in Lewisham and Southwark

Chris McCree

Daphne McKenna

Small group exercise

Two groups Share first experience of your parent’s fallibility

Lewisham

2001 census- Lewisham has a population of 248,922. Its population is 66% White, 12% Black Caribbean, and 9% Black African. Fifty percent of households are owner-occupiers.

Lewisham is ranked 39 out of 354 local authorities in England in terms of average deprivation. (Where 1 is most deprived).

Southwark

Southwark is the 9th most deprived borough in England.

49% male, 51% female. Nearly half population from minority ethnic

community. The largest BAME group are black or black

British (25.9%). 8% are black Caribbeans and 16.1% black Africans– the largest black African community nationally.

Borough MINI 2K (Schz) Estimated rate of schizophrenia admissions/100,000 population 16-59

Population aged 16-59(% of sector total)Source MINI 2k programme)

Estimated number of admissions for schizophrenia and psychoses(% of sector total)

Estimated number of schizophrenia and psychoses admissions at risk of conviction adj for ethnicity*

Lambeth 2.01 189.6 173900 (19) 330 (26) 452 (30)

SouthwarkSouthwark 2.322.32 219.3219.3 142800 142800 (16)(16)

313 (25)313 (25) 429 (29)429 (29)

LewishamLewisham 1.551.55 146.7146.7 150500 150500 (17)(17)

221 (18)221 (18) 287 (19)287 (19)

Bexley 0.79 74.4 128300 (14) 95 (8) 67 (4)

Bromley 0.66 9 176500 (20) 110 (9) 77 (5)

Greenwich 1.56 147.0 129500 (14) 190 (15) 182 (12)

SEL 139.7 901500 (100) 1259 (100) 1493 (100)

Lewisham and Mental Health

Lewisham has significant rates of mental illness. Suicides contribute significantly to the number of premature deaths in the borough. The Mental Illness Needs Index 2000 (MINI 2K) score for Lewisham for schizophrenia and other psychoses is 1:55. This score indicates that Lewisham has comparatively greater mental health needs than other PCT areas in the country.

Lewisham borough has the eighth highest level of deprivation of all Primary Care Trusts/Local Authorities in the UK. There is evidence that those from a poorer background are more likely to suffer from a psychotic illness

Lewisham has the fourth highest level of substance misuse of the six boroughs in the South East London Sector — 5.7 people per 1,000 residents aged between 15 and 44 were in drug treatment programmes in 2001-2002 (National Drug Treatment Monitoring System).

Southwark and Mental Health

The MINI 2000 score for Southwark is 2.32 Severe and enduring mental illness General practice data for February 2006 shows

that there are 2423 Southwark residents with severe long-term mental health problems who require and have agreed to regular follow-up. Many of these will have schizophrenia or bipolar depressive disorder. Schizophrenia is a severe and in many cases enduring mental illness.

Mental Health Resources in Lewisham The inpatient mental health teams provide assessments of needs to

people with severe and/or enduring mental health problems. Access to Community Mental Health services in Lewisham is via one

of our three Community Mental Health teams. Northover, Southbrook and Speedwell community mental health teams

The Community Mental Health teams are multi-disciplinary teams run jointly with the South London and Maudsley NHS Trust (SLAM) and consist of Psychiatrists, Social Workers, Community Psychiatric Nurses, Psychologists and Occupational Therapists

Lewisham Services

A&E Psychiatric Liaison Service, Lewisham  Clare Ward - Lewisham Central and Eastern

Sector 

Community Forensic Services  Community Opportunities Service (Central L

ewisham) 

Community Opportunities Service (North Lewisham) 

Community Opportunities Service (South Lewisham) 

Deptford Primary Care Mental Health Team  Edward Street  Heather Close  Jigsaw 

Johnson Unit  Ladywell Social Work Team  Lewisham Psychological Therapies Service -

Secondary Care  

Lewisham Psychological Therapies Services - Primary Care 

Lewisham Residential Services Team  New Hope Project  Newstead Road  Northover CMHT  Powell Ward - Lewisham North Sector  Southbrook CMHT  Speedwell CMHT  Triage Ward  Wharton Ward - Lewisham South and South

West Sector

Voluntary sector provision in Lewisham

A search of the internet for charitable organisations working with mental health issues in Lewisham revealed 54 entries

Mental health Resources in Southwark

The Southwark Directorate provides a comprehensive mental health service for adults of working age. There are 4 Locality Teams in Southwark these are East, West, St Giles and Lordship Lane. The teams are fully integrated with Southwark Social Services.

Southwark Services Cambridge House Advocacy (Mental Health)  Cares of Life Services  Clinical Decision Unit - ES2  Clinical Decision Unit - JBU  Community Link Centre  Co-ordinated Psychological Treatment Service   CREST - North Southwark Home Treatment Team  CREST - South Southwark Home Treatment Team  DB2 Ward  ES1 Ward - Psychiatric Intensive Care Unit  ES2 Ward  High Support Team  Intensive Psychological Treatment Services   Jim Birley Unit   John Dickson Ward  Lordship Lane Locality - Assessment and Brief Treat

ment Team 

Lordship Lane Locality - Support and Recovery Team 

Mental Health Liaison Team  North East Locality - Assessment and Brief Treatme

nt Team 

North East Locality - Support and Recovery Team  North West Locality - Assessment and Brief Treatme

nt Team 

North West Locality - Support and Recovery Team  Occupational Therapy services: Adult Acute Inpatien

t and Crisis Services, Southwark- Guys Hospital 

Occupational Therapy services: Adult Acute Inpatient and Crisis Services, Southwark- Maudsley Hospital 

