Getting a whole system view of mental health services

In the latest of a series of blogs about the Mental Health Implementation Plan launched earlier this week, the Deputy Director of Bradford District Care NHS Foundation Trust discusses the development of its First Response service to deliver 24/7 support and tackle its out of area beds crisis.

If you’re working in mental health, February 2014 is one of those key dates that you remember.

It’s when the Crisis Care Concordat was published that outlined a national commitment to giving people the right help, when they are having a mental health crisis.

That’s when we started our journey to redesign mental health services across the Bradford and Airedale districts, to provide urgent care, 24/7, close to home.  March 6 2015 is also a key date for us; it’s when we had our last out-of-area placement.

In 2014, we knew things weren’t right and we were spending £1.8million on out-of-area beds, so something had to change.  Seventeen months on, the biggest learning is you can’t change one area in isolation, it just wouldn’t work.  You need to look at the whole pathway.  It’s the same for organisations; everyone needs to be on-board because it’s whole-system change.

Looking back, our First Response service that gives a single phone number for all urgent care, has had the biggest impact.  At the start, it was hard to gauge take-up because we introduced a ‘no wrong door’ approach and actively encouraged self -referral calls, and we’re now taking 6,000 calls a month.

The single point of access gives us a level of information that we’ve never had before, including the type of calls and help required, so we can see where the pressures are and can flex services, or introduce new ones.  We’d never had that whole-system view before.

In the early days, whole-system change meant we needed to look at staff roles – changing some, introducing others – which was challenging for some staff. But now, staff can see that it’s working better and working relationships are stronger, but it has to be a big team effort at the Trust and across all agencies.  Ward staff and home treatment teams have to join up, whether it’s ensuring a safe discharge or supporting someone at home to prevent an unnecessary admission.

Our staff now work across key areas such as A&E, First Response and our home treatment teams, so there is a better understanding of roles and how they fit together.

Alongside this, the Crisis Care Concordat has built stronger cross-organisational working.  It means we can pick up the phone and sort out issues quickly.  Whether it’s the council, police or voluntary partners, the traditional organisational boundaries don’t get in the way.

Of all the changes, there are key roles that keep the system moving.  The advanced nurse practitioner can make senior clinical decisions, support people at home and prescribe, which means people aren’t delayed unnecessarily. The telehealth coaches support individuals on the phone and signpost to the right professional or service, and the housing support manager who works with people on admission.

The bed manager is also key.  Everybody, whether it’s a nurse, approved mental health professional or consultant, goes through our bed manager – or the advanced nurse practitioner out-of-hours – so we can co-ordinate beds.  This means for every admission, we’re having consistent multi-disciplinary discussions and, if hospital is the right place, we have time to prep before the individual comes on the ward.

It’s about managing the processes, making sure they’re joined-up, so that people see the right care professional, in the right place, at the right time.

The biggest learning is you can’t make major changes and then hope things will run themselves because of the number of services and organisations involved.  You need to keep your foot on the pedal and you need high levels of drive and commitment across the team, every single day, with key skills to make it happen.

Debra Gilderdale

Debra Gilderdale is Deputy Director of Bradford District NHS Care Foundation Trust and is responsible for acute and community mental health, CAMHS, IAPT and learning disabilities.

Her role includes the transformation of services across all teams, including acute and crisis mental health, taking a whole-system integrated approach to providing high quality care.

Debra is also leading on the Urgent and Emergency Care Mental Health Liaison Vanguard for West Yorkshire, and is a Positive Practice Mental Health Collaborative specialist lead for Transformation and Improvement.