Peckham Befrienders Project  Psychological Medicine - Liaison Team Guys Ho

spital 

Psychological Medicine - Liaison Team Kings College Hospital 

Ruskin Ward  Southwark Community Forensic Team  Southwark Community Outreach Team (SCOT)  Southwark Psychological Therapies Service   Southwark Section 136 Suite  Southwark Vocational Team  Southwark Welfare Benefits Team  Southwark Wellbeing Workshops  St Giles Locality - Assessment and Brief

Treatment Team 1  St Giles Locality - Assessment and Brief

Treatment Team 2  St Giles Locality - Support and Recovery Team

1  St Giles Locality - Support and Recovery Team

2  START Team (Outreach Service for homeless

people)  STEP Southwark team for early intervention in

psychosis   Traumatic Stress Service 

Southwark Voluntary sector

A search of the internet for charitable organisations working with mental health issues in Southwark revealed 87 entries

The Guidance- a summaryScreeningEnsure screening systems routinely and reliably identify and record informationabout adults with mental health problems who are also parents.

AssessmentAll organisations need to adapt existing assessment and recording processesto take account of the whole family and train staff in their use.

Planning care Care planning needs to take a holistic approach to include appropriate careplans for each individual family member as well as the family as a whole and indoing so staff should aim to increase resilience and reduce stressors.

Providing care Commissioning, funding and management processes should ensure that theyaddress and meet the full spectrum of needs of parents with mental healthproblems and their children.

Continued..

continuedProviding care Commissioning, funding and management processes should ensure that theyAddress and meet the full spectrum of needs of parents with mental health problemsand their children.

Reviewing care plansReviews should consider changes in family circumstances over time, include bothindividual and family goals and involve children and carers in the process.

Strategic approachMulti-agency, senior level commitment is required to review and implement policyand practice guidance and the training and workforce development needed toprovide a successful service to parents with mental health problems and theirchildren.

Workforce development Major investment is needed in training and staff development for front line managersAnd practitioners particularly joint training that addresses how to work withcomplexity, think individual, think family and work across service interfaces.

Initial Impressions- Lewisham

Findings of practice survey had not been widely shared

Change in Senior Management Imminent inspection SCR’s did not directly involve mental health

issues

Initial Impressions Southwark

Great that will add much needed national support, it cannot be ignored now!

Its so much work we will need to continue to take it in stages

How can SCIE help with the implementation It will be hard work getting all agencies to sign up

and made aware of this guidance Wish some of these ideas could be pulled

together nationally

The Way Forward Lewisham

Set up a small multi-agency group to review existing provision/ procedures in the light of guidance

Identify key drivers in Lewisham Presentation to LCSB re. aspects to implement

and consider details Agree with SCIE how these can be measured to

provide an evidence base for future guidance

Screening Key Drivers

Evidence Gaps Solution Parental involvement /agenciesinvolved

Assessment

Planning care

Providing care

Reviewing care plans

Strategic approach

Workforce development

The Way Forward Southwark Family strategy produced in 2007 will need to be updated Parents network bid Staff training re Think family [ pilot the Family Partnership model] Service developments need to continued to be supported; Building

bridges and AMH in Children centre service Parents film bid Plan a local conference/workshop to highlight the guidance and inform

the network about what we are doing. Continue the monthly F.S meetings try and involve more staff Work to raise money for an evaluation of the strategy and its various

components 12 month Joint funded post between Children’s social care and Adult

mental health.

Conclusion

Different Boroughs Different needs Different resources Same guidance Different approach Same aim- better outcomes for families affected

by parental mental health difficulties!

In Southwark

“this Strategy represents an attempt to develop a family orientated approach within adult mental health services to strengthening the link with children’s services to support family life and well being. By “family” we mean anyone who is identified by a service user as their family”

Strengths of the Strategy

It grapples with the continual paradox of risk, child protection and genuine user involvement.

It is written with sensitivity so that risk is not the all consuming focus of the work. If service users engage with services all risks are minimized.

It is clearly articulated in the Strategy that one of the primary reasons that service users do not engage with services is because of the fear of having their children taken away from them.

In this talk we aim to:

Highlighting examples of users’ experiences where services have in the past failed to support family life.

We want you as users and workers to consider how to make the best use of this strategy to improve the experiences of families in the future.

We suggest mechanisms to begin the cultural shift required to embed the Strategy,

Issues of concern to users

Fertility Treatment Pregnancy Access to services Separation Medication

Support.

Sensitive and appropriate support can keep families together in their different and diverse family roles.

Supporting people to develop coping strategies and point them in the direction of non pharmaceutical solutions such as complementary therapy and talking treatments.

Being a parent

Being a parent is real challenge for everyone and is one of the most important jobs we will do.

As the strategy recognizes all of us will need support from strategic services while bring up our children slide.

One of the greatest strengths of this Family Strategy is it promotes working with users in a non-judgmental and compassionated way.

Staff Training

User Focused Monitoring

Continuing User Involvement

Finally

This Strategy can be a vehicle to bring about change, challenge stigma & discrimination, build good relationships and make our lives and your jobs happier.